Many people visit hand therapy clinics with complaints of a painful thumb. While this issue used to primarily affect women over the age of 55, we're now seeing more younger men and women experiencing similar discomfort. One of the primary causes of painful thumb is a condition known as trapeziometacarpal osteoarthritis, or rhizarthrosis. Recent research by Collona and Borghi provides a thorough overview of this condition and explores various conservative treatment options.
What is Rizarhrosis?
Rhizarthrosis mainly affects women after menopause and involves the first joint of the thumb, where the wrist meets the base of the thumb bone. Several factors can contribute to the development of this condition, such as:
- Previous injuries to the thumb
- Weak ligaments caused by hormonal changes or underlying conditions like Marfan syndrome or Ehlers-Danlos syndrome
- Repetitive stress on the thumb from occupational activities
The symptoms of rhizarthrosis include:
- Pain and weakness when gripping or pinching objects
- Difficulty with everyday tasks, like using keys, opening jars, or carrying heavy items
As the condition worsens, joint stiffness increases, particularly in moving the thumb. Over time, people may avoid using the thumb to prevent pain, which can lead to lasting rigidity. In severe cases, the thumb may become misshaped (referred to as a "Z thumb").
Importance of Accurate Diagnosis
It's essential to differentiate rhizarthrosis from other thumb-related issues that share similar symptoms. Proper assessment typically involves physical examinations conducted by a therapist or doctor. Specific tests, such as the Grind test, can help confirm the diagnosis. Pain upon direct touch at the joint is another strong indicator of the problem. Proper evaluations also consider other potential conditions like scaphoid fractures, de Quervain's disease, and arthritis of the wrist.
X-rays help show changes in the joint, like reduced space and bone growths, which help categorize the stage of the condition.
Treatment Options
The type of treatment chosen depends on the severity of the condition, the extent of symptoms, and functional challenges. Generally, initial treatment aims to relieve pain, stabilize the joint, and minimize stress on it. If conservative treatments don't help, surgery may be considered.
Conservative Treatment Approaches:
- Bracing or Splinting: Special thumb braces can provide support and limit movement in the affected joint. While rigid braces offer more protection, they can restrict thumb movement. Softer options may allow for more flexibility but provide less support. Our clinic has had success with a specific type of soft splint that allows for almost full thumb movement while also providing adequate support.
- Therapeutic Exercises: Strengthening and stabilizing the thumb muscles are critical. Specific exercises can help improve movement and control. Recommended exercises can include thumb opposition (touching the thumb to each finger), tearing paper, tracing a line on a ball, using sticks to pick up objects, and squeezing a ball. These exercises not only help maintain or increase thumb range of motion but also focus on muscle endurance and coordination.
- Manual Therapy:Different techniques can be used to relieve symptoms. The neurodynamic technique works on gently moving joints to alleviate pain. Other techniques, such as Kaltenborn and Mulligan, focus on improving joint movement and comfort. Each method has shown varying degrees of effectiveness.
- Pain Relief Modalities: Certain therapies, such as laser therapy and shockwave treatment, are being researched for their effectiveness in easing symptoms. Our clinic also uses a form of therapy called TECAR, which uses high-frequency currents to help reduce pain and enhance healing. Hydrotherapy, involving warm water jets, is another effective approach that can increase range of movement and decrease pain prior to exercises.
- Infiltrative Therapy: For targeted relief, injections of hyaluronic acid or steroids can provide significant pain relief and improve hand function. Recent research suggests that hyaluronic acid may offer longer-lasting benefits. There is also emerging interest in using platelet-rich plasma for treatment.
Conclusion
Rhizarthrosis is a degenerative condition affecting the base joint of the thumb, causing pain, stiffness, and difficulty with typical daily activities. While it predominantly affects post-menopausal women, it can occur in anyone. Understanding the underlying factors and effective treatment strategies is crucial for managing this condition successfully. By utilizing a combination of supportive measures, exercises, and targeted therapies, many people can find relief and regain function in their thumbs.
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