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<Provider Id="sundheddkcms"> <Item Id="{FF3F69AB-628E-408A-8B5F-375EF3D490BE}" Name="artrose-tommelfinger" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{2D29BD5B-8914-4E1B-AB1B-C989ECE433E9}" SortOrder="400" PublishDate="2009-01-19T13:27:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2> <h3>Diagnostiske kriterier</h3> <ul> <li>Smerter i tommelfingerens rodled ofte trækkende distalt mod grundleddet</li> <li>Efterhånden kommer hvilesmerter, indskrænket bevægelighed og svaghedsfornemmelse</li> <li>Der er palpationsømhed omkring rodleddet</li> <li>Diagnosen bekræftes ved røntgen</li> </ul> <h3>Sygehistorie</h3> <ul> <li>Åbning af skruelåg eller vridning af klud er klassiske smerteudløsende aktiviteter</li> <li>Der kommer også smerter, når patienten skal dreje en nøgle i en dør eller åbne en dør</li> <li>Ofte er smerterne værre, når hånden er i ro efter arbejde. Triadesmerter - smerter ved igangsættelse, herefter lindring, atter smerter efter noget tid</li> <li>Patienten klager over, at det er blevet svært at holde på noget med tommel-pegefingergreb</li> <li>Der er smerter, stivhedsfornemmelse og nedsat kraft i tommelfingerens rodled med nedsat arbejdsfunktion</li> <li>Typisk varierende symptomer men med langsom forværring</li> <li>Betydelig artrose kan give konstante smerter</li> </ul> <h3>Kliniske fund</h3> <ul> <li>Ved undersøgelse findes ofte hævelse og ømhed over leddet</li> <li>Ekstension og samtidig adduktion af tommelfingeren giver smerter. Bevægeligheden er moderat nedsat (kapsulært mønster)</li> <li>Ved tiltagende ledforandringer ses dorsal subluksationstendens i rodleddet, og der kan komme svanehalsdeformitet med hyperekstension i grundled og let fleksion i yderled (Kaldes "Z-finger" konfiguration)</li> <li>Udvikling af knogleprominens over leddet</li> <li>Krepitation ved bevægelse i leddet</li> </ul> <h3>Supplerende undersøgelser i almen praksis</h3> <ul> <li>Ingen relevante</li> </ul> <h3>Andre undersøgelser hos specialist</h3> <ul> <li>Diagnosen kan bekræftes med røntgenundersøgelse (Bett´s projektion)</li> <li>Røntgenundersøgelse foregår uden belastning, og hvis leddet er spændt ud på grund af væskeansamling, vil der ikke være afsmalnet ledspalte trods manglende brusk. Ved normal røntgenundersøgelse men overbevisende symptomer kan artroskopi derfor være nødvendig for at bekræfte diagnosen</li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li>Traumatisk synovit <ul> <li>Resultat af traume eller overbelastning</li> <li>Symptombilledet er som ved artrose, men røntgen viser normale forhold</li> <li>Den medicinske behandling er som ved artrose</li> </ul> </li> </ul> <h2>Behandling</h2> <h3>Behandlingsmål</h3> <ul> <li>Symptomlindring</li> </ul> <h3>Generelt om behandlingen</h3> <ul> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/226500">Analgetika</a> eller <a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a>, immobilisering med skinne og ergoterapi kan give god smertelindring i en periode<a href=" " data-type="journal-reference" data-value="Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders AR, Vermeulen GM, Conservative treatment of thumb base osteoarthritis: a systematic review. J Hand Surg Am 2015;40: 16-21.e1-6" data-value-piped="Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders AR, Vermeulen GM|Conservative treatment of thumb base osteoarthritis: a systematic review.