If you are considering occupational or physical therapy as a treatment for carpometacarpal osteoarthritis (CMC OA), also known as thumb arthritis, we want you to be as informed as possible—so we can truly partner to create the best course of treatment for YOU.
In therapy, we tend to work from “menus” of evidence-based assessments and treatments. This gives us the flexibility to meet the specific needs of each patient. Below, you’ll find the assessment and treatment options your therapist may use, along with the evidence supporting them.
We’ve also included self-assessments to help you determine how much your thumb arthritis symptoms are impacting your quality of life, and whether it’s time to seek out therapy.
Members of the OT Potential Club can login for detailed clinical decision support on this diagnosis, including a comprehensive assessment search, goal bank, treatment info, handouts, a community forum and more.
Please note that this page is for educational purposes and does not substitute advice from your medical provider. At the bottom of this page, you’ll find therapists near you who can support you in your thumb arthritis treatment.
A Quick Note on Why to Pursue Therapy First
This article focuses on therapy treatment for thumb arthritis. As with most conditions, conservative treatment like therapy is typically the first course of care. That is because therapy is safer and much more cost-effective compared to invasive options like surgery (which come with a host of risks and potential complications—not to mention long recovery times). Surgery for thumb arthritis can cost between $2,614–$4,178, depending on the surgical technique used. Alternatively, therapy typically costs $75–$150 per session.
There are multiple surgical techniques that can be used to address thumb arthritis, and they all have been shown to reduce pain and improve the function of the hand.1 Among individuals who have undergone surgery for thumb arthritis in one study, 88% reported satisfaction with their outcomes.2 Surgery should be considered when a person no longer responds to other conservative interventions. One can expect to return to most activities 12 weeks after surgery. However, full recovery may take up to a year, and therapy is recommended to facilitate recovery and achieve the best outcomes.3
The number and frequency of therapy sessions needed to treat thumb arthritis conservatively will vary based on your initial evaluation. In general, the higher your initial disability score, the more frequent your sessions. Ultimately, our goal as OTs is to move you toward self-management with a personalized prescribed program. (Read more about this in the discharge section below.)
Special Tests to Help Confirm the Diagnosis of Thumb Arthritis 4, 7
If you already have an X-ray or MRI confirming CMC joint osteoarthritis, your therapist may skip these physical tests. Because these “provocative” tests are designed to pinpoint which structure is hurt, they can sometimes be uncomfortable.
However, if your diagnosis isn’t clear yet, an Occupational Therapist (OT) or Physical Therapist (PT) will use these tests to create your personalized treatment plan—especially once your initial pain is under control and they can see how easily your joint is triggered.
- Pressure shear test
- CMC grind test
- Additional options:
More Therapist-Recommended Assessments for Thumb Arthritis
Although your CMC arthritis symptoms might be localized to the hand and thumb, it is important to evaluate other parts of the arm. This is because all of these structures are connected and influence each other. The other benefit of a thorough examination is that it can help discern whether other diagnoses are contributing to your symptoms.
Assessments also serve as a point of comparison for tracking your progress and response to treatment over time. An accurate and thorough baseline allows your therapist (and you!) to discern how much the interventions are helping. Your therapist may perform certain assessments at various intervals over the course of therapy.
Core Therapy Outcome Measures
Here are two metrics that many OTs and PTs collect with every patient. Our most-used assessment measures your quality of life. At the end of the day, this is the most important outcome for us. We want our treatments to have a significant impact on your day-to-day life.
- Quality of Life Patient Reported Outcome Measure
- Grip Strength
Patient Rated Outcome Measures → Administer at evaluation, re-evaluation, and discharge.4-5
- Pain assessments
- Disability and Pain assessments
Observations 4-5
- Posture
- Thumb joint positioning
Range of Motion 4-7
- Shoulder ROM all planes
- Elbow ROM all planes
- Wrist ROM all planes
- Kapandji Score for thumb opposition
- Thumb Composite Flexion/Extension
- Thumb abduction
Strength 4, 7-8
- Pain-free grip strength bilaterally
- Pain-free pinch strength, assessing the variety of functional pinch patterns used, bilaterally
- Manual Muscle Testing
- Intrinsic and extrinsic thumb muscles
- Wrist flex/extend
- Elbow flex/extend
- Shoulder flex/abduct/ER/IR
Testing for Differential Diagnoses
- Carpal Tunnel Syndrome
- C6 Radiculopathy
- De Quervain’s tenosynovitis
- Scaphotrapeziotrapezoidal (STT) arthritis
- Scaphoid nonunion/SNAC
- Radioscaphoid arthritis
Setting Goals for Thumb Arthritis Therapy
Therapy works best when there is buy-in from the patient. It is important that you work with your therapist to set treatment goals that truly reflect what’s important to you.
Goals may focus on areas such as activities of daily living, strength and coordination, and pain and fatigue management, among others.
