Thumb Arthritis (CMC / Basal Joint Arthritis)

As a hand surgeon, I see thumb arthritis every day. It is one of the most common reasons adults develop lasting pain at the base of the thumb, especially after age 40. This guide explains, in clear terms, what thumb CMC (basal joint) arthritis is, how we diagnose it, which non-surgical treatments work, when surgery such as CMC arthroplasty/LRTI is appropriate, and what to expect before and after surgery.

What Is Thumb CMC (Basal Joint) Arthritis?

Simple definition

Thumb CMC arthritis is wear-and-tear (osteoarthritis) of the joint at the base of the thumb, where the thumb meets the wrist (the carpometacarpal, or CMC, joint). The smooth cartilage that normally lets the bones glide painlessly wears out. As cartilage thins, the bones rub together, causing pain, swelling, stiffness, and weakness.

Why the CMC joint is so vulnerable

The CMC joint is shaped like a small saddle and allows the thumb to move in many directions: pinching, gripping, turning keys, opening jars, and bringing the thumb across the palm. That wide motion comes at a price. The joint absorbs high forces every time you pinch or grip, and its supporting ligaments can stretch over time. When the ligaments loosen and cartilage wears down, the joint becomes unstable. The body responds by forming bone spurs and extra bone, which can make the thumb look bony or slightly shifted out of position.

What Causes Thumb CMC Arthritis?

In most people, thumb CMC arthritis develops slowly over many years. It is rarely caused by a single event.

• Age-related wear — risk increases after age 40 and rises steadily with age.
• Female sex — women are affected more often than men, likely due to hormone effects and differences in joint shape and ligament looseness.
• Family history — having close relatives with thumb or hand arthritis increases your risk.
• Prior injury — fractures, dislocations, or serious sprains of the thumb can damage cartilage and speed up arthritis.
• Loose ligaments (joint laxity) — naturally looser ligaments allow extra motion and earlier wear.
• Repetitive or forceful thumb use — jobs and hobbies that require frequent strong pinching or gripping (for example, hairstyling, manual labor, sewing, assembly work, or certain sports) add stress to the joint.

What Are the Symptoms of Thumb CMC Arthritis?

Symptoms often start gradually and may come and go at first. Over time, they tend to become more frequent and persistent.

• Pain at the base of the thumb — usually where the thumb meets the wrist, felt as a deep ache or sharp pain with certain movements.
• Pain with pinch and grip — trouble opening jars, turning keys, snapping buttons, writing, sewing, using tools, or opening doors.
• Weakness — reduced grip or pinch strength; objects feel harder to hold or the hand tires quickly.
• Visible bump or swelling — a bony bump, swelling, or tenderness at the base of the thumb.
• Stiffness and loss of motion — difficulty moving the thumb away from the hand or across the palm.
• Grinding or clicking — a grinding, popping, or clicking feeling (crepitus) when you move the thumb.
• Pain that worsens with use — flares with heavier activity and often improves with rest.

How Is Thumb CMC Arthritis Diagnosed?

Diagnosis is usually straightforward and can often be made at your first visit using your story, a focused exam, and simple X-rays. Advanced tests like MRI are rarely needed.

History and physical exam

We start by asking when your pain began, what activities make it worse, your work and hobbies, and which treatments you have already tried. Then we examine your hand and thumb, looking for:

• Tenderness directly over the CMC joint
• Swelling or a bony bump at the base of the thumb
• Loss of motion or weakness with pinch and grip
• Any deformity or drifting of the thumb

We gently stress and move the joint to see exactly where the pain is coming from and how stable the joint feels.

The CMC grind test

A key exam maneuver is the CMC grind test. I hold the base of your thumb, press the thumb bone gently into the joint, and rotate it. If this recreates your familiar pain and I feel grinding, it strongly suggests arthritis in that specific joint.

X-ray findings

Standard X-rays of the hand and wrist are usually enough to confirm the diagnosis. On X-ray we may see narrowed joint space (loss of cartilage), bone spurs, small cysts in the bone, or changes in the alignment of the joint.

Importantly, X-rays do not always match how much pain you feel. Some people with severe-appearing arthritis have only mild pain, and others with mild changes can have significant symptoms. Treatment decisions are based on your pain, function, and goals — not the X-ray alone.

Non-Surgical Treatment for Thumb CMC Arthritis

Most patients do not need surgery right away. We usually start with non-surgical treatments that can reduce pain, protect the joint, and keep you independent in daily life.

Activity modification

Changing how you use your hand is often the single most effective step. Helpful changes include:

• Using jar openers, key turners, and larger grips on pens, utensils, and tools.
• Avoiding tight pinch when possible by using your whole hand (power grip) instead of just thumb and index finger.
• Breaking up heavy or repetitive tasks into shorter sessions with rest breaks.
• Switching hands for certain tasks when you can.

