Rhizarthrosis Part I: A Literature Review

Abstract

Rhizarthrosis (RA), or trapeziometacarpal osteoarthritis, is an arthritic degenerative process that affects the first joint of the thumb. The objective of this work is to provide therapists with an overview of the fundamental issues related to the therapeutic management of trapeziometacarpal joint instability.Prevalent in females, especially post-menopause, and linked to age, RA involves ligament and muscle structures, with causes ranging from hormonal influences to mechanical factors. Understanding the biomechanics, stability, and factors contributing to RA is crucial for effective intervention. This study explores the role of ligaments, muscles, and anatomical variants in thumb joint degeneration, emphasizing the importance of stability and congruence.RA manifests as pain at the base of the thumb, limiting grip strength and hindering everyday tasks. Pain initially occurs during specific movements but can progress to constant discomfort, affecting sleep. Chronic RA leads to joint stiffness, deformities like the "Z thumb," and muscle atrophy, impacting daily functions.Clinical evaluation involves pain assessment, joint mobility examination, and palpation. Diagnostic tests like the grind test and lever test aid in confirming RA. Radiographic examination reveals joint space degeneration and osteophytes and helps classify RA stages using the Eaton-Littler classification.Conservative treatment aims to alleviate pain, reduce joint stress, and enhance function. Orthoses help stabilize the joint. Therapeutic exercises, emphasizing muscle strength and dynamic stability, prove beneficial. Manual therapies like neurodynamic, Kaltenborn, Mulligan, and Maitland techniques target pain reduction and improve joint mechanics.The studies on conservative approaches provide evidence that a multimodal intervention consisting of joint mobilization, neural mobilization, and exercise is beneficial in reducing pain in patients with RA. When conservative therapy fails, surgical intervention is indicated.

Rhizarthrosis Part II: A New Approach of Manual Therapy and Therapeutic Exercise

“…RA represents a significant challenge in hand pathology due to its impact on thumb joint functionality. Given the potentially debilitating condition caused by a degenerated TMj, the importance of appropriate treatment of RA is well recognized [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

“…Considering the image of the horse and the rider proposed by Neumann [26] (see Part I of this work [2]), to make it more specific, in order to better understand the imbalance present at the base of the RA, it is necessary to reconsider first the direction of the rider and second the "horse racing gesture". About the direction, the ulnar direction (face facing the 2nd metacarpus) is closer to reality than the radial one; moreover, the equestrian gesture of jumping at obstacles is more suitable to describe RA causes.…”

“…In this case, the orientation of the saddle is more inclined, and the rider must seek balance. During the jump, the rider needs the stirrups to keep stability (see Part I [2]); in the event of an insufficient stiffness of stirrups, the rider would rotate forward and slide backward. The stirrups are representative of the ligamentous structures.…”

“…This results in maintaining or increasing strength, function, stability, and mobility while improving occupational performance. Conservative treatment is preferred to surgery in mild forms at initial stages (I and II grade of Eaton-Littler classification of the disease, before significant TMj destruction; for a more in-depth presentation of the Eaton-Littler scale, see Part I [2,3]). Anyway, the choice of treatment depends more on the severity of the reported symptoms and the functional needs of the patient, than Eaton-Littler's radiographic staging [4].…”

“…Mulligan [13], and Maitland [14]. A summary of these techniques was presented in Part I [2]. These works, which were produced by the same research group, do not report a comparison of the results between the different techniques used, to verify whether there is one that is better than the others in terms of effectiveness [6][7][8][9][10]15].…”