Orthopedics-Online

What is saddle arthritis of the thumb?

Synonyms

medical: Rhizarthrosis, Carpometacapal joint arthrosis

Synonyms in the broader sense:

Saddle joint arthrosis
Osteoarthritis of the thumb
Arthrosis of the thumb saddle joint

definition

In principle, the joint bodies are different according to the shape Joint shapes distinguished. On the one hand, these are the ball joint, the nut joint, the sliding joint, the wobble joint, the roller joint, the egg joint and the saddle joint.

The Saddle joint (=Articulatio sellaris) consists of two saddle-shaped joint surfaces that are optimally matched to one another in terms of structure and "fit".

The Saddle thumb joint is located between the large polygonal bone (= Os trapezium) and the first mid-ray bone.

A Thumb saddle joint osteoarthritis (med .: Rhizarthrosis) represents a Wear and tear (Arthrosis) in the area of the thumb saddle joint. Often, the arthrosis also affects other joints of the hand, which means that consequences caused by the arthrosis can also arise in these joints.

Symptoms

In the case of saddle joint arthrosis, there is typically pain in the joint.
With regard to the pain sensation, it should be noted in advance that Individuals perceive the same pain very differently can. For the disease of the thumb saddle joint osteoarthritis, this means that some patients are already at an early stage Resting pain feel, while others perceive the resting pain only in more advanced stages. At this point, a “normal” pain-sensitive patient is assumed.
in the Early stage The patient often has a feeling of the disease Powerlessness in the area of the thumb. So-called often occur especially in combination with everyday movements exercise-related pain on. Also Pressure pain are initially typical. However, the pain sometimes increases quite quickly, as the wear and tear inevitably progresses.
In more advanced stages if the pain increases, becomes more severe and sometimes radiates to other areas.
The clinical findings of osteoarthritis of the thumb saddle joint are expressed in a Capsule swelling, consequently a swelling around the area of the saddle joint. Typically a Tenderness be exercised.

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Pain associated with saddle joint arthrosis

The pain is considered to be the leading symptom in the disease of the thumb saddle joint. The intensity and duration of the pain varies greatly from person to person.
The stage of the disease also has an influence on which form of pain dominates. In the early stages, the pain symptoms usually appear in the form of stress pain. However, as the disease progresses, resting pain can also develop, which is perceived as very stressful.
In addition to pain, swelling is a classic symptom of saddle joint arthrosis. Therefore, the capsule tension often leads to pressure pain.
The respective forms of pain vary in their frequency, intensity and duration and tend to intensify with increasing signs of wear and tear on the thumb saddle joint.
The pain is often not only localized in the area of the thumb saddle joint, but also radiates into the fingers and hand.
The pain can also lead to functional impairment, usually in the form of a reduction in strength and mobility. For example, it is difficult for those affected to grasp and hold objects tightly while experiencing pain in the thumb saddle joint. In addition, depending on the stage of the disease, mobility can be restricted due to the pain. Turning and grip movements in particular are perceived as very painful.
The therapeutic steps are based on the respective pain symptoms, as the pain is a good measure of how far the disease has progressed or how much the affected person is restricted and stressed as a result.

Read more on the subject below:

Pain in the wrist of the thumb
Saddle joint pain

Figure thumb saddle joint

Image of the right hand seen from the palm side with the thumb saddle joint

Thumb saddle joint -
Articulatio carpometacarpalis
pollicis
Distal phalanx -
Phalanx distalis
Phalanx -
Phalanx proximalis
Metacarpal bones
of the thumb -
Os metacarpi
Trapezoidal bone
(= large polygonal leg) -
Trapezium
Spoke - radius
Cubit -Ulna
Scaphoid bone of the hand -
Scaphoid bone
Trapezoidal bone
(= small polygonal leg) -
Trapezoid bone
Metacarpal bones -
Ossa metacarpi

You can find an overview of all Dr-Gumpert images at: medical illustrations

diagnosis

In order to secure the diagnosis will usually be a X-ray image created. X-rays are usually the only imaging tests that can be meaningful. However, they are usually only there if the disease is already in one more advanced stage is located. A positive x-ray result only appears when it has already been bony changes as a result of the more advanced osteoarthritis.

