Massage therapy · Kitchener–WaterlooThumb Osteoarthritis

There are three bones in the thumb: the distal phalanx at the tip, the proximal phalanx, and the metacarpal. The base of the metacarpal meets a small wrist bone called the trapezium at the CMC joint, near the wrist at the fleshy part of the thumb. This joint lets the thumb swivel, pivot and pinch, and it is where thumb osteoarthritis most often develops (AAOS, n.d.; Royal Berkshire NHS Foundation Trust, 2024).

Arthritis at the base of the thumb is very common (AAOS, n.d.).

Rheumatoid arthritis is a different, inflammatory type of arthritis, but your doctor may check for other forms of arthritis when assessing your thumb (AAOS, n.d.).

Why does thumb arthritis cause pain? When the cartilage wears down, the bones begin to rub together, causing pain (AAOS, n.d.). The thumb can become stiff and slightly swollen. Over time, extra bone can grow around the joint, which can be seen on X-rays and may form a bump at the base of the thumb (AAOS, n.d.).

1. Activity Changes

Small changes to the way you do things can avoid pain at the base of your thumb. Using the hand when it hurts does not harm the thumb joint, so there is no need to avoid painful activity altogether (Royal Berkshire NHS Foundation Trust, 2024).

2. Ice

Applying ice to the joint for 5 to 15 minutes several times a day can help with pain and swelling (AAOS, n.d.). Wrap ice in a cloth and never put it directly on the skin.

3. Exercise and Therapy

Gentle exercises can improve movement and strengthen the muscles of the thumb, and can be done with a hand therapist (AAOS, n.d.). Although arthritis cannot be reversed, it can be managed: working to maintain movement can delay stiffness, but can sometimes aggravate pain (Royal Berkshire NHS Foundation Trust, 2024). I can also guide you through these exercises and set you up with a home programme.

4. Anti-Inflammatory Medication

The American Academy of Orthopaedic Surgeons (AAOS, n.d.) says anti-inflammatory medicines (NSAIDs) such as ibuprofen or naproxen can help with pain, and that an anti-inflammatory gel such as diclofenac rubbed onto the joint is another option that may have fewer side effects than tablets. The Royal Berkshire NHS Foundation Trust (2024) advises that painkillers can be useful from time to time but routine use is not recommended, because regular use can cause side effects such as stomach ulcers or heart and kidney problems. (This medicine information comes from the American Academy of Orthopaedic Surgeons and the Royal Berkshire NHS Foundation Trust, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

5. Bracing and Support

Bracing and support, such as a splint that supports the base of the thumb, might be helpful during activities or overnight (AAOS, n.d.). I can help you work out which type might suit you and how to get one, and point you to a doctor, physiotherapist or hand therapist if you need one made or fitted.

Options outside my scope

• Steroid injection: a steroid injection into the joint can give short-term pain relief, though the effect wears off and there are some risks (AAOS, n.d.; Royal Berkshire NHS Foundation Trust, 2024; NICE, 2022).
• Surgery: if other treatments no longer help, surgery such as removing the trapezium bone, fusing the joint or joint replacement may be discussed; it is usually a last resort (AAOS, n.d.; Royal Berkshire NHS Foundation Trust, 2024).

How I can help (see the My Approach tab)

• Hands-on work and gentle joint mobilisation for a stiff, sore thumb
• Exercises for thumb movement, pinch and grip strength
• Advice on splints and protecting the joint in everyday tasks

I'm careful with pressure where there are bony changes around the joint. If the joint becomes hot and very swollen, or other joints start to flare, see your family doctor or nurse practitioner.