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Rhizarthrosis: Causes, Symptoms and Treatment

Rhizarthrosis is osteoarthritis of the thumb carpometacarpal joint. It causes pain and restricted movement at the base of the thumb and is one of the most common joint conditions of the hand.

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Things worth knowing about "Rhizarthrosis"

Rhizarthrosis is osteoarthritis of the thumb carpometacarpal joint. It causes pain and restricted movement at the base of the thumb and is one of the most common joint conditions of the hand.

What is Rhizarthrosis?

Rhizarthrosis is osteoarthritis of the thumb carpometacarpal (CMC-I) joint, also known as the thumb saddle joint. In this condition, the cartilage between the first metacarpal bone and the trapezium (a carpal bone in the wrist) gradually breaks down, leading to pain, stiffness, and reduced function of the thumb. Rhizarthrosis is one of the most common forms of hand osteoarthritis and predominantly affects women after menopause, although it can also occur in younger individuals following joint injuries.

Causes

Rhizarthrosis develops due to a combination of genetic predisposition, hormonal changes, and mechanical overloading of the thumb saddle joint. Common risk factors include:

Age: Cartilage quality and resilience decrease with age.
Sex: Women are significantly more affected, especially after menopause, as estrogen has a protective effect on joint cartilage.
Genetic predisposition: A family history of joint degeneration increases the risk.
Occupational overuse: Repetitive gripping, pinching, or twisting motions (e.g., in craftspeople, musicians) can accelerate joint wear.
Previous injuries: Prior fractures or ligament injuries at the thumb saddle joint may lead to secondary rhizarthrosis.
Inflammatory joint diseases: Conditions such as rheumatoid arthritis can contribute to cartilage breakdown.

Symptoms

Symptoms typically develop gradually and worsen over time. Common signs include:

Pain at the base of the thumb, particularly during gripping or pinching activities
Swelling and tenderness around the thumb saddle joint
Loss of grip strength, making everyday tasks such as opening bottles or writing difficult
Restricted range of motion, especially when spreading the thumb away from the hand (abduction)
Crepitus (a grinding or crackling sensation) in the joint during movement
In advanced stages: visible deformity of the thumb base due to joint subluxation

Diagnosis

Diagnosis is made by a physician based on medical history, physical examination, and imaging studies:

Clinical examination: The grind test is characteristic -- applying axial compression and rotation to the thumb saddle joint reproduces pain in affected individuals.
X-ray: Imaging typically shows joint space narrowing, osteophyte formation (bone spurs), and subluxation of the first metacarpal.
MRI or ultrasound: These may be used in unclear cases to assess soft tissue changes or associated conditions.

Treatment

Conservative Treatment

In the early and moderate stages, non-surgical approaches are the first line of management:

Splints (orthoses): A thumb saddle joint splint immobilizes and offloads the joint, reducing pain during activity and at night.
Physiotherapy: Targeted exercises strengthen the surrounding muscles and improve joint stability.
Pain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac help reduce pain and inflammation.
Corticosteroid injections: Injecting corticosteroids directly into the joint can provide short-term relief during acute flare-ups.
Hyaluronic acid injections: These may help lubricate the joint and reduce pain.
Occupational therapy: Advice on modifying daily activities and using assistive devices to reduce stress on the thumb joint.

Surgical Treatment

If conservative measures fail to provide sufficient relief, several surgical options are available:

Trapeziectomy: Removal of the trapezium bone. This is the most commonly performed procedure, with consistently good long-term outcomes.
Denervation: Cutting pain-conducting nerve fibers around the joint to reduce pain while preserving movement.
Arthrodesis (joint fusion): Fusing the joint in a functional position. This is particularly suitable for younger, physically active patients.
Joint replacement (arthroplasty): Replacement of the joint with an implant -- less established than in large joints but an option in selected cases.

Prognosis

Rhizarthrosis is a chronic and progressive condition. However, early treatment can slow its progression and significantly improve quality of life. After surgical treatment, particularly trapeziectomy, most patients experience considerable pain relief and improved thumb function. Long-term results are generally favorable.

References

Spies CK, Langer M, Hahn P, Unglaub F: The Treatment of Idiopathic Arthritis of the Thumb Carpometacarpal Joint. Deutsches Aerzteblatt International, 2018; 115(6): 83–90.
Hochberg MC et al.: Rheumatology, 6th Edition. Mosby Elsevier, 2015.
National Institute for Health and Care Excellence (NICE): Osteoarthritis: Care and Management. Clinical Guideline CG177, 2014. Available at: www.nice.org.uk

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