Therapy Treatment Interventions for Thumb Arthritis
After a thorough evaluation and goal-setting process, it is time to start making progress. Below are treatment interventions that can be implemented as part of a holistic therapy program.
Aerobic Warm-up
- Supports endorphin release, synovial fluid activation.
Orthosis (as needed to manage pain)
- Your therapist will evaluate your individual presentation and determine which orthotic approach best supports your symptoms. Depending on your needs, this may include a custom‑fabricated orthosis or a well‑fitted prefabricated option designed to optimize comfort, function, and joint protection.4-5, 10-11
Manual Therapy
- Gentle joint mobilization of the thumb CMC joint.5
- Gentle, steady pressure to the webspace of your thumb.5, 12
Thumb Arthritis Exercises / Neuromuscular Re-education
- Dynamic stabilization exercises of the intrinsic/extrinsic thumb muscles, based on where your weaknesses are.5, 13-15 Exercises include:
- Stable C Posture
- FDI Strengthening
- Place and Hold Tip Pinch
- Isometrics of Stabalizers
- Joint position sense test to promote proprioception.4, 16
- Proximal strengthening, including scapular stabilization, posture correction, and core strength.
Self-Care Home Management 4-5, 10, 17
- Joint protection education.
- Activity modifications and adaptive equipment suggestions.
Incorporating Functional Tasks and Occupation-based Interventions Based on Patient Goals 4, 18-19, 10, 17
- Engage in occupation-based interventions to practice joint protection techniques in the clinic.
- Educate on maintenance of the stable “C” posture during daily activities and functional tasks.
Pain Management Tools
- Application of Kinesiotape.
- Modalities: moist heat, paraffin, fluidotherapy.4-5
- Pain neuroscience education.20-21
- Over-the-counter topicals including Arnica Gel, BioFreeze, and/or Salonpas.
Home Exercise Program
- Prioritize 1-3 exercises to enhance patient adherence to the home program.
Discharge Suggestions
It is important to understand that unfortunately, because arthritis is a degenerative condition, it cannot be cured. However, therapy can teach you new habits and techniques to help you manage the pain and prevent your condition from getting worse. We recommend that you:
- Follow your therapist’s discharge recommendations to maintain progress made in therapy.
- Continue to use self-management and empowerment strategies to control any remaining symptoms.
- Follow a home exercise program with a proximal posture component for an additional 3 months to help establish good habits for body mechanics, even if you feel like your symptoms are being managed well.
- Consult your therapist immediately if your condition worsens or if you continue to have difficulty with your daily activities after 3 months.
Choosing a Therapist for Thumb Arthritis
Both occupational therapists and physical therapists can treat arthritis of the thumb. In less severe CMC arthritis cases, a generalist therapist from either discipline should be able to help.
It is important to note that both OTs and PTs can pursue advanced certification as a Certified Hand Therapist. To achieve this rigorous specialization of the hand, wrist, elbow, and shoulder, therapists must log 4,000 hours of experience treating the upper extremity and pass a formal examination. They must also complete various recertification requirements every 5 years.
Below, you can find occupational therapy professionals who have tagged “hand therapy” as a focus area. The ones with a “CHT” in their credentials are Certified Hand Therapists.
Conclusion
Hopefully this article helped you understand what therapy for thumb arthritis entails—and whether you’re a good candidate for this type of treatment.
This article is updated once per month based on newly released research. If you have any research you would like us to consider, please drop it in the comments.
Therapists who would like more detailed information on CMC OA treatment best practices can join us as members of the OT Potential Club.
Therapists who would like more detailed information on CMC OA rehabilitation best practices can join us as members of the OT Potential Club.
Courses on OT and Thumb Arthritis
References
Here’s the science that backs the assessment and treatment outlined above.
- Hidajat, N. N., Aditya, R., Arsa, W., & Malik, R. (2024). Outcome comparison between carpometacarpal arthroplasty and trapeziectomy in patients with carpometacarpal osteoarthritis: A systematic review. Orthopedic Reviews, 16.
- Hawken, J. B., Yousaf, I. S., Sanghavi, K., Higgins, J. P., Giladi, A. M., & Means Jr, K. R. (2021). Thumb carpometacarpal arthritis surgery: The patient experience. Plastic and Reconstructive Surgery, 148(4), 809-815.
- Minnesota Valley Surgery Center (MVSC). (n.d.). When can I return to work following a thumb CMC arthroplasty?
- Algar, L., Naughton, N., Ivy, C., Loomis, K., McGee, C., Strouse, S., & Fedorczyk, J. (2023). Assessment and treatment of nonsurgical thumb carpometacarpal joint osteoarthritis: A modified Delphi-based consensus paper of the American Society of Hand Therapists. Journal of Hand Therapy, 36(4), 982–999.
- O’Brien, V., Johnson, J., Pisano, K., & Enke, A. (2022). Dynamic stabilization of the painful thumb: A historical and evidence-informed synthesis. Journal of Hand Therapy, 35(3), 388–399.
