What is rhizarthrosis and where is it located?
Thumb osteoarthritis, also known as thumb osteoarthritis or basal osteoarthritis of the thumb, is a degenerative disease that affects the trapeziometacarpal joint. This joint, located at the base of the thumb, is essential for hand function, enabling vital movements such as opposition and pinching, which are crucial for everyday tasks like writing or grasping small objects. Cartilage degeneration causes friction between the bones, leading to pain, inflammation, and loss of function.
Why it occurs: causes and risk factors
Main cause: joint wear and tear
The underlying cause is the degeneration of articular cartilage. Over time and with use, this tissue can lose its thickness and elasticity, becoming rough. This causes the bones to rub directly against each other, resulting in pain, inflammation, and, eventually, the formation of osteophytes (bone spurs) and deformities.
Biomechanical factors and “poor joint control”
An imbalance in the strength of the muscles that move the thumb can be a trigger. The muscles that oppose the thumb are often stronger than those that abduct or extend it. This pulls on the bones abnormally, altering their natural position and putting stress on the joint at specific points, which accelerates cartilage wear in those areas.
Previous traumas and injuries
A history of injury to the wrist or the base of the thumb can directly damage the cartilage or alter the stability of the joint. This creates a weak point that is more prone to developing osteoarthritis.
Who is most at risk of developing rhizarthrosis?
There are several factors that significantly increase the likelihood of developing rhizarthrosis, such as advanced age (more common in people over 50-60 years old due to natural wear and tear), being female, genetic predisposition, performing repetitive activities and high-risk professions with repetitive movements, being overweight or obese, and muscle weakness in the hand.
How to recognize it: Symptoms and signs
Initial symptoms
The first symptoms to appear are pain at the base of the thumb and mild swelling.
advanced symptoms
These include constant pain, morning stiffness, a visible deformity in very advanced stages, and crepitus of the thumb due to friction of the rough surfaces of the bone.
Rhizarthrosis and loss of strength in the hand
Pain and joint instability prevent the hand muscles from forming a strong grip, making it difficult even to turn a doorknob. This weakness is usually progressive and very debilitating.
What is the pain of rhizarthrosis like?
It is a deep pain, located at the base of the thumb and the thenar eminence. It worsens with activity that requires pinching or gripping strength and is initially relieved by rest.
Difference between osteoarthritis and rhizarthrosis
Osteoarthritis is the general term for cartilage degeneration in any joint of the body. Rhizarthrosis is, specifically, osteoarthritis affecting the trapeziometacarpal joint at the base of the foot.
Medical evaluation and diagnosis
The diagnosis is based on the patient's medical history, symptoms, and a thorough physical examination. Imaging tests such as X-rays or magnetic resonance imaging (MRI) are used to confirm the diagnosis in doubtful cases.
Rhizarthrosis treatment: how to relieve pain and improve mobility
Rest and modification of activities
You must learn to use your hand more efficiently and using tools that reduce the load on the joint.
Use of splints or immobilizers for the thumb
Splints or orthoses immobilize the trapeziometacarpal joint in a neutral position, reducing pain by limiting movements that cause damage. They are typically used during periods of acute pain or when performing high-risk activities.
Medication to control pain and inflammation
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in controlling pain and inflammation during acute flare-ups. Simple pain relievers such as paracetamol can also be used.
Physiotherapy and hand therapy
Physiotherapy is crucial, especially specialized hand therapy. The physiotherapist works to reduce pain and inflammation, improve mobility, strengthen stabilizing muscles, and retrain movement patterns for proper biomechanics.
Injections when the pain is persistent
When pain is not controlled with the above measures, injections can be performed. The most common are corticosteroids, which have an anti-inflammatory effect, or hyaluronic acid, which improves the viscosity of the synovial fluid and acts as a lubricant and shock absorber.
Exercises for rhizarthrosis
Gentle thumb mobility exercises
Opposition: Touch the tip of your thumb to the tip of each of your other fingers, forming an “O” with each pair.
Flexion and extension: Bring your thumb across your palm to the base of your little finger (flexion) and then pull it away and up (extension).
Exercises to improve strength without overloading
Foam pinch: Gently squeeze a foam or sponge ball between your thumb and forefinger. Hold the pressure for 5 seconds and relax.
