Managing early Osteoarthritis of the thumb
How Osteoarthritis affects the base of the thumb
The joint at the base of the thumb, the carpometacarpal joint (or the CMC joint) is one of the most
common joints in the body to be affected by osteoarthritis. The CMC joint has been described as
the most important joint of the hand. Age related changes to the joint cause pain and impair hand
function. Tasks like opening jars, taps, milk cartons, hand writing, holding a book or newspaper,
lifting and carrying pots and plates can become painful and increasingly hard to do.
It is thought that instability of the thumb muscles leads to osteoarthritis of the CMC joint. This
instability may occur for a number of reasons including hypermobility, previous injury and trauma,
obesity, hormonal and hereditary factors, chronic and repeated stress and occupations involving
repetitive fine manual tasks.
Conservative Management
In addition to the below exercises, the following can be tried in combinations with guidance from
your GP and therapist:
• Rest from aggravating activities
• Analgesics
• Non steroidal anti-inflammatory medication
• Splinting
Thumb exercise programmes show some benefits to pain and hand function in the early stages
of the process. There is little benefit from exercise when there is a fixed deformity or subluxation
(partial or incomplete dislocation of the joint). Specific exercises at the right time have the potential
to delay or reduce the need for surgery.
Osteoarthritis Base of Thumb Home Exercise Programme
Things to remember while performing the exercises:
• Occasional discomfort or a stretching feeling may be felt while performing the exercises.
• No exercise should cause sharp or excessive pain. Please inform your therapist if any
exercise causes sharp pain.
• All exercises should be performed slowly and gently. Hold for a count of 10 at the end of
the movement.
• Aim to do the exercises up to 4 times per day.
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Stage I
With the palm facing down, move the thumb out to the side and as far away from the index
finger as you can. Hold for 5-10 seconds. Repeat up to three sets of 10.
Place hand and forearm palm down on a table. Using the opposite hand, gently stretch the
thumb out to the side, away from the palm, moving from the base of the thumb. Hold for a count
of 10, repeat three times.
Rest on the little finger side of the hand, with your wrist slightly extended. Bend the top joint
of the thumb and raise the thumb up towards the ceiling. Hold for 5-10 seconds before
returning to the starting position. Repeat up to three sets of 10. (2 x views are shown of the
same position below).
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Rest on the little finger side of the hand, with your wrist slightly extended. Bend the top joint and
stretch out the thumb as though moving to hold a glass. Hold for 5-10 seconds and then return
to the starting position. Repeat up to three sets of 10.
Stage II
Only progress to these exercises when the previous ones can be performed easily and without
discomfort.
Rest on the little finger side of the hand, with the wrist slightly extended. Place a rubber band
around your thumb and fingers. Stretch the band by raising your thumb upwards, with the top joint
bent, as far as you can. Ensure that the wrist remains in the starting position. Hold for 5-10 seconds,
return to the starting position. Repeat up to 10 times. As the exercise gets easier, replace the
rubber band with a stronger one.
It’s possible to include the index finger also, as seen in the second picture.
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Alternatively, make a loose fist on the table, as shown below with the thumb tucked in (start
position), then move away from the hand (end position). Be careful to avoid extending the thumb
backwards (error picture), as does not engage the muscles we are looking to strengthen.
Stage III
Practice activities that involve pinching remembering to keep the top joint of the thumb bent and
your wrist slightly extended.
Further Information
If you have any questions or queries regarding any of the information, please do not hesitate to
ask your Physiotherapist.
Occasionally, if people have severe pain with destruction of the joint, a steroid injection or
surgery is possible. We have another document with more information on this titled
‘Osteoarthritis at the base of the Thumb’ which you can also find on our MSK Therapies page.
Sources of information
1. Østerås N, Kjeken I, Smedslund G, et al. Exercise for hand osteoarthritis. Cochrane
Database Syst Rev 2017; 1:CD010388.
2. Deveza LA, Robbins SR, Duong V, et al. Efficacy of a Combination of Conservative
Therapies vs an Education Comparator on Clinical Outcomes in Thumb Base
Osteoarthritis: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:429.
Important information
This patient information is for guidance purposes only and is not provided to replace
professional clinical advice from a qualified practitioner.
Your comments
We are always interested to hear your views about our leaflets. If you have any comments,
please contact the Patient Experience Team – Tel: 0300 131 4731 (direct dial) or by email at:
[email protected]
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Hand hygiene
The trust is committed to maintaining a clean, safe environment. Hand hygiene is very important
in controlling infection. Alcohol gel is widely available at the patient bedside for staff use and at
the entrance of each clinical area for visitors to clean their hands before and after entering.
Other formats
If you require any of the Trust leaflets in alternative formats, such as large
print or alternative languages, please contact the Equality and Human
Rights Department.
After reading this information are there any questions you would like to ask? Please list below
and ask your Occupational or Physiotherapist.
Reference
Written by: David Collie, Upper Limb Advanced Practitioner
The following clinicians have been consulted and agreed this patient information:
Mrs Scarlett McNally, Consultant Orthopaedic Surgeon
Mr Hemant Thakral, Consultant Orthopaedic Surgeon
Miss Miranda Champion, Consultant Orthopaedic Surgeon
Next review date: February 2025
Responsible clinician/author: David Collie, Upper Limb Advanced Practitioner
© East Sussex Healthcare NHS Trust – www.esht.nhs.uk
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