Hand Therapy – Carpometacarpal Joint Osteoarthritis

What is the carpometacarpal joint (CMC joint)?

The CMC joint is found at the base of the thumb and is formed by two bones – the metacarpal bone of the thumb, and the trapezium which is a small carpal bone belonging to the wrist.

The ends of these bones are covered by cartilage, which protects the bones and allows smooth movement of the joint.

The joint is surrounded by a joint capsule, which contains a lubricant called synovial fluid; this also allows smooth movement of the joint.

Ligaments and muscles give support to the joint.

What is Osteoarthritis (OA) and how can it affect my CMC joint?

OA is a degenerative condition (a condition that gets worse over time) that can affect many joints in the body, including the CMC joint of the thumb. OA is the most common form of arthritis.

The tissues commonly affected by OA are –

• Cartilage – this can become roughened and eventually wear away leaving exposed bone.
• Bone – small bony growths called spurs can grow at the ends of the bones which form the joint.
• Synovial fluid – this can become thickened and may result in swelling if too much of it is produced by the body.

Over time, these changes may result in deformity of the joint, pain, stiffness and a loss of normal function.

There are a number of factors, which can increase the likelihood of a person developing OA.

• Age – joints are more likely to become affected by OA, as we get older.
• Gender – females are more at risk of developing CMC joint OA than men.
• Trauma – previous trauma or injury such as a fractured bone can increase the chances of developing OA in later life.

What can be done to help?

Protecting your joints

• You may have noticed that your normal activities cause pain in and around your thumb. It may be helpful to think about these activities and ask yourself if there is a different way of completing this activity. For example – instead of carrying a heavy bag in one hand, can you spread the load between both hands?

• There are numerous devices available, which are designed to assist you in your daily activities around the home. For example, jar openers and adapted tap fittings. Your hand therapist will be able to discuss this with you.

Examples of joint protection techniques

Instead of this

Try this

Instead of this

Try this

Hug large objects close to your body

Exercise

Exercise is important in maintaining healthy joints and in managing existing joint problems. It helps by reducing stiffness in the joints and by keeping the muscles, which move and support the joint strong.

What exercise should I do for my thumb arthritis?

Prior to commencing your exercises try to warm your affected hand using a heat pack/hot water bottle (gentle heat) or by soaking your hand in a bowl of warm water. Do this for up to five minutes.

Stage I: Range of Motion

Exercise 1

Place your hands in front of your body. Use your other hand to grasp the affected thumb at the third joint and pull. Hold 30 seconds.

Repetition: ×3 Hold: 30 seconds Complete: Every 1-2 Hours

Exercise 2

Place your arm and forearm palm down on a table. Using the opposite hand, gently stretch the thumb out to the side, moving from the base of the thumb. Hold for 5-10 seconds.

Repetition: ×10 Hold: 5-10 seconds Complete: Every 1-2 Hours

Exercise 3

Rest your little finger on a table with your wrist slightly bent back. Bring your thumb in line with your index finger then stretch your thumb away from your palm. Hold for 5-10 seconds and then return to the starting position.

Repetition: ×10 Hold: 5-10 seconds Complete: Every 1-2 Hours

Exercise 4

Touch the tip of your thumb to the tip of each finger in turn. When you reach your little finger, try to slide your thumb down to the bottom of the little finger

Repetition: ×10 Hold: 5-10 seconds Complete: Every 1-2 Hours

Exercises 5

Rest your little finger on a table with your wrist slightly bent back. Bend the tip of your thumb and then lift up your thumb from the bottom joint of your thumb. If required support under the bottom joint of your thumb with your other hand.

Repetition: ×10 Hold: 5-10 seconds Complete: Every 1-2 Hours

Exercise 6

Rest your little finger on a table with your wrist slightly bent back. Bend the tip of your thumb as if reaching for a glass. Hold 5-10 seconds and then return to the starting position.

Repetition: ×10 Hold: 5-10 seconds Complete: Every 1-2 Hours

Stage II: Strengthening

Only progress to these exercises when previous ones (Stage I) can be performed easily and without discomfort.

Exercise 1

With your thumb and fingers lightly gripping a tennis ball, gently squeeze against the ball and then relax

Repetition: ×10 Hold: 5-10 seconds Complete: Every 1-2 Hours

Exercise 2

With your thumb and fingers lightly gripping a tennis ball, lift your index and middle fingers away from the ball. Gently squeeze your thumb against the ball and then relax

Repetition: ×10 Hold: 5-10 seconds Complete: Every 1-2 Hours

Exercise 3

Resting your hand on a tennis ball, place an elastic band around your fingers as shown. Straighten your index finger and move it sideways, away from your middle finger

Repetition: ×10 Hold: 5-10 seconds Complete: Every 1-2 Hours

Exercise 4

Make a loose fist. Place an elastic band around your fingers and thumb, keeping your palm on a flat surface. Keeping the tip of your thumb bent, slide your thumb away and up, whilst keeping your hand in contact with the table. Then return to the starting position

Repetition: ×10 Hold: 5-10 seconds Complete: Every 1-2 Hours

Stage III: Proprioception

Proprioception is your brain’s ability to sense movement, action and location of a body part.

Exercise 1

Screw a loose bottle top on and off 10 times in each direction

Repetition: x10 Complete: every 1-2 Hours

Exercise 2

Place a paper clip on a piece of paper. Ensure that you keep a “double bend” at your thumb joints

Repetition: ×10 Complete: Every 1-2 Hours

Exercise 4

Rip up pieces of paper ensuring that you keep a “double bend” at your thumb joints

Repetition: ×10 Complete: Every 1-2 Hours

Splinting

Your hand therapist will be able to provide you with a suitable splint, which will help to support the CMC joint.

If you are in constant pain, you may be advised to wear your splint near full time to decrease your pain at rest. It may take over 6 weeks of splint wearing to notice a significant reduction in your pain.

Pain relief

You might like to discuss with your GP or pharmacist which medications are best for you if you need help in managing your symptoms.

Cortisone injections

These can provide temporary relief for some people whose symptoms are severe and who are not getting relief from the usual medications. Your consultant can discuss this with you.

Surgery

This may be considered if other methods have failed to help. Your consultant will discuss what surgical options may be available to you.

Contact Numbers

Please contact the Hand Therapy Team if you have any concerns or questions or if your splint is uncomfortable, rubbing or is damaged.

North Tees and Hartlepool NHS Foundation Trust

Hand Therapy Team
North Tees Hospital
First Floor, Hand Therapy, North Wing
Hartlepool Hospital
Physiotherapy Outpatients Department, Ground Floor

Monday to Friday
08:30am-04:30pm
Telephone: 01429 522471

References

• Aebischer, B., Elsig, S., Taeymans, J (2016).Effectiveness of  physical and occupational therapy on pain, function and quality of life in patients with trapeziometacarpal osteoarthritis – A systematic  review  and meta-analysis Hand Ther.; 21(1): 5-15
• Bertozzi L, Valdes k, Vanti C, Negrini S, Pillastrini P, Villafane JH.(2015). Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review with meta-analysis. Disabil Rehabil.; 37(22):2025-43.
• Buhler, M., Chapple, C.M, Stebbings S, Sangelaji B, Baxter GD. (2019). Effectiveness of splinting for pain and function in people with thumb carpometacarpal osteoarthritis: a systematic review with meta-analysis. Osteoarthritis Cartilage; 27(4):547-559

Comments, concerns, compliments or complaints

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Leaflet feedback

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Leaflet Reference: PIL1424
Date for Review: 08/03/2026