Rizartroza este o afectiune degenerativa a cartilajului articular, apare din cauza slabiciunii

legamentului palmar profund care in mod normal previne miscarile vicioase dorsale.

Pierderea cartilajului din articulatia trapezometacarpiana deterima contactul os-os cu dureri si

deformare.

Severity can also progress to pain when resting and pain at night. In more severe cases,
progressive destruction and mal-alignment of the joint occurs, and a bump develops at the base
of the thumb as the metacarpal moves out of the saddle joint. This shift in the joint can cause
limited motion and weakness, making pinch difficult. The next joint above the CMC may
compensate by loosening, causing it to bend further back (hyperextension).

Less severe thumb arthritis will usually respond to non-surgical care. Arthritis medication,
splinting and limited cortisone injections may help alleviate pain. A hand therapist might provide
a variety of rigid and non-rigid splints which can be used while sleeping or during activities.

Patients with advanced disease or who fail non-surgical treatment may be candidates for surgical
reconstruction.
A variety of surgical techniques are available that can successfully reduce or eliminate pain.
Surgical procedures include removal of arthritic bone and joint reconstruction
(arthroplasty), joint fusion, bone realignment, and even arthroscopy in select cases. A
consultation with your hand surgeon can help decide the best option for you.

Eaton has described a widely accepted radiographic staging system for thumb CMC joint
degenerative arthritis:

Stage I: Normal or slight widening of the joint shadow due to synovitis

Stage II: Mild joint shadow narrowing with osteophyte formation of 2 mm or less

Stage III: Marked joint shadow narrowing with osteophyte formation of more than 2 mm

Stage IV: Stage III disease with scaphotrapezialtrapezoidal osteoarthritis

Volar Ligament Reconstruction

- NU are dezavantaje
- Indicatii relative pt st I si II, st III-IV contraindicatii absolute
- Incizie Wagner care se prelungeste proximal si ulnar pana la distal wrist flexion crease si
se opreste la marginea ulnara a FRC, sunt disecte si retractate ms tenarieni si o parte din
tendon LAP care se insera pe mascia oponentului
- Disectie mai profunda la fibrele transverse de pe FRC si continua distal spre trapez peste
care sta ligamentul volar transvers (LIAC)
- Se inspecteaza articulatiile trapezometacarpiana si scafotrapezoida prin artrotomie
- TMC are de obicei sinovita, se face sinovectomie si se reduce articulatia cat mai
congruent
- Se recolteaz FRC, doar jumatate naiba intelege mai departe

Trapezectomie
- Se scoate trapezul, se inchide capsula cu 3-0 non-abs, se inchide se imobilizeaza 3-4S

Hematoma and Distraction Artroplastie

- Trapezectomie completa cu distractor
- Stadiul I este o contrainedicatie absoluta

Trapezectomie si interpozitie de tessut natural sau artificial „Anchovy”

- Stadiul I este o contraindicatie absoluta
Trapezectomie completa cu reconstructia ligamentului FRC
- Stadiul I este o contraindicatie absoluta

Reconstructia ligamentului tendon interposition (LRTI)

- Stadiul I este o contraindicatie absoluta
- Se excizeaza trapezul apoi se pregateste baza metacarpului, se retracta SEP plm