Arthrosis of the first metacarpal joint (rhizarthrosis)

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Osteoarthritis of the thumb is a common problem that occurs with age. With this pathology, the articular cartilage between the first metacarpal bone and the trapezium bone wears out.

Arthrosis of the finger can cause serious discomfort, pain, swelling, and limited movement of the thumb. When the stage is advanced, it becomes difficult to pick up various objects. Pain occurs when turning the key or opening a tightly closed lid.

Treatment for arthrosis of the thumb generally consists of a combination of medications and various orthoses. Severe cases are subject to surgical treatment.

Symptoms of arthrosis of the thumb.

Pain is the first and most common symptom of rhizarthrosis of the thumb (in fact, this formulation is an oily word, because rhizarthrosis is a separate term that describes arthrosis of the thumb). Pain may occur at the base of the first toe when moving, gripping, grasping, and putting weight on the toe.

Other manifestations of the disease:

Inflammation, stiffness, tenderness at the base of the big toe
Decreased grip strength
Limitation of movements
Enlargement, bone deformation at the base of the thumb. Hyperextension of the metacarpophalangeal joint, also called swan neck deformity.

Ulnar styloiditis

Local symptoms with styloiditis of the ulna are similar to those with radiation injury. One of the differences is that pain with ulnar styloiditis can radiate to the 4th and 5th fingers of the hand. This is due to pinching of the ulnar nerve in the inflamed tissue. There is also a difference in diagnostic tests.

The finger test and the Filkenstein test are not performed for this disease. When performing a test with abduction of the palms, pain and limitation of movements will occur when abducted to the radial side (towards the thumb).

Causes of arthrosis of the thumb

Rhizarthrosis usually occurs with age. Previous trauma or damage can also lead to the development of deforming arthrosis of the finger.

In a normal saddle joint (the name given to the first metacarpal joint because of its characteristic shape), cartilage covers the ends of the bones, acting as a kind of cushion that allows the bones to slide smoothly against each other. As arthrosis develops, the cartilage covering the articular surfaces is damaged, thinned, and they become rough and rough. Bone begins to rub against bone, causing unnecessary friction and damage to the joint.

Damage to the joint in turn causes the formation of marginal bony growths, which can sometimes be seen and felt under the skin.

Symptoms of metacarpal fractures

Metacarpal fractures usually occur after a fight, car accident, or fall. Less commonly, these are open injuries (circular saw, axe, production machine). Symptoms include:

pain (most intense in the fracture area);
edema;
shortening of the finger;
deformities (for example, lack of a “knuckle”);
subcutaneous hemorrhage.

Risk factors for thumb arthrosis

Female
Age over 40
Obesity
Congenital features such as joint hypermobility, joint deformities
Previous thumb injuries such as sprains or fractures
Systemic diseases affecting the structure and function of articular cartilage, such as rheumatoid arthritis. Despite the fact that arthrosis of the base of the first metacarpal is in most cases osteoarthritis (also known as arthrosis deformans), rheumatoid arthritis can also affect this joint, but less frequently than other small joints of the hand.
Working or other repetitive activity that puts a lot of stress on the thumb.

Prevalence (epidemiology) of metacarpal fracture

Fractures of the metacarpal bones and phalanges of the fingers account for approximately 10% of all fractures of the bones of the human body and approximately 30% - 40% of all fractures of the upper limb. In men, fractures of the metacarpal bones occur 3 times more often than in women.

People who engage in combat sports such as football, basketball, boxing, karate, etc. are much more at risk of getting a similar fracture. Everything is clear here - injuries, blows. But there are patients who received a fracture without much stress or trauma. Such fractures are called pathological. For example, there is an intraosseous tumor, benign or malignant, which weakens the structure and strength of the bone, and the patient does not know about it, since they are asymptomatic. And he learns about the pathology during an X-ray at the emergency room for a fracture. Sometimes fractures occur due to osteoporosis (weakening of bones due to decreased calcium levels). Most metacarpal fractures occur in the active and working population, especially young people and adolescents.

Diagnosis of arthrosis of the thumb

During the consultation, it is worth asking about your complaints and examining your joints for deformities, growths, and signs of inflammation.

A characteristic manifestation of rhizarthrosis is pain when rotating and pressing the first metacarpal bone towards the wrist, I always perform this test. With this movement, the patient may feel pain, crunching, that most unpleasant sensation of bone rubbing against bone.

