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Pain, stiffness or limited mobility of the hand is often dismissed as a "minor" problem that "we'll deal with on our own." The truth is that many of these complaints, whether it's pain in the thumb or numbness in the wrist, can be a sign of a serious condition that, if delayed, can worsen quality of life.

In this interview, Dr. Elena Mateva, orthopedic traumatologist at VITA Hospital, talks about the most common painful conditions of the hand, how they present, and when it is important to seek timely consultation.

Dr. Mateva, what are the most common painful conditions of the hand?

There are many. One such condition is pain at the base of the thumb - a problem that concerns a large proportion of our patients and your readers, and it can be due to various pathological conditions. The most common cause is wear - degeneration, osteoarthritis, called "rhizarthrosis," of the base joint of the thumb. It can also be a symptom of inflammation or nerve compression in the wrist area - carpal tunnel syndrome, or tendon compression.

What condition is rhizarthrosis, and what are the characteristic symptoms of this condition?

The most characteristic symptoms are gradually arising pain, initially after strain, most often in middle-aged women. The pain spreads throughout the thumb and into the small muscles of the palm. Sometimes rhizarthrosis is post-traumatic, in which case it can also occur in younger people. Gradually, a bony prominence at the base of the thumb and a limitation of its movements are added to the pain. In the most advanced stages, the thumb becomes significantly deformed, shaped like the letter "Z." It is very important to know that the various pathological conditions described above are often found in the same patient, mutually complicate one another, and impair the function of the affected hand.

What are the problems associated with diagnosing rhizarthrosis?

The diagnosis is made easily, and expensive diagnostic methods are not needed, because the symptoms are very characteristic. X-rays are taken in special projections for the thumb, which reveal the condition of the bones and joints in the area and help distinguish it from certain other conditions.

Do you recommend the use of corticosteroid injections, as is done in the treatment of joint inflammatory conditions?

Rhizarthrosis has several stages, and in the early stages there is an inflammatory reaction of the joint structures. In that case, it is entirely appropriate to use anti-inflammatory medications.

Improper handling of corticosteroid preparations can indeed have adverse effects. In the treatment of rhizarthrosis, hyaluronic acid can also be applied intra-articularly, in order to preserve the vitality of the cartilage for longer. The decision to use one or the other type of intra-articular injection rests solely with the treating physician. In most cases, injections into this miniature joint must be performed under X-ray guidance, to ensure that the medication reaches its intended destination and does not affect the surrounding soft tissues.

Can rhizarthrosis become a chronic condition?

Rhizarthrosis, like all other joint-degenerative diseases, is chronic, with a gradual onset and a faster or slower evolution, and pain and disability of the affected hand of varying intensity.

To what extent is physical therapy effective for hand conditions?

All physical therapy procedures aim to have an anti-inflammatory and pain-relieving effect. In the early forms of most conditions, they are effective to varying degrees, but not in advanced cases. In carpal tunnel syndrome, short-term pain relief and reduction of numbness are achieved, but the compression is not eliminated, and the relief is temporary.

Unfortunately, a considerable proportion of patients with carpal tunnel syndrome are still delayed at various levels, being diagnosed with "tendovaginitis", "poor circulation", "neck spurs", or even "insomnia and neurosis", and in this way treatment is delayed while the nerve suffers permanent damage. Even when correctly diagnosed, many patients are offered an inadequate solution, which also wastes time and worsens the long-term prognosis regarding nerve recovery. Taking medications, vitamins, food supplements, and physical therapy cannot lead to a cure.

No method of prevention for the condition is known, and the primary method of addressing carpal tunnel syndrome is surgery - the dense tissue compressing the nerve is cut. Timely performance of the surgery leads to full recovery. When it is delayed, recovery is slower and incomplete, but there is nevertheless significant and substantial relief of the subjective symptoms of numbness and pain. It is important that the surgery be performed by a hand surgery specialist in order to avoid complications.

Is there a place for prevention, in particular diet, in rhizarthrosis?

In patients with rhizarthrosis, prevention consists of determining the optimal load for the affected hand, the way objects are handled, adapting everyday objects and the way they are gripped so as to spare the affected thumb as much as possible. Wearing protective orthotic devices - splints that immobilize and give rest to the thumb - is required. Diet and taking oral food supplements are of no particular significance.

Is surgical treatment required for this condition, and when should the operation not be delayed?

When the condition is particularly painful and it is almost impossible to perform any activities with the thumb, surgical treatment is recommended. Rhizarthrosis is one of the first conditions in medicine for which, back in the early 1970s, the use of silicone implants began, placed in the location of the removed diseased bone. Different surgical techniques are used for the different stages of the disease.

At the beginning you mentioned "tendon compression." What are these conditions?

These are the so-called "stenosing tendovaginitis". As the name itself suggests, there is a narrowing along the path of smooth gliding of the tendon. They are most often due to inflammation, which in turn is caused by work and repetitive monotonous movements. These are among the most common hand conditions. When the finger-flexing tendons are affected, there is a triggering phenomenon when straightening the finger, hence the popular name - "trigger finger". It is important to know that, if left untreated, this can lead to extremely painful locking of the finger, with no ability to either bend or straighten it. Pain can also be present at the base of the thumb due to compression of some of its tendons. Hand surgery is a relatively new, extremely dynamically developing specialty.

If you experience pain, stiffness or limited mobility in your hands, do not delay a visit to a specialist. Book a consultation with an orthopedist at DCC VITA and take care of your hand health today.