Thumb Base Osteoarthritis in Vienna — Osteoarthritis of the Thumb Saddle Joint
The thumb hurts when you open a bottle, turn a key or grip firmly — and your strength fades. Behind this there is often thumb base osteoarthritis (rhizarthrosis), the wear of the thumb saddle joint. I examine your hand and discuss the right route with you — from an orthosis through to an operation.
In short
Thumb base osteoarthritis (rhizarthrosis) is osteoarthritis of the thumb saddle joint, that is, cartilage wear between the trapezium of the carpus and the first metacarpal. Typical signs are pain at the base of the thumb when gripping and turning, and a noticeable loss of strength in the pinch grip. The condition is assessed through the examination, ultrasound and an X-ray, which I arrange where needed. Treatment begins conservatively with a thumb orthosis, physiotherapy and ultrasound-guided injection. If that is not enough, two surgical routes are available: implant-free suspension arthroplasty or joint replacement with a prosthesis.
What is thumb base osteoarthritis?
The thumb saddle joint connects the trapezium (Os trapezium) of the carpus with the first metacarpal. Its saddle shape allows the thumb to rotate and to oppose the other fingers — this is what makes gripping possible in the first place. When you grip firmly, high forces act on this small joint.
In thumb base osteoarthritis (osteoarthritis of the thumb saddle joint) the cartilage becomes thinner, the joint space narrows and bony spurs form at the margins. Often the ligament that guides the base of the joint also loosens; the thumb then drifts towards the palm. Women are affected more often than men; an earlier fracture close to the joint can also lead to osteoarthritis. Not every change on an X-ray causes symptoms — it is the person who is treated.
Typical symptoms
- Pain at the base of the thumb — when opening bottles, turning a key, doing up buttons.
- Loss of strength — the pinch grip becomes unreliable, objects slip away.
- Tenderness and swelling — directly over the joint at the root of the thumb.
- Rubbing and grating — noticeable when the thumb is turned under load.
- Malalignment — later the thumb sits closer to the palm.
Similar symptoms are caused by tenosynovitis of the hand; carpal tunnel syndrome, by contrast, typically makes the fingers go numb at night. If several joints are affected, osteoarthritis of the wrist and fingers is more likely; the page on hand pain gives an overview by site of pain.
How I make the diagnosis
I begin with a conversation about your everyday life: which movements hurt, since when, and what you do with your hand at work and in your private life. The clinical examination follows — tenderness over the saddle joint, the position and mobility of the thumb, strength compared with the other side. Turning the thumb under gentle pressure usually provokes the familiar pain. In the practice I use ultrasound to assess tendons, capsule and irritation; to assess the bone I arrange an X-ray, and an MRI only if the findings are unclear.
Treatment: conservative first
The aim is to ease the pain, preserve grip strength and relieve the thumb in everyday life.
- Thumb orthosis — a fitted splint supports the saddle joint during demanding activities and at night.
- Adjustments in everyday life — thicker handles, aids for opening jars, spreading the load over the whole hand instead of the pinch grip.
- Physiotherapy and exercise — exercises for the muscles that guide the thumb ray; both are available in the same building at the Orthozentrum Döbling.
- Ultrasound-guided injection — placed precisely at the joint when irritation is the main problem; magnetic field therapy in addition.
In selected cases I discuss PRP therapy with patients. The evidence in osteoarthritis is inconsistent; I tell you beforehand what you can expect.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. I describe how things work in a private practice on a separate page.
When an operation is necessary
If the symptoms persist or gripping no longer works, I discuss the operation with you. For the thumb saddle joint, two routes through a small open approach are available:
- Suspension arthroplasty — I remove the worn trapezium and suspend the first metacarpal with a strip of your own tendon, without an implant.
- Joint replacement with a prosthesis — a saddle joint prosthesis replaces the destroyed joint; the length and leverage of the thumb are preserved.
Which route suits you depends on the X-ray findings, on bone quality and on your demands. I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare. For an operation, direct settlement with a supplementary private insurance is possible.
Whether a procedure is sensible depends on the findings — we make this decision together, after I have examined you. You can arrange an appointment at my practice in Vienna-Döbling by telephone or by email.
Frequently asked
Frequently asked questions about thumb base osteoarthritis
The typical sign is pain directly at the base of the thumb when gripping, twisting something open and turning a key, together with a loss of strength in the pinch grip and often a grating sensation under load. The joint can be swollen and tender. Only the examination together with an X-ray brings certainty, because tenosynovitis at the thumb causes similar symptoms.
A fitted thumb orthosis stabilises the saddle joint and takes load off the cartilage. It is usually worn at night and during activities that demand strength in the pinch grip. It makes everyday life easier without intervening in the joint; the osteoarthritis itself does not go away as a result. I discuss which design suits you after the examination.
When orthosis, physiotherapy and injection no longer ease the symptoms sufficiently, when the pain is also present at rest, or when gripping in everyday life no longer works. What counts are your symptoms and the clinical findings, not the X-ray alone. I discuss openly with you what a procedure can and cannot achieve.
In suspension arthroplasty I remove the worn trapezium and suspend the first metacarpal with a strip of your own tendon; this method requires no implant. In joint replacement I insert a saddle joint prosthesis, which preserves the length and leverage of the thumb. Which route suits you depends on the findings and on bone quality.
First a splint protects the thumb so that the reconstruction can heal. Physiotherapy then begins: movement without load at first, later a gradual build-up of strength for the pinch grip. I deliberately give no general time frames, because they vary with the procedure, your occupation and the course of healing. I adjust the plan at the follow-up visits.
Usually yes, often with adjustments. Thicker handles help, as do tools with a longer lever, aids for opening jars and movements that spread the load over the whole hand instead of the pinch grip. I look specifically at what is feasible in your occupation and in your sport.
No, a referral is not needed. Please bring everything you have to the first consultation: e-card, previous reports, doctors' letters and X-ray, CT or MRI images. Appointments are by arrangement; you can reach me by telephone from Monday to Friday between 9:00 and 16:00. As a rule, an appointment is available within a week.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.