For radiological diagnostics, X-rays are usually sufficient. If rhizarthrosis is suspected, photographs should be taken of the first metacarpal joint, rather than of the entire hand or just the thumb.

In the pictures you can see:

Bone growths
Bone that is compacted due to worn-out cartilage
Narrowing of the joint space

Classification of hand sections

The human hand (manus) is divided into three sections:

Wrist (carpi);
Metacarpal part (metacarpi);
Finger bones (ossa digitorum) , they are often called “phalanxes”.

By the way, the words “manual” and “manicure” come from the Latin word “manus”.

I decided to color this boring x-ray a little. I highlighted the wrist in red, the metacarpus in blue, and the bones of the fingers (phalanx) in green.

Carpal bones (ossa carpi)

The bones of the wrist include eight small, dense bones, which are arranged in two rows - proximal and distal. In order not to get confused in them, you should adhere to the principles that I described in the article on how to teach human anatomy.

In this picture, I have highlighted the proximal row of carpal bones in red, and the distal row in green.

Now let's take a look at a real x-ray and try to find the proximal and distal rows of the carpal bones (the colors are the same):

Proximal row of carpal bones:

Scaphoid bone (os scaphoideum) . This bone occupies the most lateral (most “radial”) position of all the bones of the proximal row. Also, the scaphoid is the largest bone of the proximal row. Do not confuse it with the trapezium bone from the distal row, which will be discussed below. To avoid such confusion, first learn to distinguish between the proximal and distal rows, and then the individual bones;
Lunate bone (os lunatum) . The distal surface of this bone is very concave. That's why it looks like half a moon. True, this is not particularly noticeable when you look at the entire brush. This structural feature is much better distinguished when you examine the lunate ossicle separately. On the preparation you can find it immediately after the scaphoid bone - the lunate bone very tightly adjoins it on the medial side;
Triquetral bone (os triquertum) . The name of the triangular bone is also very characteristic - if you look at this bone separately, you will clearly see three sides. The triquetrum occupies the most medial (most “ulnar”) position of all the bones of the proximal row;
Pisiform bone (os pisiforme) . This bone is the smallest of all the carpal bones. It articulates very tightly with the triquetrum, so you can easily find the pisiform if you find the most medial bone of the proximal row (that is, the triquetrum).

When you need to find any carpal bone, the first step is to distinguish between the proximal and distal rows. Let's get our bearings on the anatomical tablet, when the hand is shown to us with conventional fingers down.

First of all, let's find the radius and ulna bones. Using the radius we find the side where the thumb is located, and along the ulna we find the side where the little finger is located:

After this, we need to find the wrist bones on the tablet. This is very easy to do - the eight small, dense bones are very different from all the other bones:

Next, you should distinguish between the distal and proximal rows of carpal bones. We already learned this in the last section, so the proximal row can be found without difficulty (do not forget that in front of us is the palm, which is located with the conventional fingers down):

And now that we have all the landmarks in place, we can immediately find, for example, the scaphoid bone (os scaphoideum). We remember that she:

Located in the proximal row;
Occupies the most “radial” position;
It is the largest bone of the proximal row;
Similar in shape to a boat ship.

We carefully examine all the bones of the wrist and find the scaphoid bone:

Using the same principle, we find the lunate bone (os lunatum). To see its crescent shape, we must look at it separately. It is the distal edge of the lunate that creates the characteristic shape that truly resembles a half moon:

Knowing that it is closely adjacent to the scaphoid on the medial side, we can find it on the tablet:

We move even more medially (that is, towards the little finger) and meet the triangular bone (os triquertum). The pisiform bone (os pisiforme) is very tightly adjacent to it. And here there is a small subtlety - you can clearly see the pisiform bone only on the palmar surface of the hand. The palmar surface is the inner surface on the side of which the fingers do not have nails.

Look, from the palmar side of the hand, the pisiform bone (yellow color) “sits” on the trihedral bone (blue color), like a helmet on the head:

But on the dorsal surface of the hand (which is with nails, external) we clearly distinguish the outlines of a trihedral bone, while practically not seeing the pisiform one:

Let's consolidate our knowledge with a real x-ray. You can already see at first glance the boundaries of the wrist and both rows of bones. I decided not to even highlight them.

But I decided to isolate the bones of the proximal row of the wrist. So, the contours of the scaphoid bone are outlined in red, the lunate bone is green, the triquetrum bone is blue, and the pisiform bone is yellow.