Splinting and bracing

A thumb splint or brace supports the CMC joint and limits painful motion while still allowing light use of the hand. Options range from soft neoprene sleeves to more rigid custom-molded splints made by a hand therapist.

Most patients wear the splint for heavier activities or during painful flares and remove it for lighter tasks to avoid stiffness. Many people notice a clear drop in pain when the joint is well supported.

Anti-inflammatory medications (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help reduce pain and swelling. They may be taken by mouth or used as a topical gel or cream applied over the joint.

Because NSAIDs can affect the stomach, kidneys, blood pressure, and other medications, we always review your medical history before recommending them. Do not start regular NSAID use without checking with your healthcare provider.

Corticosteroid (cortisone) injections

If splints and medications are not enough, a corticosteroid injection into the CMC joint can provide stronger temporary relief by calming inflammation. Some patients get months of benefit; others get a shorter response.

Injections do not cure the arthritis or rebuild cartilage, but they can substantially lower pain so you can function better and may delay or avoid surgery. There is a limit to how often we safely repeat injections in the same joint, so we time them carefully.

Hand therapy

Working with a certified hand therapist can improve both pain and function. Therapy may include:

• Gentle exercises to maintain or improve motion of the thumb and wrist
• Strengthening of the small muscles that support and stabilize the thumb
• Education on joint protection and better ways to do everyday tasks
• Fitting, adjusting, or making custom splints or braces

Hand therapy is helpful whether or not you choose surgery and is almost always part of the recovery plan after an operation.

When Is Surgery for Thumb CMC Arthritis Recommended?

Surgery is considered when non-surgical treatments are no longer enough and thumb pain clearly limits your quality of life. We base the decision on your symptoms and function, not just your X-ray.

• Persistent pain at the base of the thumb despite splints, medications, injections, and therapy
• Difficulty with essential daily activities such as dressing, cooking, work tasks, driving, or hobbies
• Progressive deformity, collapse, or drifting of the thumb that affects how you use your hand
• Pain that regularly wakes you from sleep or forces you to stop activities you enjoy

The goal of surgery is to reliably reduce pain and improve function. Surgery does not restore the original joint or make the thumb “like new,” but most well-selected patients are pleased with their ability to use the hand again.

Surgical Options for Thumb CMC Arthritis

Several operations are used for thumb CMC arthritis. The most common and well-studied options remove the arthritic bone surfaces and stabilize the thumb so the bones no longer grind against each other. Two key procedures are trapeziectomy and CMC arthroplasty with ligament reconstruction and tendon interposition (LRTI).

Trapeziectomy (removal of the arthritic bone)

The trapezium is the small wrist bone that forms the lower half of the CMC joint. In a trapeziectomy, this arthritic bone is removed. Taking away the worn joint surface stops bone-on-bone contact and usually leads to significant pain relief.

After the bone is removed, the thumb is supported by the remaining ligaments and soft tissues. Over time, the space where the bone was fills with scar tissue that acts as a cushion. Many patients do very well with this procedure alone.

CMC arthroplasty with ligament reconstruction and tendon interposition (LRTI)

In some patients, the trapeziectomy is combined with ligament reconstruction and tendon interposition, often called CMC arthroplasty or LRTI. During this surgery, a small piece of one of your own tendons is used to:

• Rebuild or reinforce the ligaments that stabilize the base of the thumb
• Fill part of the empty space left after the trapezium is removed, acting as a soft tissue cushion

The choice between a simple trapeziectomy and an LRTI depends on your age, activity level, the stability of the joint, and the surgeon’s experience and preference. Both procedures are designed to relieve pain and allow a strong, useful thumb for everyday activities.

What to expect on the day of surgery

Thumb CMC surgery is typically an outpatient procedure, so you go home the same day. Anesthesia often includes a nerve block to numb the arm, sometimes combined with light sedation. The operation usually takes about one to two hours, depending on the specific technique.

After surgery your hand is placed in a bulky dressing and splint. Some pain is expected, but most patients control it with a short course of prescription pain medicine, along with elevation, ice, and then over-the-counter medications as allowed.

Recovery After Thumb CMC Surgery: What to Expect

Recovery is gradual and typically takes several months. Most patients use the hand for light daily tasks by 2 to 3 months and continue to improve for up to a year.

First 2 weeks: protection and wound care

Right after surgery, your hand and thumb are in a bulky dressing and splint to protect the repair. During this time you should:

• Keep the hand elevated above heart level as much as possible.
• Gently move the fingers to reduce swelling and stiffness.
• Keep the dressing clean and dry.

Stitches are usually removed around 10 to 14 days after surgery, depending on how the incision is healing.

Weeks 2 to 6: custom splint and early motion

Once the initial dressing comes off, many patients are fitted with a custom-molded thumb splint. This allows safe, controlled motion while still protecting the healing structures.

