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You are here: Home / Hand Conditions / Rhizarthrosis

Rhizarthrosis

diagram outlining the location of rhizartrosis in the hand

Rhizarthrosis: loss of cartilage between the trapezius and the first metacarpal

In a normal joint, cartilage covers the end of the bones and serves as a shock absorber to allow smooth, pain-free movement.

In osteoarthritis (OA, or “degenerative arthritis”) the cartilage layer wears out, resulting in direct contact between the bones and producing pain and deformity. One of the most common joints to develop OA in the hand is the base of the thumb.

The thumb basal joint, also called the carpometacarpal (CMC) joint, is a specialized saddle-shaped joint that is formed by a small bone of the wrist (trapezium) and the first bone of the thumb (metacarpal). The saddle shaped joint allows the thumb to have a wide range of motions, including up, down, across the palm, and the ability to pinch.


Causes


Osteoarthritis at the base of the thumb is more commonly seen in women over the age of 40. The exact cause is unknown, but genetics, previous injuries such as fractures or dislocations, and generalized joint laxity may predispose to-wards development of this type of arthritis.


Symptoms and signs


image showing a hand affected by rhizarthrosis who has difficulty opening a bottle
Rhizarthrosis: difficulty opening bottles or doors (pain and lack of strength)

image showing a hand affected by rhizarthrosis who has difficulty opening a door


The most common symptom is pain at the base of the thumb. The pain can be aggravated by activities that require pinching, such as opening jars, turning door knobs or keys, and writing.

Severity can also progress to pain when resting and pain at night. In more severe cases, progressive destruction and mal-alignment of the joint occurs, and a bump develops at the base of the thumb as the metacarpal moves out of the saddle joint. This shift in the joint can cause limited motion and weakness, making pinch difficult. The next joint above the CMC may compensate by loosening, causing it to bend further back (hyperextension).

image and xray showing advanced rhizarthrosis in z shape
Advanced rhizarthrosis: deformation of the thumb in a Z shape – radiological and clinical aspect

Diagnosis


The diagnosis is made by history and physical evaluation. Pressure and movement such as twisting will produce pain at the joint. A grinding sensation may also be present at the joint. X-rays are used to confirm the diagnosis, although symptom severity often does not correlate with x-ray findings.

xrays of the base of the thumb showing the kapandji incidence rihizarthrosis
X-rays of the base of the thumb – Kapandji incidence

Treatment


Less severe thumb arthritis will usually respond to non-surgical care. Arthritis medication, splinting and limited cortisone injections may help alleviate pain. A hand therapist might provide a variety of rigid and non-rigid splints which can be used while sleeping or during activities.

Patients with advanced disease or who fail non-surgical treatment may be candidates for surgical reconstruction. A variety of surgical techniques are available that can successfully reduce or eliminate pain. Surgical procedures include removal of arthritic bone and joint reconstruction (arthroplasty), joint fusion, bone realignment, and even arthroscopy in select cases. A consultation with your hand surgeon can help decide the best option for you.

image of hand using a rigid splint to treat rhizartrosis during the night
Rhizarthrosis: rigid overnight splint

© 2009 American Society for Surgery of the Hand

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The Geneva Hand & Wrist Specialist team consists of surgeons and hand therapists who work together in privates practices located in Geneva and Genolier.

Geneva Hand & Wrist Specialist

The Geneva Hand & Wrist Specialist team can be reached on the following numbers:

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Genolier: +41 22 366 97 94

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