Separation with a rubber band: Place a rubber band around the thumb and other fingers. Open the thumb, separating it from the fingers, and return with control.
Useful stretches for the joint
Extension stretch: With the palm of your hand resting on a table, gently separate your thumb to the side until you feel a slight stretch at the base.
Flexion stretch: With your palm facing upwards, use your other hand to bring your thumb down and towards your palm, stretching the base. Hold for 15-20 seconds.
What not to do if you have rhizarthrosis?
Avoid repetitive, high-strength movements, do not hold heavy objects with only your thumb, do not ignore pain, and do not use utensils with very thin handles that force a strained pincer grip.
When is surgery needed?
This is considered when well-applied conservative treatment has failed and the patient continues to have a debilitating pain which significantly interferes with their quality of life and daily activities.
Types of surgery for rhizarthrosis
Trapeziectomy with suspensionplasty involves removing the trapezium bone and reconstructing the ligaments using a tendon from the patient to stabilize the base of the thumb. It eliminates pain and maintains a good range of motion.
In arthrodesis, the metacarpal bone is fused to the trapezium. This eliminates pain completely but sacrifices joint mobility. It is reserved for young patients with physically demanding jobs.
In joint replacement (arthroplasty), the damaged joint is replaced with a prosthesis. It offers a faster recovery and preserves movement, but it is not without long-term complications. It is indicated for elderly patients with low functional demands.
Does the operation completely eliminate the pain?
In general, yes. The main goal of surgery is to eliminate pain. Techniques like trapezectomy have a very high success rate in long-term pain control, although it's common to experience mild residual discomfort during the first few months of rehabilitation.
What happens if I don't have surgery for rhizarthrosis?
If surgery is recommended and the patient chooses not to have it, the disease will continue its natural progression. This can lead to a progressive increase in pain, loss of strength and function in the hand, fixed deformity of the base of the thumb, and severe limitations in performing basic activities.
Frequently Asked Questions (FAQs)
What worsens rhizarthrosis?
Repetitive, forceful pinching movements (pinching, writing a lot, using scissors), holding heavy objects with the thumb, tasks that require forceful wrist rotation (opening jars, turning keys), and maintaining poor hand postures for a long time.
What degree of disability does rhizarthrosis cause?
It can cause anything from mild to severe disability (inability to work in manual occupations, difficulty dressing, bathing, or eating). The World Health Organization recognizes it as a potential cause of severe functional limitation of the hand.
How long does rhizarthrosis last?
Rhizarthrosis is a chronic and progressive disease. Once it begins, the degenerative process does not stop completely. With appropriate treatment, its progression can be slowed and symptoms controlled for many years, but it does not "last" for a limited time.
What is better for rhizarthrosis, cold or heat?
Both are useful, but in different phases. Cold (ice wrapped in a cloth) is best in acute phases or after an activity that has caused pain. It helps reduce inflammation and soothe acute pain. Apply for 10-15 minutes. Heat (warm water, hot compress) is better for the muscular stiffness For chronic conditions or before mobility exercises. Helps relax muscles and increase circulation. Apply for 15-20 minutes.
What are the consequences of rhizarthrosis?
If not treated properly, the consequences can include chronic pain, permanent deformity (Z-shaped or "window" thumb), significant loss of grip and pinch strength, joint stiffness, and a major functional limitation that affects the person's autonomy.
Is rhizarthrosis curable or can it be slowed down?
There is no cure in the sense of regenerating lost cartilage, as the damage is irreversible. However, its progression can be slowed and symptoms controlled very effectively through conservative treatments and, if necessary, surgery. The goal is for the person to live pain-free and with the greatest possible functionality.
Conclusion
Recognizing the early symptoms of rhizarthrosis allows access to a wide range of treatment options. It's not necessary to live with pain and disability; the vast majority of patients can regain an excellent quality of life, maintaining hand function for the activities that truly matter.
En FisioPOU, our clinic physiotherapy in MadridWe conduct an individualized assessment to identify the degree of the rhizarthrosis and design a treatment plan tailored to your needs. We apply manual therapy, specific exercises for thumb mobility and strengthening, joint protection techniques, neuromuscular bandage and programs rehabilitation in Madrid to relieve pain and improve hand function.
Don't let thumb pain limit your daily activities. Book your appointment today and regain mobility and strength with physiotherapists specializing in hand pathology.
