Rhizarthrosis · Thumb saddle joint · Vienna
The jar won't open any more, the key hurts to turn, the thumb "gives way" – rhizarthrosis is one of the most common forms of hand arthritis, affecting mainly women from mid-life onwards. The good news: it is very treatable. From splints to a proven operation, I guide you through it – conservative for as long as it makes sense.
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The thumb saddle joint sits at the base of the thumb, between the wrist and the first metacarpal. It is a kind of ball bearing that gives the thumb its enormous mobility – and because it is involved in almost every grip, it is put under particularly heavy load.
In rhizarthrosis the cartilage of this joint wears down. The thumb hurts under load, loses strength and stability, and in the advanced stage the base of the metacarpal visibly drifts out of the joint – the thumb looks "crooked". Women are affected far more often than men, usually from mid-life onwards.
Pain on strong gripping: opening jars, turning keys, wringing out laundry
Loss of strength: the thumb "gives way", things drop out of the hand
Tenderness directly at the ball of the thumb, near the wrist
Advanced: visible deformity, restricted movement, grinding in the joint
The combination of the typical history, tenderness over the joint and a positive "grind test" (pain on compression and rotation of the thumb) usually points to the diagnosis. An X-ray confirms it and shows the extent of the wear. Important is distinguishing it from carpal tunnel syndrome or tendonitis, which can cause similar symptoms.
Rhizarthrosis can be managed very well without surgery for a long time – and if surgery does become necessary, the result is excellent as a rule.
A custom-made or well-fitted thumb orthosis unloads the joint – especially at night and during stressful activities – and often relieves symptoms considerably. Occupational therapy teaches joint-friendly grips and everyday aids.
For acute, stronger symptoms a targeted injection into the thumb saddle joint calms the inflammation and buys a low-pain phase – good for letting the conservative measures take effect.
If conservative measures are no longer enough, I remove the small worn-out wrist bone (the trapezium) and stabilise the thumb with the body's own tendon tissue – the resection-suspension arthroplasty. A proven, usually outpatient procedure that permanently removes the painful bone-on-bone friction. Patient satisfaction is high.
Pain at the base of the thumb on strong gripping, twisting (keys, jar lids) and pinching is the classic picture of rhizarthrosis – arthritis of the thumb saddle joint. It mainly affects women from mid-life onwards. Also typical is fading strength: the thumb "gives way". Examination and an X-ray confirm the diagnosis quickly.
Rhizarthrosis is joint wear in the thumb saddle joint – the joint between the wrist and the first metacarpal that gives the thumb its great mobility. Because it is loaded with almost every grip, it is particularly often affected by arthritis. The cartilage thins, the joint hurts and loses strength and stability.
No, in most cases not. Treatment starts with a well-fitted thumb orthosis, occupational therapy and adapting stressful activities; injections can bridge painful phases. Only when these measures are no longer enough after months, and the thumb genuinely limits daily life, does surgery become the topic.
The best-proven procedure is removal of the small worn-out wrist bone (the trapezium) and stabilisation of the thumb with the body's own tendon tissue – the resection-suspension arthroplasty. The procedure is usually outpatient and reliably, permanently removes the painful bone-on-bone friction.
After the operation the thumb is immobilised in a splint or cast for a few weeks, followed by occupational therapy. Light activities are possible again after a few weeks; full strength and freedom from pain develop over a few months. The patience pays off: the great majority of patients are very satisfied with the result.
For office work many patients are fit again after 2–4 weeks; for jobs with strong gripping (trades, care work) more like 6–10 weeks, because the thumb first has to become fully loadable again. We discuss the realistic duration for your work before the procedure.
Thumb arthritis is very treatable – the earlier, the more options. Let's find the right path together. In English.
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