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Aktuelle Aspekte zur Therapie der Rhizarthrose

Current aspects of therapy of rhizoarthrosis

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Zusammenfassung

Schmerzen und Funktionseinschränkungen des Daumens sind die beiden relevanten Kriterien für eine differenzierte Indikationsstellung zur Therapie der Rhizarthrose. Das Röntgenbild ist zwar integraler Bestandteil der Diagnostik, für den Therapiealgorithmus jedoch von nachgeordneter Bedeutung.

Die konservative Therapie steht immer am Anfang der Behandlungskette. Eine Linderung der Beschwerden ist für die intermittierende Ruhigstellung durch eine Schiene und die Anwendung technischer Hilfsmittel im Alltag nachgewiesen. Die intraartikuläre Injektion von Hyaluronsäure oder Kortison wird unterschiedlich eingeschätzt. Manchmal guten Erfahrungen im klinischen Alltag steht der fehlende Nachweis der Wirksamkeit in randomisierten Studien gegenüber. Bei persistierenden Beschwerden nach Ausschöpfung der konservativen Maßnahmen kann die Indikation zur operativen Therapie gestellt werden. Hierbei ist die isolierte Trapezektomie das Verfahren der Wahl. Suspensions(Interpositions)-Arthroplastiken sind nicht mit besseren klinischen Ergebnissen assoziiert. Neuere Verfahren mit dem Ziel, die Proximalisierung durch Interposition zu verhindern, sind nach den bislang publizierten Daten der Trapezektomie ebenso nicht überlegen.

Abstract

In patients with carpometacarpal osteoarthritis of the thumb, treatment strategies should be based on functional impairment and pain. Although X‑ray imaging is an integral component of the diagnostics, it is of subordinate importance for the therapy algorithm. Conservative therapy is always the first step in the chain of treatment. The efficacy of non-operative treatment, including intermittent immobilization using splinting and the application of technical assist devices in the daily routine has been proven to achieve pain relief. The intra-articular injection of hyaluronic acid or glucocorticoids is still under debate as some good experiences in routine clinical applications are contrasted by the lack of effectiveness in randomized studies. The indications for operative treatment are fulfilled by persisting pain after exhausting all the options for conservative therapy. In this case isolated trapeziectomy is the method of choice. Suspension (interpositioning) arthroplasty is not associated with improved clinical results. More recent procedures which aim to avoid proximalization by tendon interposition, have not yet shown better clinical outcome compared to trapeziectomy alone.

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Danksagung

Alle Röntgenbilder wurden vom Institut für Diagnostische und Interventionelle Radiologie des Universitätsklinikums Düsseldorf/Univ.-Prof. G. Antoch zur Verfügung gestellt; der Abdruck erfolgt mit freundlicher Genehmigung.

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  1. Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    T. Lögters, S. Gehrmann & J. Windolf

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  1. T. Lögters
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  2. S. Gehrmann
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  3. J. Windolf
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Correspondence to T. Lögters.

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T. Lögters, S. Gehrmann und J. Windolf geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Schädel-Höpfner, Neuss

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Lögters, T., Gehrmann, S. & Windolf, J. Aktuelle Aspekte zur Therapie der Rhizarthrose. Unfallchirurg 119, 1000–1006 (2016). https://doi.org/10.1007/s00113-016-0250-9

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