Treatment Options for Thumb Arthritis: What to Do Next.
- Baytide Health
- 5 hours ago
- 4 min read
Thumb arthritis—most commonly arthritis of the carpometacarpal (CMC) joint at the base of the thumb—is a frequent and often debilitating condition. This joint is responsible for pinch strength, grasp, and fine motor control, which means even mild degeneration can significantly affect daily activities such as opening jars, turning keys, writing, or using a phone.
The good news is that thumb arthritis does not automatically mean surgery. In fact, many people can successfully manage symptoms and slow progression with a structured, stepwise treatment approach. Below, I outline the primary treatment options, starting with conservative care and progressing to surgical intervention when necessary.
Step 1: Conservative Management With Hand Therapy
Conservative treatment should always be the first line of care for thumb arthritis, particularly in the early and moderate stages. From a hand therapy perspective, the goal is not simply pain reduction, but joint preservation.
Why Therapy Matters
Thumb arthritis often worsens due to poor joint positioning, muscle imbalance, and collapse of the thumb into adduction and flexion. This altered alignment concentrates force on a small portion of the joint, accelerating cartilage wear.
Key Therapy Goals
Hand therapy focuses on restoring more optimal thumb mechanics to distribute load across the entire joint surface and reduce ongoing degeneration.
This includes:
Improving thumb abduction and extension, allowing the thumb to sit in a more functional, open position
Increasing web space between the thumb and index finger, which decreases compressive forces at the CMC joint
Optimizing muscle balance, particularly strengthening stabilizers such as the first dorsal interosseous and opponens muscles
Joint protection education, including activity modification and ergonomic strategies to reduce repetitive stress
By improving alignment and mechanics, therapy helps redirect forces through the entire joint rather than a single degenerating area, which can significantly decrease pain and slow further wear and tear.
For many patients, consistent therapy over several weeks to months leads to meaningful improvements in function and symptom control.
Step 2: Splinting and Injection for Symptom Control
If symptoms persist despite therapy, the next step often involves additional support through splinting and/or injection.
Splinting
A properly fitted thumb CMC splint can be highly effective. Unlike generic braces, a hand therapist-designed splint:
Positions the thumb in functional abduction and extension
Provides stability without eliminating motion
Reduces joint shear forces during daily activities
Supports the thumb during sleep to prevent prolonged collapse into painful positions
Splints are commonly used during higher-demand tasks or overnight, rather than full-time, to avoid unnecessary stiffness.
Corticosteroid Injection
A cortisone injection may be recommended to reduce inflammation and pain within the joint, particularly during flare-ups. While injections do not reverse arthritis, they can:
Provide temporary pain relief
Improve tolerance to therapy and exercise
Allow patients to maintain function while delaying or avoiding surgery
It is important to note that repeated injections may have diminishing returns and are typically used judiciously as part of a broader treatment plan.
Step 3: Surgical Options for Thumb Arthritis (CMC Arthroplasty)
When conservative measures no longer provide adequate relief and pain begins to significantly limit daily function, surgical intervention may be considered. The most common surgical category is CMC arthroplasty, but there are several variations.
Common Surgical Options
1. Trapeziectomy
This procedure involves removal of the trapezium bone, which forms one side of the arthritic joint. Removing the bone eliminates bone-on-bone contact and pain.
2. Ligament Reconstruction and Tendon Interposition (LRTI)
Often performed in conjunction with a trapeziectomy, this procedure uses a tendon (typically from the forearm) to stabilize the thumb and fill the space left by the removed bone. This is one of the most commonly performed surgeries for thumb arthritis.
3. Suspensionplasty
A variation of LRTI, suspensionplasty uses sutures or tendon constructs to “suspend” the thumb metacarpal and prevent collapse after trapezium removal. This approach aims to preserve thumb length and stability.
4. Joint Fusion (Arthrodesis)
Fusion permanently stabilizes the joint by eliminating motion. While this can be effective for pain relief in select patients (often younger, high-demand individuals), it sacrifices mobility and can place increased stress on surrounding joints.
5. Implant Arthroplasty
In some cases, an artificial implant is used to replace the joint. While this may preserve motion, implants carry risks such as loosening or failure and are typically reserved for specific patient populations.
The Role of Hand Therapy After Surgery
Regardless of the surgical technique, post-operative hand therapy is essential for optimal outcomes. Therapy helps:
Restore motion safely
Rebuild strength and stability
Prevent stiffness and compensatory movement patterns
Guide return to functional activities
Surgery addresses structural pain, but therapy ensures that the thumb functions effectively long-term.
Final Thoughts
Thumb arthritis is a progressive condition, but early and appropriate intervention can dramatically influence outcomes. From a hand therapist’s perspective, the emphasis is always on preserving joint mechanics, reducing excessive forces, and maintaining function for as long as possible.
Many patients can manage symptoms successfully with therapy, splinting, and education alone. When surgery becomes necessary, understanding the options—and committing to proper rehabilitation—makes all the difference in achieving lasting relief and functional use of the hand.
If thumb pain is interfering with daily activities, seeking care early can help protect the joint and expand your treatment options.
Comments