In such stages, x-rays that were taken under stress can also include a instability of the joint depict. This is usually on one loosened capsular ligament apparatus traced back.

You can find further information under our topic: Diagnosis of saddle joint arthrosis

course

The arthrosis of the thumb saddle joint usually proceeds insidiously, so that its full picture only develops over a long period of time (months to years).

In addition, not every course is the same, so the intensity of the complaints can differ significantly from patient to patient. At the beginning of the disease occur gradually load-dependent Pain in the area of the ball of the thumb (e.g. turning movements when unscrewing lids, gripping difficulties), which usually occur again in resting states. With time however, the intensity, frequency and duration of the painful complaints increaseuntil there are hardly any painless phases - neither under stress nor at rest.

As the disease progresses, osteoarthritis increases Deformations of the thumb saddle jointso that the thumb is no longer completely centrally located in the joint and the contour of the thumb or ball of the thumb can also change externally. The coordination of hand movements is getting worse and gripping movements are getting weaker.

in the Terminal stage, if there is a complete stiffening of the thumb saddle joint, it is even a complete functional failure of the thumb and thus a functional restriction of the entire hand is possible.

X-ray of the wrist with the thumb saddle joint

Metacarpal (thumb)
Large polygonal bone (trapezium)

Treatment of saddle arthritis of the thumb

The treatment of the thumb saddle joint arthrosis is conservative in the majority of cases. Surgical techniques are used only rarely and in severe illness.

The primary goal of conservative therapy is to relieve pain in the thumb and thereby improve the ability of the affected hand to work.

Pain relief is brought about by treating the underlying inflammation. Since this is an inflammation that is not caused by bacteria, no antibiotics are used.
The basis of conservative therapy is immobilization of the thumb. If necessary, a so-called thumb orthosis can be used, but it should not be worn permanently.

Read more about this here: Thumb brace

In addition to protecting the thumb, local cooling of the thumb saddle joint can also relieve discomfort.

In addition, ointment dressings (e.g. Voltaren® ointment) and anti-inflammatory non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac or ibuprofen are used.

In the case of the latter, however, the intake should be limited in time due to their side effect profile.

If the above measures do not provide adequate pain relief, a cortisone injection can be given into the joint space. Although this often leads to a permanent improvement in symptoms, it should not be carried out too often due to the side effects.

Please also read: Side effects of cortisone

If the symptoms persist despite the correct implementation of the above-mentioned therapy, an operative procedure can be considered.

Appointment with ?

I would be happy to advise you!

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You will find me:

Lumedis - orthopedic surgeons
Kaiserstrasse 14
60311 Frankfurt am Main

You can make an appointment here.
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
For more information about myself, see Lumedis - Orthopedists.

Conservative therapy

Possible conservative forms of therapy include:

Treatment with heat
Taking so-called anti-inflammatory drugs (NSAIDs)
Corticoid infiltration in the area of the joint
Manual therapy (form of physiotherapy)
Immobilization of the joint by putting on a cuff or a splint

If it is a simpler form of the thumb saddle joint osteoarthritis and especially if the osteoarthritis was detected in the early stages, conservative therapy in the form of physiotherapy is usually indicated. As a rule, drug therapy is also carried out during this time in the form of taking specific rheumatoid drugs (Celebrex®, Voltaren®, ibuprofen, ...), which are intended to alleviate acute pain in particular.

If pain occurs during exercise phases, the patient is usually prescribed an orthosis / bandage. It must be noted that although the joint is spared, muscles, for example, are also weakened. This is why orthoses / bandages should only be worn when absolutely necessary, for example in stressful situations. Carrying it should never become a habit!

Cortisone is usually injected when the joint gap in the thumb saddle joint osteoarthritis has only been minimally altered by the wear and tear of the cartilage. The injection is made directly into the joint, so there are also injection-related risks, such as the risk of infection. Side effects of cortisone that affect the entire body do not usually occur. The aim of such an injection is to bring about the longest possible symptom-free phase. Injections that are too frequent should be avoided because, in addition to the general risk of infection, there can also be regression in the area of skin and adipose tissue.