Distal row of carpal bones.

A wonderful surprise awaits us here from ancient anatomists. These guys made a huge number of scientific discoveries that changed our lives, but they couldn't come up with a good name for two bones located next to each other. As a result, we have a trapezoid bone and a trapezoid bone (these are different bones, try not to confuse them).

So:

Trapezium bone (os trapezium) . This bone has the most lateral and closest location to the thumb of all the bones of the distal row. It is sometimes called a "polygonal bone". Remember that first comes the “trapezoid” figure itself, and then the derivative from it, “trapezoidal”. So in the bones of the wrist of the distal row - the most lateral position is occupied by the trapezium bone, and after it comes...
Trapezoid bone (os trapezoideum) . By the way, it looks much more like a trapezoid than a trapezium bone;
Capitate bone (os capitatum) . This is the largest of all the carpal bones in the distal row. Moreover, it is believed that it is the largest of all the carpal bones in general. In fact, it has only one competitor - the scaphoid bone from the proximal row, which is also very large;
Hook bone (os hamarum) . And now we have before us the most medial, that is, the most “ulnar” of all the carpal bones of the distal row. Unlike the very strange trapezium bone, which doesn't really live up to its name, the hamate bone actually looks quite similar to a hook.

To find these bones on the anatomical tablet and in the picture, you should repeat the first two steps from the previous section. Only instead of the proximal row we must find the distal row:

Well, then, according to the principle familiar to us, we select a landmark, for example, the trapezium bone (os trapezium). As we remember, it is the most lateral, and the most “radial” - that is, it is closest to the thumb. We find it unmistakably, using this one sign:

After this, we mentally compliment the imagination of ancient anatomists and find the trapezoid bone (os trapezoideum), which fits very tightly to the trapezoid bone. Don’t forget a good lesson: “first comes the figure itself, then something similar to it. First (that is, from the lateral edge) comes the trapezoid, then the trapezoid.”

Next we have the largest bone of the entire wrist in general - the capitate bone (os capitatum). Note how conveniently it articulates with the lunate in the proximal row.

The row is completed by the hamate bone (os hamarum) - the most medial. Based on this feature alone, it cannot be confused with any other bone. We find the distal row, in it we see the most medially located bone (that is, closest to the little finger) - this is the hamate bone. The second sign is appearance. A curved shape with a sharp angle - you will not see anything like it in the entire brush. Here is our hamate bone:

Now let's find all these bones on the x-ray. The trapezoid bone and the trapezoid bone look a little “stuck together.” Therefore, it is best to start understanding the capitate bone - it is the largest and most noticeable (red color). We step back from it to the medial side and immediately see the hamate bone (green).

After this, we go to the lateral edge and examine the border between the trapezium and trapezoid bones - by the way, it can be quite difficult to distinguish. The main thing is not to confuse that first, that is, from the edge, there is a trapezoid bone, and then, to the center of it, the trapezoid bone (blue color) is located.

Metacarpal bones (ossa metacarpi)

There was always a little confusion that made it difficult to remember the hand bones. In Russian, the prefix “za” is found in the word “wrist,” which means the most proximal part of the hand. In Latin, the prefix is added to the next section, to the metacarpus, and it sounds “metacarpi”, instead of “carpi” - “wrist”. The wrist is "carpi" and the metacarpus is "metacarpi".

The metacarpus bones are highlighted in yellow in this image.

So there are five metacarpus bones. These are long, tubular bones, very different from the short, dense, spongy bones of the wrist. The bones of the metacarpus do not have special names, they are simply numbered from the first to the fifth in the direction from the thumb to the little finger. That is, the metacarpal bone of the thumb is the first metacarpal bone, and the metacarpal bone of the little finger is the fifth metacarpal bone.

Each metacarpal bone has a body (corpus ossis metacarpi), a head (caput ossis metacarpi) and a base (basis ossis metacarpi). The base of the metacarpal bone articulates with the bones of the wrist, and the head is the surface for connection with the bones of the fingers.

Let's look at these parts using the example of the third metacarpal bone, which we see (from left to right) from the palmar, dorsal and ulnar surfaces.

The base is highlighted in red, that is, the place where the connection with the wrist occurs. The body is highlighted in yellow - as in most long bones of the body, it is located in the middle. In green I circled the round head - that is, the place where the metacarpal bone connects to the proximal phalanx of the finger.

All bones of the metacarpus are very similar in structure to each other, except for one. You're probably thinking about your thumb now?