|J Hand Surg Am|2015|40|16-21.e1-6|25534834" data-url="reference-link" data-pubmedid="25534834" title="Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders AR, Vermeulen GM, Conservative treatment of thumb base osteoarthritis: a systematic review. J Hand Surg Am 2015;40: 16-21.e1-6">1</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Bertozzi L, Valdes K, Vanti C, Negrini S, Pillastrini P, Villafañe JH, Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis. Disabil Rehabil 2015;37: 2025-43" data-value-piped="Bertozzi L, Valdes K, Vanti C, Negrini S, Pillastrini P, Villafañe JH|Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis.|Disabil Rehabil|2015|37|2025-43|25559974" data-url="reference-link" data-pubmedid="25559974" title="Bertozzi L, Valdes K, Vanti C, Negrini S, Pillastrini P, Villafañe JH, Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis. Disabil Rehabil 2015;37: 2025-43">2</a></li> <li>Bandage der støtter leddet kan have god effekt. I begyndelsen bør den kun anvendes om natten samt i forbindelse med belastende, gentagne aktiviteter</li> </ul> <h3>Håndtering i almen praksis</h3> <ul> <li>Symptomatisk behandling med analgetika, immobiliserende ortose og evt. ændret arbejdsergonomi bør forsøges før henvisning til ortopædkirurg</li> </ul> <h3>Råd til patienten</h3> <ul> <li>Patienten bør undgå smertefulde aktiviteter og om muligt skifte til et arbejde med mindre belastning af tommelfingeren</li> </ul> <h3>Medicinsk behandling</h3> <ul> <li>Svage analgetika anbefales som førstevalg i perioder med smerter <ul> <li>F.eks. [DliActiveSubstance;6381;paracetamol]: 1 g x 3 i 1 -4 uger</li> </ul> </li> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a> <ul> <li>Systemisk behandling kan være nyttige tillæg i perioder med mange smerter</li> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/grupper/215000">Lokaltvirkende NSAID</a> har kortvarig effekt, men effekten forsvinder efter ca. fire ugers sammenhængende behandling<a title="Lin J, Zhang W, Jones A, Doherty M, Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials. BMJ 2004;329: 324-6" href="EditorPage.aspx?da=core&id=%7BFF3F69AB-628E-408A-8B5F-375EF3D490BE%7D&ed=FIELD6255092929&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H6255093257&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-value-piped="Lin J, Zhang W, Jones A, Doherty M|Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials|BMJ|2004|329|324-6" data-type="journal-reference" data-value="Lin J, Zhang W, Jones A, Doherty M, Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials. BMJ 2004;329: 324-6" data-url="reference-link">3</a> <ul></ul> </li> </ul> </li> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/grupper/171050">Steroidinjektion</a> eller injektion af [DliActiveSubstance;6084;hyaluronsyre] kan have god effekt i måneder, hvis artrosen ikke er for udtalt<a href=" " data-type="journal-reference" data-value="Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders AR, Vermeulen GM, Conservative treatment of thumb base osteoarthritis: a systematic review. J Hand Surg Am 2015;40: 16-21.e1-6" data-value-piped="Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders AR, Vermeulen GM|Conservative treatment of thumb base osteoarthritis: a systematic review.|J Hand Surg Am|2015|40|16-21.e1-6|25534834" data-url="reference-link" data-pubmedid="25534834" title="Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders AR, Vermeulen GM, Conservative treatment of thumb base osteoarthritis: a systematic review. J Hand Surg Am 2015;40: 16-21.e1-6">1</a> <ul> <li>Fx [DliActiveSubstance;6144;methylprednisolon]<a href="~/link.aspx?