What are the treatment options for thumb arthritis?

In short

Thumb arthritis is treated in order, starting with conservative treatment. That means changing the grips that load the joint at the base of the thumb, an anti-inflammatory medication such as ibuprofen, and a thumb spica brace worn at night. A cortisone shot comes next, and surgery only if those steps fail.

Written for patients by The Hand and Wrist Institute. Prepared for review by John T. Knight, MD. Last updated September 5, 2026How we write and review

Call (817) 382-6789 to have this looked at, or book online with Dr. Knight.

What thumb arthritis is

Pinch the base of your thumb with your other hand and walk your fingers toward the wrist until you feel a knuckle that shifts when you circle the thumb. That is the TMC joint, or what we call the trapeziometacarpal joint, where the thumb meets the small square bone at the edge of the wrist. It is saddle-shaped and moves in every direction so the thumb can reach across to the other fingers, which is why it takes so much load.¹

Over time the ligaments loosen and the cartilage between those surfaces thins, the way tread wears off a tire. That is wear and tear arthritis, or what we call osteoarthritis. It can also follow inflammatory arthritis such as rheumatoid arthritis, or an old fracture that ran into the joint and did not heal in good position.¹ What provokes it is ordinary: twisting a jar lid, turning a key, wringing out a cloth.

Is it thumb arthritis or de Quervain's tendinitis?

These two get mixed up because both hurt on the thumb side, so the test is where the pain sits and what brings it on. Thumb arthritis hurts at the base of the thumb, at that knuckle where it joins the wrist, and it flares with pinching, gripping and twisting, often aching at rest once it has been there a while. De Quervain's tendinitis sits further back, on the thumb side of the wrist itself, and it flares when you tuck the thumb into a fist and tip the wrist toward the little finger.²

Both are common and can be present together, and an x-ray separates them by showing whether the joint space has narrowed.

How thumb arthritis is treated, in order

1. Change the grips. Ease off the forceful pinching and twisting that reproduce the pain, and use a wider handle or a jar opener where you can.
2. Take an anti-inflammatory medication such as ibuprofen to settle the inflammation in the joint.
3. Wear a thumb spica brace, particularly at night, so the joint rests while you sleep.¹
4. If that has not been enough, a cortisone shot into the joint comes next, as a last resort before surgery.
5. Surgery is considered only when conservative treatment has failed and the pain is there with day-to-day activity, at rest, or at night.

The surgery works through two small incisions at the base of the thumb. The worn small bone is removed so it can no longer grind against the thumb, and a very strong suture with a metal button at each end is passed between the two remaining bones to hold the thumb off them. Dr. Knight is direct about what this does and does not do: it takes the grinding pain out of gripping and preserves the movement you had, but it does not restore normal pinch strength.

Afterwards the thumb is protected first and rehabilitated second, and he states that sequence below. When you are back to full use is set at the visit rather than promised here.

When to call us

• Pain at the base of the thumb on pinching or twisting that has not settled with a brace and an anti-inflammatory
• Thumb pain at rest, or thumb pain that wakes you at night
• A bump developing at the base of the thumb, or the thumb starting to sit differently
• Losing the pinch you need to hold a key, a pen or a cup