Rhizarthrosis: arthrosis of the thumb causing disability of the hand

It consists of progressive destruction of joint cartilage, causing the bones to rub against each other, resulting in inflammation and pain and later, stiffness, deformity, limited mobility and strength of the thumb.

It is more common in women over the age of 40 and is worsens when opening a bottle or turning a key to open a lock. It is usually triggered by a fall or trauma, but it can also arise from repetitive pinching or twisting movements.

The initial treatment is non-surgical. The first approach is a splint worn for 6 or more weeks to immobilize the thumb, as well as anti-inflammatory drugs. Manual therapy and intra-articular anti-inflammatory injections are also conservative treatment options. In cases where these interventions are not tolerated, or, more importantly, if pain persists, surgery may be needed.

There are different types of surgical interventions possible to treat this pathology. One of the surgical techniques has been developed at the Hospital Particular do Algarve. It is performed on an outpatient basis, not requiring general anaesthesia, permitting a quick recovery and excellent mobility, recovered strength and substantial reduction of pain.

It is necessary to wear a plaster cast for one week in the postoperative period, followed by a removable splint and rehabilitation of the hand, with the recovery period lasting between 6-12 weeks.

After surgery, muscle strength is reduced when compared to the “normal” hand, but it is superior to the strength experienced before surgery. It is not always possible to be totally free from pain.

Time off work stop varies between 4 to 16 weeks depending on the patient’s activity.

In addition to medical intervention, rehabilitation of the hand is important and includes:

• Rest splints during the night and/or daytime during pain crises. They keep the joint in a correct position, stabilizing the thumb with an anti-painful anti-inflammatory effect and prevent worsening of deformities;

• Function splints used during daily living activities mainly in the early stages. They allow the use of the hand while maintaining the thumb in a correct position without overloading the joint, act as a stabilizer for the joint while preventing deformities;

• Learning how to use the hand without overloading the joint at the base of the thumb by using compensation devices and technical aids. In the specific case of rhizarthrosis, it is very important to encourage the patient to make the handles of everyday objects thicker, such as toothbrushes or hairbrushes, cutlery, etc.

• Performing the same task with repetitive gestures for a long period of time must be avoided. Stopping for short periods every 30 minutes is advised.

• Hand rehabilitation sessions depend on each patient’s medical condition, but the main objective is to restore the function of the thumb, decreasing pain, increasing strength and mobility, which are usually the patients’ most frequent complaints.