Under the guidance of a hand therapist, you typically begin gentle range-of-motion exercises for the thumb and wrist. Lifting, gripping, and pinching are still limited during this stage.

Weeks 6 to 12: strengthening and functional use

Around 6 weeks after surgery, you gradually transition out of the splint for light activities. Therapy shifts toward strengthening the muscles that support your thumb and improving coordination for daily tasks.

By 8 to 12 weeks, many patients use the hand for most everyday activities such as dressing, light cooking, and office work, though heavy gripping or strong pinching may still be uncomfortable.

3 to 12 months: long-term recovery

Strength and comfort usually keep improving for many months. It is common to notice steady gains up to a year after surgery. Many patients report much less pain than before surgery and good ability to perform normal daily tasks, though the thumb may feel different than it did before arthritis started.

When Should You See a Hand Surgeon for Thumb Pain?

You should see a hand specialist if thumb pain is lasting, getting worse, or limiting what you can do. Early evaluation often means more choices for simple, non-surgical care.

Signs it’s time for an evaluation

• Pain at the base of the thumb lasting more than a few weeks
• Difficulty with daily activities such as opening jars, turning keys, writing, or using tools
• Swelling, tenderness, or a visible bump at the base of the thumb
• Loss of motion, weakness, or a feeling that the thumb is drifting out of position
• Pain that interferes with work, hobbies, or sleep

Red-flag symptoms: seek prompt care

Some symptoms may indicate a more urgent problem such as a fracture, infection, or nerve issue. Call a medical professional promptly or seek urgent care if you have:

• Sudden severe thumb pain after an injury, especially with deformity or inability to move the thumb
• Marked swelling, warmth, or redness around the joint, especially if you have a fever or feel ill
• New or worsening numbness, tingling, or weakness in the thumb or hand

If you are unsure whether your symptoms are urgent, it is always reasonable to call your doctor’s office for guidance.

Dr. Keith Michael Nord: Local Expert in Thumb CMC Arthritis in Jackson, TN

For patients in West Tennessee, Keith Michael Nord, MD, at West Tennessee Bone & Joint Clinic in Jackson, TN, is a trusted local expert in the diagnosis and treatment of thumb CMC (basal joint) arthritis. As an orthopedic hand and upper extremity specialist, Dr. Nord evaluates the whole hand and wrist, not just the painful joint, to build a treatment plan that fits your goals and daily activities.

In clinic, Dr. Nord focuses first on non-surgical options — activity changes, splinting, medications, injections, and hand therapy — and clearly explains what you can realistically expect from each. When surgery is the right choice, he offers modern CMC arthroplasty options, including trapeziectomy with or without ligament reconstruction and tendon interposition (LRTI), and guides patients through recovery with close follow-up and coordinated hand therapy.

If thumb pain is interfering with your work, hobbies, or everyday tasks and you live in or near Jackson, Tennessee, scheduling a consultation with Dr. Nord at West Tennessee Bone & Joint Clinic is an excellent next step.

FAQ: Thumb CMC (Basal Joint) Arthritis

Is thumb CMC arthritis the same as carpal tunnel syndrome?

No. Thumb CMC arthritis is a problem with the joint at the base of the thumb, causing joint pain, swelling, and stiffness. Carpal tunnel syndrome is a nerve problem at the wrist that typically causes numbness, tingling, and weakness in the fingers. Some patients can have both conditions at the same time, but they are diagnosed and treated differently.

Can thumb arthritis be cured without surgery?

Non-surgical treatments cannot regrow cartilage or reverse arthritis, so they do not “cure” the condition. However, splints, activity changes, medications, injections, and therapy can control symptoms very well for many people, sometimes for years. We usually try these options fully before considering surgery.

Will my thumb be as strong as before if I have CMC arthroplasty or LRTI?

Most patients regain good functional strength for everyday tasks like opening jars, turning keys, and using tools. Very heavy gripping or forceful pinching may always feel a bit weaker than a completely normal thumb, but the trade-off is much less pain and better overall use of the hand.

How long will I be off work after thumb CMC surgery?

This depends on your job and which hand is operated on. Many people with desk-based work can return in 2 to 4 weeks with restrictions and a splint. Jobs that require heavy lifting, forceful grip, or repetitive hand use may require 2 to 3 months or more before full duty. Your surgeon will give recommendations based on your specific situation.

Will arthritis come back after trapeziectomy or LRTI?

Once the trapezium bone is removed, the original arthritic joint is gone, so arthritis does not “grow back” in that same spot. Nearby joints can still develop wear-and-tear changes over time, but this is usually much less of a problem than the original CMC arthritis.

When should I see a hand surgeon?

Consider seeing a hand surgeon when thumb pain lasts more than a few weeks, is getting worse, or is limiting the activities that matter to you despite simple measures like rest, splints, and over-the-counter pain relief. An early, accurate diagnosis and a clear treatment plan can help you stay active and protect your hand function over the long term.