_id=2760D3678A8F4C43BBD03F2AC5ED29AE&_z=z"> </a>inj. 40 mg/ml <ul> <li>Ledlinjen palperes dorsalt mellem metacarpal- og carpalbenet, og der injiceres 0,25 ml (10 mg) intraartikulært </li> </ul> </li> </ul> </li> </ul> <p>Se mere i video om steroidblokade: </p> <ul> <li><a href="~/link.aspx?_id=DBC5CFAA1DD84F38B05192BBABAE1191&_z=z">Steroidblokade ved rodledsartrose</a></li> </ul> <h3>Anden behandling</h3> <ul> <li>Operationer<a href=" " data-type="journal-reference" data-value="Vermeulen GM, Slijper H, Feitz R, Hovius SE, Moojen TM, Selles RW, Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am 2011;36: 157-69" data-value-piped="Vermeulen GM, Slijper H, Feitz R, Hovius SE, Moojen TM, Selles RW|Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review.|J Hand Surg Am|2011|36|157-69|21193136" data-url="reference-link" data-pubmedid="21193136" title="Vermeulen GM, Slijper H, Feitz R, Hovius SE, Moojen TM, Selles RW, Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am 2011;36: 157-69">4</a>: <ol> <li>Stivgøring af leddet. Anvendes især til yngre patienter, der har brug for et kraftigt greb, også selv om det er på bekostning af nedsat bevægelighed</li> <li>Fjernelse af håndrodsknogle (os trapezium) eventuelt kombineret med udfyldning af tomrummet med et stykke sene (interpositionsartroplastik). Operationen har været brugt i mange år, og har god effekt på smerterne. Patienterne må dog forvente et lidt langsomt rehabiliteringsforløb, og det blivende resultat ses først efter 6-12 måneder</li> <li>Indsættelse af kunstigt led af metal og plastik. Denne operation giver hurtigere rehabilitering end trapeziumresektion og ofte en bedre kraft. Der har tidligere været problemer med holdbarheden af leddet specielt hos yngre med kraftbetonet arbejde eller fritidsaktiviteter. Nyere undersøgelser har dog vist betydelig bedre holdbarhed af de nyere proteser, så det nu er en god behandling til yngre aktive patienter<a href=" " data-type="journal-reference" data-value="Bæk Hansen T, Joint replacement for trapeziometacarpal osteoarthritis: implants and outcomes. J Hand Surg Eur Vol 2021;46: 115-119" data-value-piped="Bæk Hansen T|Joint replacement for trapeziometacarpal osteoarthritis: implants and outcomes.|J Hand Surg Eur Vol|2021|46|115-119|32338193" data-url="reference-link" data-pubmedid="32338193" title="Bæk Hansen T, Joint replacement for trapeziometacarpal osteoarthritis: implants and outcomes. J Hand Surg Eur Vol 2021;46: 115-119">5</a></li> </ol> </li> <li>Arbejdsaktive med manuelt arbejde kan have behov for sygemelding under behandling. I udtalte tilfælde kan det også være aktuelt med rehabilitering</li> </ul> <p><strong>Se mere i video om operation: </strong></p> <ul> <li><a href="~/link.aspx?_id=62F767F59666401FA8F85519624F9D3A&_z=z">Operation, rodledsartrose, finger</a></li> </ul> <h3>Kirurgi</h3> <ul> <li>Se ovenfor</li> </ul> <h3>Forebyggende behandling</h3> <ul> <li>Ingen kendte. Der er således ikke vist nogen oplagt sammenhæng mellem udviklingen af slidgigt og belastning af tommelen i forskellige arbejdsfunktioner</li> </ul> <h3>Henvisning</h3> <ul> <li>Hvis der er vedvarende smerter, selvom de daglige aktiviteter mindskes. Hvis en støttebandage ikke hjælper, og medikamentel behandling ikke har effekt nok</li> </ul> <h2>Sygdomsforløb, komplikationer og prognose</h2> <h3>Sygdomsforløb</h3> <ul> <li>Tilstanden forværres som regel langsomt</li> </ul> <h3>Komplikationer</h3> <ul> <li>Ingen ud over tiltagende fejlstilling og dårlig funktion af fingeren ved tiltagende ledforandringer</li> </ul> <h3>Prognose</h3> <ul> <li>Operation giver god smertelindring og god funktion hos 80-85 % af patienterne ved interpositionsartroplastik, men med relativt lang