Thumb arthritis: exercises, splints and easier ways to use your hand
The joint at the base of the thumb, where the thumb bone meets a small wrist bone (the trapezium), lets the thumb swivel and pinch. It is one of the commonest places for osteoarthritis. It causes pain when you grip, pinch or turn things (keys, jars, doors), aching after use, a weaker pinch, and sometimes a bump or step at the base of the thumb.
About 1 in 5 people over 55 in the UK has painful thumb base arthritis. It doesn't necessarily get worse, and for many people it becomes less bothersome over time. Exercises, a splint and easier ways to use your hand are the core treatments; this page sets out what the trials found.
Exercise is for pain that has been checked or is clearly mild and settling.
Get urgent medical help if
Call 999 or go to A&E after an injury (don't drive yourself) if the arm, wrist or hand is numb, tingling or has pins and needles; a bone is sticking out or a bad cut is bleeding heavily; or the wrist, thumb or a finger has changed shape, is at an odd angle, or has turned blue, grey, white or cold.
Same day (NHS 111, an urgent treatment centre or an urgent GP appointment): a wrist or hand injury that is very painful, getting worse, very swollen or bruised, stiff, or that you can't use. It may be broken.
Same day: after a fall onto an outstretched hand, pain or tenderness at the base of the thumb on the back of the wrist (the hollow called the snuffbox), even if the wrist moves well or the first X-ray was normal. A broken scaphoid can hide on the first X-ray and is slow to heal if it's missed, so ask what follow-up is planned.
Same day: a joint or lump that is hot, red and swollen, or hand or wrist pain with a high temperature or feeling hot, cold or shivery. It could be an infection or gout.
See a doctor or physiotherapist if
Not improved after 2 weeks of looking after it at home, getting worse, keeps coming back, or stopping you doing normal activities. In many areas you can refer yourself to NHS physiotherapy.
Swollen, stiff joints in several fingers or both hands, with morning stiffness lasting more than 30 minutes. NICE asks GPs to refer suspected rheumatoid arthritis urgently when the small joints of the hands are affected, even if blood tests are normal.
Any tingling or loss of feeling in the hand or wrist.
You have diabetes and a hand problem: the NHS says hand problems can be more serious if you have diabetes.
Understand it
Who gets it, and how it's diagnosedEmerging evidence
Women are 2 to 3 times more likely to get it; being over 50, a family history, being overweight, a past injury, loose joints and heavy gripping work add to the risk. The OTTER trial booklet notes that the force of a pinch at the thumb tip is multiplied about twelve times at this joint.
NICE says osteoarthritis can be diagnosed without an X-ray in people 45 or over with joint pain on activity and morning stiffness lasting no more than 30 minutes. US orthopaedic surgeons describe a grind test (pressing and turning the thumb), say X-rays help, and note that many people with thumb base arthritis also have carpal tunnel syndrome, and that some have no symptoms despite advanced changes on X-ray.
Thumb arthritis aches at the base of the thumb when you pinch or grip. De Quervain's hurts on the thumb side of the wrist when you move the thumb and wrist, and often follows a new baby or heavy hand use.
Osteoarthritis stiffness usually lasts under 30 minutes in the morning. Several swollen, warm joints, often on both sides, longer morning stiffness, tiredness or a fever suggest rheumatoid arthritis, and NICE asks GPs to refer it urgently when the small joints of the hands are affected.
Exercise is recommended; trials show modest gains, mostly in functionMixed evidence
NICE says to offer exercise to everyone with osteoarthritis, tailored to the person, and to warn that pain may rise at first but keeping going brings the benefit. The American College of Rheumatology strongly recommends exercise for hand arthritis, while noting far less hand evidence than for knees and hips, and no best exercise or dose.
For the thumb base itself: a 2024 meta-analysis (14 trials, 1,280 people) found exercise reduced pain and disability compared with no treatment in the short term, with no differences between treatments in the medium and long term (low to moderate certainty). A 2026 trial of 166 people found adding exercise therapy to a splint didn't reduce pain at 3 months, but improved daily activities, work ability, satisfaction and grip, and cost less overall. Another trial found a home programme for the thumb's stabilising muscles added nothing to standard care at 6 weeks or 6 months; both groups improved.
In short: thumb exercises are safe and recommended, may help function more than pain, and work best alongside a splint and changes to how you use your hand.
A combination of treatments improves hand functionEmerging evidence
In an Australian trial of 204 people aged 40 and over, 6 weeks of education plus a thumb splint, hand exercises and an anti-inflammatory gel (diclofenac) improved hand function more than education alone at 6 and 12 weeks, and pain more by week 12. Side effects were minor, mostly skin reactions and exercise-related flares.
Thumb splints: the guidelines disagreeMixed evidence
The American College of Rheumatology strongly recommends a hand splint (orthosis) for thumb base arthritis, says an occupational therapist can help choose one, and found no type clearly better. A meta-analysis of 12 studies (1,353 people) found no short-term effect, but a moderate to large reduction in pain and a small to moderate improvement in function over 3 to 12 months (low quality); the review behind the European recommendations agreed about splints worn for longer.
NICE, by contrast, says not to routinely offer splints or supports unless the joint is unstable, exercise alone isn't working, and the device is likely to help.
Joint protection makes more people betterEmerging evidence
In a UK trial of 257 adults with hand osteoarthritis, a joint protection programme led by an occupational therapist made more people better at 6 months (33% against 21%); the hand exercise programme on its own didn't reach significance in that trial (28% against 25%). The American College of Rheumatology strongly recommends self-management programmes that include joint protection.
