Treatment of Rhizarthrosis

Rhizarthrosis refers to osteoarthritis of the trapeziometacarpal joint of the hand, which constitutes the “root” (from Rhyzos) of the thumb.

Etiopathogenesis

It affects women over 40 more frequently. Heavy manual labor, professions involving repetitive use of the pincer grip between the thumb and index finger, and previous fractures can also promote the onset of this condition.

The trapeziometacarpal joint frequently experiences instability due to congenital causes and ligament laxity.

Diagnosis

It is made through specialist consultation and standard radiographic examination. Rarely are more in-depth tests such as CT or MRI necessary.

Therapy

The initial therapeutic approach, especially in mild cases or those with minimal signs of arthritis on X-rays, is conservative with orthoses (splints).

It is highly useful to apply custom-made splints by physiotherapists experienced in this condition. The splint can be wrist-inclusive or free, depending on clinical conditions and the patient’s work requirements.

Anti-inflammatories and topical therapies (applied to the skin) with medicated patches or instrumental physiotherapy (laser and ultrasound) can also be used.

The second step is intra-articular infiltrative therapy, especially in cases where there is a fairly large and elastic joint space. The first infiltration can be done with a corticosteroid and subsequently with collagen or hyaluronic acid (one or two infiltrations).

The third step, surgical therapy, is reached in cases of more advanced arthritis or persistent and disabling pain. There are many types of interventions studied and proposed by different authors.

By far the most used interventions are biological arthroplasties, where the trapezium (the bone at the base of the joint) is removed followed by the interposition of tendon tissue in the remaining space. There are many variations of this type of intervention, now preferred because it does not involve the implantation of foreign materials and presents good results both in the short and long term. Pain is relieved while maintaining complete mobility of the 1st digit.

Dr. Nesti Cecilia, specialist in Orthopedics and Traumatology, specialist in Hand Surgery with over twenty years of experience, performs this type of intervention (arthroplasty in suspension according to the Ceruso technique).

After the intervention, a plaster splint is applied for about 15 days, followed by functional rehabilitation using a lighter removable splint.

The most frequent complications are pain on the radial flexor tendon of the wrist and minor adhesions on the scar, but with good physiotherapy, they are generally overcome.

At the MiniHospital, it is possible to perform the intervention under locoregional anesthesia (only the upper limb from the shoulder to the hand is numbed) associated with sedation more or less profound if necessary.

Hospitalization is usually in Day Hospital, or if there are particular issues, the patient may be kept overnight in the facility.