Treatment with tape

The application of a Tapes A good conservative therapy option in the treatment of saddle arthritis of the thumb.
The property of tape bandages is that the thumb saddle joint stabilized and is consciously restricted in its mobility, it but not to complete immobilization comes.

The slightly elastic plaster strips of these so-called sticking to the skin above the joint functional associations transfer the forces generated in the joint to the skin and thus support the capsule-ligament apparatus, prevent excessive movements and improve movement perception. It can also relieve pain, correct joint misalignments and improve lymphatic drainage.

The so-called kinesio tape, which the attending doctor or physiotherapist applies to the thumb saddle joint using a specific adhesive technique, is particularly well established.

Surgery for a thumb saddle joint osteoarthritis

Surgical therapy methods are arthroscopic interventions, denervation, joint replacement or resection-augmentation-transfixation-arthroplasty.

In most cases, surgery as a therapeutic measure for saddle joint arthrosis is only considered when the alternative, conservative therapy methods have exhausted themselves and have not led to the desired result over a longer period of time.

First can be a classic arthroscopic surgery in outpatient general anesthetic be sensible, which on the one hand gives the treating doctor the opportunity to get a direct Picture of the joint situation and the extent of osteoarthritis, but also on the other hand first therapeutic measures to be carried out (e.g. smoothing of articular cartilage). These can, preferably in the early stages, lead to the alleviation of symptoms.

Another option at moderately advanced osteoarthritis in the thumb saddle joint is the so-called Denervation, in which the pain-transmitting nerve fibers of the thumb saddle joint are destroyed under local anesthesia.
A disadvantage of this possibility of intervention, however, is that the Effect does not necessarily persist in the long term, as the pain transmission can be taken over by other nerve fibers after a few years and the osteoarthritis symptoms can reappear over time.

At very advanced saddle arthritis of the thumb As a rule, an arthroscopic procedure is no longer sufficient, so that other surgical methods must be used. One possibility is that Joint replacementwhich can be done with or without foreign material. The so-called Resection arthroplasty is based on one Joint replacement from own tissue. The thumb saddle joint destroyed by osteoarthritis is removed under regional or general anesthesia (the large polygonal bone is usually removed) and through a Donor tendon from the forearm (from Flexor carpi radialis muscle) reconstructed.
The operation is more complicated here, but the length of the thumb and the loss of strength can be largely compensated for.

The thumb saddle joint can also be restored using artificial endoprostheses. These consist of an anchorage in the first metacarpal bone, on which a ball sits, and an artificial joint socket with a special coating inserted in the trapezoidal bone. It is optional whether the two components are in contact with one another or are flexibly connected, as in a natural joint.

But also bringing in artificial Saddle joint prostheses Occasionally it is used in the surgical treatment of the thumb saddle joint arthrosis, although studies have not yet found any significant advantages over autologous tissue replacement.
In the Saddle joint arthroplasty the large polygonal bone involved in the thumb saddle joint is removed. Although this technique has a high success rate, the patient must reckon with a relatively long healing process of three to six months, during which the mobility of the thumb is initially severely restricted. In addition, the removal of the bone results in a shortening of the thumb and a residual reduction in strength. Physiotherapeutic treatment of the hand is necessary in any case in order to keep the extent of restricted mobility and reduced strength as low as possible.

Another method is the so-called Resection-Augmentation-Transfixation-Arthroplasty (RATA) which works neither with its own nor with external material transplantation. Under general anesthesia, the defective polygonal bone involved in the joint is removed and then the joint capsule is reinforced without foreign material, with the metacarpal bone of the thumb being fixed to the metacarpal bone with the index finger at the same time. This wire, which remains in the hand for about 6 weeks, enables stable scarring, which allows sufficient mobility and stability of the thumb saddle joint.