- McGee, C., O’Brien, V., Johnson, J., & Wall, K. (2022). Thumb carpometacarpal palmar and radial abduction in adults with thumb carpometacarpal joint pain: Inter-rater reliability and precision of the inter-metacarpal distance method. Journal of Hand Therapy, 35(3), 454–460.
- McGee, C., Valdes, K., Bakker, C., & Ivy, C. (2024). Psychometric properties of body structures and functions measures in non-surgical thumb carpometacarpal osteoarthritis: A systematic review. Journal of Hand Therapy, 37(1), 22–37.
- Riordan, E., Robbins, S., Deveza, L., Duong, V., Oo, W. M., Wajon, A., Bennell, K., Eyles, J., Jongs, R., Linklater, J., & Hunter, D. (2023). Pain, function, and radiographic disease in trapeziometacarpal osteoarthritis. Journal of Hand Therapy, 36(1), 208–213.
- Dbeis, A., & Golinvaux, N. (2025, June 23). Basilar thumb arthritis. Orthobullets.
- Deveza, Leticia A., Robbins, S. R., Duong, V., Bennell, K. L., Vicenzino, B., Hodges, P. W., Wajon, A., Jongs, R., Riordan, E. A., Fu, K., Oo, W. M., O’Connell, R. L., Eyles, J. P., & Hunter, D. J. (2021). Efficacy of a combination of conservative therapies vs an education comparator on clinical outcomes in thumb base osteoarthritis: A randomized clinical trial. JAMA Internal Medicine, 181(4), 429.
- Valdes, K., Naughton, N., & Szelwach, M. A. (2021). Patient satisfaction with the CMC controller: A cohort study. Journal of Hand Therapy, 34(1), 53–57.
- López-Royo, M. P., Pedersini, P., Cantero-Téllez, R., Valdes, K., Doménech-García, V., Herrero, P., & Villafañe, J. H. (2021). Effects of ischemic compression on trigger points in the first dorsal interosseous muscle in patients with thumb carpometacarpal osteoarthritis. International Journal of Environmental Research and Public Health, 18(6), 2961.
- Adams, J. E., O’Brien, V., Magnusson, E., Rosenstein, B., & Nuckley, D. J. (2018). Radiographic analysis of simulated first dorsal interosseous and opponens pollicis loading upon thumb CMC joint subluxation: A cadaver study. HAND, 13(1), 40–44.
- McVeigh, K. H., Kannas, S. N., Ivy, C. C., Garner, H. W., Barnes, C. S., Heckman, M. G., Brushaber, D. E., & Murray, P. M. (2022). Dynamic stabilization home exercise program for treatment of thumb carpometacarpal osteoarthritis: A prospective randomized control trial. Journal of Hand Therapy, 35(3), 435–446.
- O’Brien, V. H., & Giveans, M. R. (2013). Effects of a dynamic stability approach in conservative intervention of the carpometacarpal joint of the thumb: A retrospective study. Journal of Hand Therapy, 26(1), 44–52.
- Valdes, K. A., & Rider, J. V. (2024). Test-retest reliability of joint position sense in the carpometacarpal joint among healthy adults. Journal of Hand Therapy, 37(2), 238–242.
- Deveza, L.A., Robbins, S. R., Duong, V., Fu, K., Wajon, A., Eyles, J. P., Jongs, R., Riordan, E. A., Oo, W. M., & Hunter, D. J. (2021). Greater efficacy of a combination of conservative therapies for thumb base OA in individuals with lower radial subluxation – A pre-planned subgroup analysis of the COMBO trial. Osteoarthritis and Cartilage, 29(11), 1498–1506.
- Naughton, N., & Algar, L. (2022). Incorporation of occupational based intervention into joint protection education for individuals with thumb carpometacarpal osteoarthritis: A case series. Journal of Hand Therapy, 35(3), 332–338.
- Johnson, J., Tranchida, G., Mathiason, M. A., O’Brien, V. H., & McGee, C. (2022). Characterizing response to a dynamic stability modeled approach for thumb carpometacarpal joint pain: A retrospective study. Journal of Hand Therapy, 35(3), 346–357.
- Lepri, B., Romani, D., Storari, L., & Barbari, V. (2023). Effectiveness of pain neuroscience education in patients with chronic musculoskeletal pain and central sensitization: A systematic review. International Journal of Environmental Research and Public Health, 20(5), 4098.
- Malfliet, A., Kregel, J., Coppieters, I., Pauw, R. D., Meeus, M., Roussel, N., Cagnie, B., Danneels, L., & Nijs, J. (2018). Effect of pain neuroscience education combined with cognition-targeted motor control training on chronic spinal pain: A randomized clinical trial. JAMA Neurology, 75(7), 808-817.
OT Potential does not endorse any treatments, procedures, products, or therapists referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking medical advice should consult their medical provider.