rehabilitering</li> <li>Ved protese er rehabiliteringsperioden kortere med sygemelding 6-12 uger afhængig af, om patienten har arbejde, der belaster håndled</li> </ul> <h2>Baggrundsoplysninger</h2> <h3>Definition</h3> <ul> <li>Slidgigt i tommelfingerens rodled </li> <li>Er 2-6 gange hyppigere hos kvinder end hos mænd og forekommer i nogle materialer hos 25 % af kvinder efter menopausen<a href=" " data-type="journal-reference" data-value="Becker SJ, Briet JP, Hageman MG, Ring D, Death, taxes, and trapeziometacarpal arthrosis. Clin Orthop Relat Res 2013;471: 3738-44" data-value-piped="Becker SJ, Briet JP, Hageman MG, Ring D|Death, taxes, and trapeziometacarpal arthrosis.|Clin Orthop Relat Res|2013|471|3738-44|23959907" data-url="reference-link" data-pubmedid="23959907" title="Becker SJ, Briet JP, Hageman MG, Ring D, Death, taxes, and trapeziometacarpal arthrosis. Clin Orthop Relat Res 2013;471: 3738-44">6</a>. Artrose kan også findes hos yngre efter skader specielt fraktur i basis af 1. metacarp (Bennet fraktur)</li> </ul> <h3>Forekomst</h3> <ul> <li>Hyppig lidelse, der ses med stigende hyppighed ved stigende alder, således at langt de fleste kvinder ældre en 80 år har en eller flere tegn på slidgigt i leddet. Heldigvis er der ikke en direkte sammenhæng mellem forandringer på røntgen og de kliniske symptomer</li> </ul> <h3>Ætiologi og patogenese</h3> <ul> <li>Er som ved anden slidgigt ukendt</li> </ul> <h3>Disponerende faktorer</h3> <ul> <li>Tidligere skade, belastning i længere tid </li> <li>Rodleddet er designet til at give tommelfingeren stor bevægelighed. Det er bl.a. i rodleddet bevægelsen foregår, når tommelfingeren skal føres ind mod håndfladen</li> </ul> <h3>ICPC-2</h3> <p>[ICPC]</p> <h3>ICD-10/SKS-koder</h3> <p>[ICD10]</p> <h2>Patientinformation</h2> <h3>Link til patientinformation</h3> <ul> <li><a href="~/link.aspx?_id=BCEE88E2530F4B3C94846C749CB10068&_z=z">Information om artrose (slidgigt) i tommelfingeren</a></li> <li><a href="https://hmi-basen.dk/news.asp?newsid=12913&x_newstype=39">Hjælpemiddelbasen, artrose</a></li> </ul> <h3>Træningsfilm for hånd og fingre </h3> <ul> <li><a href="~/link.aspx?_id=DC10A7C213DA4F909EAA4AFB32CBE9C0&_z=z">Øvelsesprogram, 3 øvelser</a><br> <br> <a href="~/link.aspx?_id=F3DFB2192D6644B08A1D018DC345B083&_z=z"><img alt="" height="84" width="135" src="8396F5CD2AFA48A295F038B1C7A0856B-135-84" style="height: 84px; width: 135px;"></a></li> </ul> <ul> </ul> <h2>Link til vejledninger</h2> <ul> <li>Ingen relevante links</li> </ul> <ul> </ul> <h2>Video</h2> <ul> <li><a href="~/link.aspx?_id=62F767F59666401FA8F85519624F9D3A&_z=z">Operation, rodledsartrose, finger</a></li> <li><a href="~/link.aspx?_id=DBC5CFAA1DD84F38B05192BBABAE1191&_z=z">Steroidblokade ved rodledsartrose</a></li> </ul>]]></HtmlField> <HtmlField Name="Resume"><![CDATA[<h2>Resumé</h2> <h3>Diagnose</h3> <ul> <li>Meget hyppig lidelse, hvor den typiske patient er en midaldrende kvinde</li> <li>Symptomerne er smerter ved roden af tommelfinger ved belastning og senere i hvile</li> </ul> <h3>Behandling</h3> <ul> <li>Behandlingen er primært aflastning i ortose, ændret belastningsmønster og evt. smertebehandling</li> <li>Ved manglende effekt har steroid-blokade i leddet normalt god effekt</li> <li>Når der ikke længere er effekt af konservativ behandling, foretages operation med ledresektion eller alloplastik</li> </ul> <h3>Henvisning</h3> <ul> <li><strong></strong>Hvis der er vedvarende smerter, selvom de daglige aktiviteter mindskes, og en støttebandage plus medicinsk behandling ikke har nok 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