After being fitted with an endoprosthesis, there is not only the risk of infection but also the risk of it breaking out of its anchorage in the bone or falling victim to material fatigue.

With regard to the materials used, there have been repeated innovations over the past few decades in order to optimize the service life of the endoprosthesis. Although much progress has been made, there is a lack of long-term studies on the durability of recent developments.

homeopathy

In addition to a conservative or surgical therapy method, an attempt can also be made to have an osteoarthritis of the thumb saddle homeopathic approaches to treat. Although the effectiveness of alternative medical healing methods cannot be fully scientifically proven in many cases, they offer a good opportunity to alleviate symptoms for many patients with osteoarthritis complaints.

One option is to take a specific one Schüßler salt combination (No. 1, 2, 8, 9, 11, 16) to relieve the pain of the thumb saddle joint osteoarthritis. Further remedies for the treatment of osteoarthritis in homeopathy are among others Rhus toxicodendron (Poison oak; drop D12), Caulophyllum (Female root; drop D6), Dulcamara (Bittersweet; drops D12) and the use of certain medicinal plants, such as Nettle, Devil's claw, dandelion or Cayenne pepper.

But also the acupuncture and local use of Leeches can relieve pain, inflammation and decongestant effects.

You can find further information under our topic: Homeopathy for saddle joint arthrosis

Diet for saddle arthritis of the thumb

With a balanced diet it is possible to alleviate the symptoms of existing complaints or to prevent them from occurring. A special diet can thus be made from prophylactic as well as therapeutic aspects be used in the case of osteoarthritis of the thumb saddle.
The conscious change in diet has above all the Weight loss as a goalto relieve the joints. Since the thumb saddle joint is less stressed than a knee joint due to an increased BMI, weight reduction only plays a secondary role in thumb saddle joint arthrosis. It is much more important to protect the cartilage that is still present and to positively influence the progression of the disease through certain foods. Above all, "cartilage-protective" applies Foods like leeks, Onions and garlic, as these can provide certain beneficial ingredients. In addition, is a mineral, calcium and vitamin rich diet important. Hence, a special nutrition plan should be a lot fruit, vegetables, fish, Grain, low fat dairy products, unsaturated fatty acids (Olive oil) and high fiber foods.
It is also very important to have sufficient Amount of liquid to take in. It should above all Water or tea drink and avoid sugary drinks such as fruit juices or cola. The respective types of tea contain different active ingredients with different starting points. Recommended, in Teas Medicinal plants contained are for example dandelion, Nettle, arnica, Willow bark, Hay flowers, rosemary and many more.
Excessive consumption of coffee and sugar should definitely be avoided. Finally, it should be pointed out that a change in diet or a special diet is recommended, but the response to the therapy can vary greatly from person to person and therefore there is no guarantee of therapeutic success.

Summary

In the Thumb saddle joint osteoarthritis it is a progressive destruction of the cartilage in the area of the thumb saddle joint. This is formed by two bones: the large polygonal leg (Trapezium) of the wrist and the first metacarpal ray bone. As in general all bones in the area of a joint, these two bones are covered with a protective layer of cartilage at their connection points. However, osteoarthritis gradually destroys this protective layer of cartilage. This results in the development of pain, which increases in later stages and can sometimes also occur in phases of rest.
Different causes are assigned to the development of a thumb saddle joint osteoarthritis. These are for example:

Hormonal causeswhich especially women after the Menopause are often affected by saddle arthritis of the thumb. In most cases, however, osteoarthritis is not restricted to this joint. In most cases, other joints are then affected, especially in the hand area (arthrosis of the small Finger joints).

Joint fractures that are bad healed.

Inheritance

Cartilage can be found in every joint. Whenever bones form an articulated connection with one another, the bones are covered with cartilage at this point. In a certain way it represents a protective covering for the bone. However, if the cartilage is destroyed by osteoarthritis, the protective function of the bone is disturbed. Based on the description one can already conclude that osteoarthritis can develop in any joint in the body. Arthritic changes particularly affect the hip (coxarthrosis) and knee (gonarthrosis), as well as the spine (back pain).