No, it's not about him. The metacarpal bone of the thumb has minimal differences from the rest, it is just a little shorter and denser. But the metacarpal bone of the third finger has at its base a styloid process (processus styloideus), it is not for nothing that we considered it as an example. In this figure, the styloid process is highlighted separately:

Finger bones (ossa digitorum)

These are short, tubular bones that are also called phalanges. The thumb has two phalanges - proximal (phalanx proximalis) and distal (phalanx distales). The remaining fingers have three phalanges - proximal (phalanx proximalis), middle (phalanx media) and distal (phalanx distales).

In this image, the proximal phalanges of the fingers are highlighted in red, the middle phalanges are highlighted in green (as you can see, the thumb does not have one), and the distal phalanges are highlighted in blue.

Very often, students mistake the bones of the metacarpus for the first “phalanx”. This is a very serious mistake, in fact. So that you, dear readers, do not have any confusion, I decided to once again highlight the bones of the metacarpus, which have nothing to do with the phalanges of the fingers.

Each phalanx has a base (basis phalangis), a body (corpus phalangis) and a head (caput phalangis). In this picture, the bases of the finger bones are highlighted in red, the bodies of the bones are highlighted in yellow, and the heads of the bones are highlighted in green.

The distal phalanx of each finger has a distal phalanx tuberosity. This is a small bump to which the muscle tendons are attached.

The anatomy of the hand bones isn't that complicated, right?

Orthotics - hand brace

A rigid bandage can support the injured joint and relieve pain. For rhizarthrosis, the most convenient option is an individual orthosis made directly to the arm. It limits painful movements of the thumb while still keeping the wrist joint free.

You can wear the retainer during the day, put it on while working, or vice versa only at night. Its main functions:

Pain relief
Correct positioning of the injured joint during work
Rest for the joint

Styloiditis of the wrist

Styloiditis is an inflammation of the styloid process (from the Latin processus stiloideus) of the radius or ulna.
Accordingly, depending on which process is inflamed, the disease is called ulnar or radial styloiditis. The olecranon process is located on the lateral surface of the wrist joint on the little finger side, and the radial process is located on the thumb side. They are palpated as bone “bumps” in the indicated areas.

Actually, it is not the process itself that becomes inflamed, but the places where the ligaments and tendons attach to it or the tendon sheaths. The disease is also called “wrist styloiditis”.

Styloiditis of the radius (De Quervain's disease) occurs most often, because in this area is the tendon sheath of the abductor pollicis muscle, the narrowing of which predisposes to the onset of the disease.

Injections

Glucocorticoids (diprospan) are powerful anti-inflammatory drugs that provide quick but short-term relief from pain. I use them as a test or as an emergency treatment to relieve severe pain.
Hyaluronic acid preparations (Fermatron) are a gel-like substance that improves the rheological properties of synovial fluid and the transport of nutrients. The administration of such drugs is carried out in a course, the effect of which can last longer than a year. Further destruction of the joint is somewhat slowed down.

Surgery for arthrosis of the thumb

Conservative treatment of deformity of the joints of the fingers may be ineffective, then the question of surgical intervention arises.

The most common surgical technique for treating arthrosis deformans of the thumb is trapezectomy. During this operation, the trapezium bone is removed, the same one on which the first metacarpal bone rests and presses. The technique has proven itself all over the world and is one of the most common procedures in hand surgery.

This operation can be performed under local anesthesia, without general anesthesia. It is not painful and there are no risks associated with general anesthesia.

After the operation, there will be a pin fixing the first metacarpal. The arm will be in a cast. After 12-14 days, you can remove the sutures, remove the pin, and replace the plaster with a light and comfortable plastic orthosis. Development of the joint begins after 6 weeks from the date of surgery.

Restoration of function should be expected 2-3 months after surgery. Working with a hand therapist will certainly make your recovery easier.

Symptoms and location of pain

For each type of injury listed above, there are characteristic symptoms, based on which a qualified specialist will establish an accurate diagnosis and prescribe the necessary treatment. The main signs of damage to the wrist joint include:

Joint pain of varying intensity and location
Edema and swelling of the injured area
Changes in the appearance of the hand and wrist
Redness of the skin in the damaged area
Hemorrhage at the site of injury
Joint contracture (severe limitation of joint mobility)
Increase in overall temperature
Weakness, malaise, chills
The appearance of cones (with hygromas)