Surgical Treatment for Rhizarthrosis: A Systematic Review of the Last 10 Years

Saheb, Ricardo Lucca Cabarite; VAZ, BRENO ALVES DE SOUSA; Soeira, Thabata Pasquini; Shimaoka, Filipe Jun; Herrero, Carlos Fernando Pereira da Silva; Mazzer, Nílton

doi:10.1590/1413-785220223001e246704

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…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].…”

Section: Discussionmentioning

confidence: 99%

“…Conservative management stands as the cornerstone in early-stage RA, aligning with the preference to mitigate symptoms and improve functionality before considering surgical intervention [3][4][5]. However, relevant lacuna within the literature were recognized: a lack of comparative analyses among manual therapy techniques and the absence of specific, targeted therapeutic exercises tailored for TMj rehabilitation [6][7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…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]. Conservative treatment involves multiple therapeutic approaches: orthoses, therapeutic exercise, manual therapy, physical therapy, and infiltrative therapy [5].…”

Section: Introductionmentioning

confidence: 99%

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

Colonna,

Borghi

2024

Cureus

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Rhizarthrosis (RA), also known as trapezium-metacarpal osteoarthritis, is a degenerative condition affecting the thumb's first joint, leading to functional impairment and pain. Conservative treatment options are preferred for mild to moderate cases (Eaton-Littler grades I and II) and typically encompass a range of therapeutic modalities, including manual therapy. However, for the existing manual therapy techniques, there is a lack of comparative studies for efficacy, and therapeutic exercises are often generic and non-specific to RA. This study proposes a novel treatment protocol that combines manual therapy with specific therapeutic exercises grounded in the biomechanical analysis of the trapeziometacarpal joint. The focus is on enhancing joint stability, reducing pain, and improving function. The manual therapy component includes three phases. A passive phase, during which joint distractions are applied to alleviate discomfort and improve joint mobility. An active phase that addresses joint mobility on the adduction-abduction plane, the first plane of movement to suffer limitation: the therapist facilitates the isometric adduction of the thumb, followed by an assisted abduction. A second active phase is where Mulligan's Mobilization With Movement concept is applied. This technique involves passive pain-free joint mobilization with simultaneous active finger movements, to provide additional therapeutic benefits. The therapeutic exercises component focuses on strengthening the first dorsal interosseous muscle as an abductor to reduce thumb adductor muscle activation and joint stress. Patients are encouraged to perform finger spreading exercises using a rubber band between the first and fifth fingers, emphasizing first dorsal interosseous activation and stability of the thumb. This type of muscle strengthening does not involve movement of the trapeziometacarpal joint. It is recommended to start performing 5-10 repetitions or 5 seconds of isometric contraction, repeat throughout the day, and progressively increase the load by adding a turn to the rubber band or changing it, increasing the number of repetitions bringing it to 15 and/or increase the isometric contraction time to 10/15 seconds. The proposed therapeutic rationale, informed by biomechanical insights, lays a promising foundation for further investigation. Nevertheless, empirical validation through rigorous clinical trials remains essential to substantiate its clinical utility and advance the management of RA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Colonna,

Borghi

2024

Cureus

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“…Osteoarthritis of the STT joint is therefore a contraindication for this procedure. Two systematic reviews comparing different surgical treatment options available for the treatment of CMC-1 arthrosis – including total joint arthroplasty (TJA), trapeziectomy and arthrodesis- concluded that no procedure is superior in terms of pain, physical function, overall patient assessment, range of motion or strength 16 , 38 .…”

Section: Surgical Treatmentmentioning

confidence: 99%

Our Treatment Strategy for CMC-1 Osteoarthritis

Myncke¹,

Vanhees

Verstreken

2022

Handchir Mikrochir Plast Chir

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Osteoarthritis of the carpometacarpal joint of the thumb ( CMC-1) is a common problem and many patients will seek medical attention and may eventually need surgical treatment. As no treatment option has shown consistent superiority, a variety of surgical procedures have been proposed. In this review paper we present our algorithm for the approach of symptomatic CMC-1 osteoarthritis, supported by scientific evidence and our personal experience. It is primarily based on patient demands, status of CMC-1 disease and associated problems around the thumb. The selection of a successful surgical treatment plan with restoration of a pain free and fully functional thumb is the goal. We’ll outline the pro’s and con’s of the surgical procedures and although trapeziectomy has long been the gold standard, the advent of reliable total joint arthroplasties with good short and long-term outcome reports has changed our treatment protocol completely.

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“…However, it remains controversial which surgical technique to consider as the gold standard, 4 and the recent literature is unclear as to whether interposition is necessary or not. 5 …”

Section: Introductionmentioning

confidence: 99%

Tenoplasty in suspension with or without tendon interposition: A prospective randomized study in the treatment of advanced thumb carpometacarpal arthritis

Fidanza,

Rovere,

Colafarina

et al. 2024

Journal of Orthopaedics

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Surgical Treatment for Rhizarthrosis: A Systematic Review of the Last 10 Years

Cited by 5 publications

References 23 publications

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

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

Our Treatment Strategy for CMC-1 Osteoarthritis

Tenoplasty in suspension with or without tendon interposition: A prospective randomized study in the treatment of advanced thumb carpometacarpal arthritis

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