NICE suggests considering an anti-inflammatory gel for osteoarthritis outside the knee, and not routinely offering paracetamol or weak opioids. The American College of Rheumatology conditionally recommends anti-inflammatory gels, heat or cold, paraffin wax and, for the thumb base, kinesiology tape, and conditionally recommends against capsaicin cream on the hands (it can get into the eyes); the NHS says capsaicin may be prescribed for hand arthritis if anti-inflammatory gels haven't helped. The two disagree on capsaicin.
Steroid injections at the thumb base: little evidence of benefitEmerging evidence
In a trial of 40 people with moderate to severe thumb base arthritis, a steroid injection was no better than a saline injection at any point up to 24 weeks, and a review found no clear benefit from steroid or hyaluronic acid injections at the thumb base. NICE says joint injections give short-term relief (2 to 10 weeks) and can be used to support exercise.
Surgery hasn't been tested against non-surgical careEmerging evidence
Most operations remove the trapezium. A 2026 Cochrane review (25 studies, 1,591 people) found no trials comparing surgery with non-surgical care, and that adding a tendon reconstruction to simply removing the trapezium may make little or no difference; most studies had a high risk of bias. The NHS says surgery is for the small number of people whose daily life is still seriously affected after other treatments, and that fusing a joint relieves pain but stops it moving.
NICE doesn't recommend acupuncture, TENS, therapeutic ultrasound, laser or other electrotherapy, or hyaluronan injections for osteoarthritis. The NHS doesn't prescribe glucosamine or chondroitin because there's no strong evidence they work.
Some discomfort during these exercises is fine and doesn't mean you are doing damage. Keep it to about 5 out of 10 or less. It should settle within half an hour or so, and your hand should be no worse the next morning. If it is, do fewer, smaller or lighter next time, not nothing. An NHS wrist rehabilitation booklet uses the same limit: an unpleasant stretch of about 5 out of 10 that settles within 30 minutes.
Tingling and numbness are different: stop and get advice if an exercise brings them on and they don't fade quickly, or if your grip or thumb gets weaker.
Don't rest the hand completely for long, either: for repetitive strain, the NHS says resting for more than a few days makes the area weaker and less flexible. If a joint becomes hot, red and swollen, stop and get it checked.
Start at the first stage. Each move opens a full guide with a 3D demo.
Stage 1
Settle: level 1 thumb exercises
About weeks 0 to 4: level 1 of the OTTER II trial booklet. Start each session with your hand in a bowl of warm water, gently circling the thumb one way for a minute and the other way for a minute. Aim for at least 3 sessions a week of about 20 minutes, and move up a level only when this one is easy.
Up to 10 holds of 10 s for each lift, then the O-sign · The OTTER level 1 dose, thumb joints slightly bent; add the web-space stretch, held for 30 s, as in an NHS leaflet
Up to 10 holds of 5 s · Thumb only: a band round the hand and the middle of the thumb, lifting the thumb against it (OTTER level 2); a stronger band when it is easy
Move on when: Level 2 is easy, with no rise in pain the next day.
Follow along: a timer, a cue and the next move, one step at a time.
Stage 3
Strengthen: level 3, everyday pinch and grip
From about week 8. Practise pinch tasks with the thumb slightly bent and the wrist slightly back: write your name and address 5 times, tear paper 20 times, open clothes pegs (OTTER level 3). Keep the level 2 work going 2 to 3 times a week: in trials, the benefits faded when people stopped.
Move on when: Keep going: two or three sessions a week maintain the gains.
Follow along: a timer, a cue and the next move, one step at a time.
What to change for now
Some soreness after thumb exercise is normal
The OTTER trial booklet says some slight thumb discomfort after the exercises is not unusual and should stop within 24 hours. In hand arthritis trials, side effects of exercise were few, mainly a short flare of pain or swelling.
Joint protection taught by an occupational therapist made more people better in a UK trial: bigger grips, two hands, gadgets and pacing. The swaps below come from that programme, the OTTER booklet and the NHS.
They are safe and recommended. Trials show modest gains in the short term, mostly in function rather than pain: in a 166-person trial, adding exercise to a splint didn't reduce pain at 3 months but improved daily activities, grip and satisfaction.
Should I wear a thumb splint, and when?
The guidelines disagree. The American College of Rheumatology strongly recommends one; NICE says not routinely, unless the joint is unstable and exercise alone isn't enough. In pooled trials, the benefits appeared over 3 to 12 months rather than days. An occupational therapist can help you choose.
Will thumb arthritis get worse?
Not necessarily. The NHS says osteoarthritis doesn't necessarily get worse and can improve, and US orthopaedic surgeons note it often becomes less bothersome over time. Some people have no symptoms despite advanced changes on an X-ray.
Is a steroid injection worth it for thumb arthritis?
At the thumb base, a trial found a steroid injection no better than a placebo injection. NICE says joint injections can give short-term relief (2 to 10 weeks) to help you exercise.
When is thumb arthritis surgery considered?
When daily life is still seriously affected after other treatments, the NHS says. No trial has compared surgery with non-surgical care, and no operation is clearly better than simply removing the small bone at the base of the thumb.
Can I have thumb arthritis and carpal tunnel together?
Yes: many people with thumb base arthritis also have carpal tunnel syndrome, US orthopaedic surgeons say. Tingling or numbness points to the nerve; see the carpal tunnel guide.
Which gadgets help with thumb arthritis?
Jar openers, tap turners, an electric tin opener, foam tubing to thicken handles, and thicker pens. In a UK trial, learning these joint protection habits made more people with hand arthritis better at 6 months.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
