Thumb pain: the base of the thumb, the wrist side, a thumb that catches, an injury, and what helps

Where it hurts is the best clueStrong evidence

The NHS sorts thumb pain by its pattern: pain, swelling and bruising after an injury points to a sprain or a break; pain, swelling and stiffness at the base that lasts, sometimes with a lump, to de Quervain's or arthritis; aching that is worse at night, with numbness or a weak thumb, to carpal tunnel syndrome; and pain at the base on the palm side with clicking to a trigger thumb. It asks you not to self-diagnose, and the map above is a guide to the likely cause, not a diagnosis.

NHS inform adds that pins and needles, or sharp, hot or burning pain, in the hand or thumb can come from the neck, even when the neck doesn't hurt.

Sources 1, 2, 3

Thumb base arthritis: common on X-rays, a problem for fewer peopleStrong evidence

The base of the thumb, where it meets a small wrist bone, is one of the commonest places for osteoarthritis. On X-rays it is common and rises with age: in 16 population studies, about 5.8% of men and 7.3% of women had it at 50, and 33.1% and 39.0% at 80; in 7,792 Dutch adults aged 55 and over, 25.3% had it. Far fewer see a doctor about it: in southern Sweden, 1.4% of adults (2.2% of women and 0.62% of men) had a doctor's diagnosis, most often women aged 70 to 74 (5.3%).

Women are 2 to 3 times more likely to get it, US orthopaedic surgeons say. In a Finnish study of 3,595 adults, a higher body weight went with it and heavy physical work didn't, though a study like this shows a link, not a cause. Many people with these changes on an X-ray have little or no pain, UK and US hand surgeons say. The NHS describes a bump at the base of the thumb and trouble writing, opening jars or turning keys.

Sources 4, 5, 6, 7, 8, 9, 10

De Quervain's, a trigger thumb and a torn ligamentEmerging evidence

De Quervain's affects two thumb tendons in a tunnel on the thumb side of the wrist. Pain is worse lifting the thumb, as in the hitchhiker position, or using scissors; mothers of small babies seem particularly prone, and there is little evidence that it is caused by work, though hand use aggravates it, UK hand surgeons say. In the 30 treatment trials, 80% of people were women, with an average age of 46.

In a trigger thumb, a thickened tendon catches at the mouth of its tunnel, so the thumb clicks, sticks bent or needs pushing straight, often worse in the morning. The NHS says it is more likely over 40, with diabetes or with rheumatoid arthritis, and hand surgeons add that it isn't caused by arthritis.

Skier's thumb is a tear of the ligament on the index-finger side of the thumb's knuckle, usually from a fall onto the thumb while gripping something, such as a ski pole. Less often the ligament stretches slowly over years (gamekeeper's thumb), with a weak pinch. The NHS lists the thumb among the commonest places for sprains.

Sources 11, 12, 13, 14, 15, 16, 17, 18

Phones, gaming and repeated thumb use: what the studies showEmerging evidence

In 18 studies of university students, 19.2% to 68.7% reported wrist, hand or thumb pain, linked with time on the phone, how it is held, frequent thumb movements and the screen's size and weight. Across 42 studies of over 67,000 mostly young people (average age 24.6), phone use was linked with de Quervain's, carpal tunnel syndrome and tendon problems. In 7,092 young Swedish adults, texting predicted new hand and finger symptoms a year later (an odds ratio of 2.0, roughly double the odds), mostly short-lived.

In 477 students followed for 6 months, those who no longer met a threshold for smartphone addiction had less pain and fewer tendon changes on ultrasound, while those who stayed hooked didn't improve despite some cut in screen time. All these studies are observational: they show links, not cause and effect. No study we read links phone use to thumb arthritis, which is uncommon before 50. The NHS calls pain from repeated movements repetitive strain injury.

Sources 19, 20, 21, 22, 23, 4

Other causes, each with its own clues

These are less common, but they need a different kind of help:

• Carpal tunnel syndrome: numbness, tingling or pins and needles in the thumb and first two fingers, a weak thumb or difficulty gripping, usually worse at night.
• Rheumatoid arthritis: several swollen, stiff joints, often in both hands, with long morning stiffness. NICE asks GPs to refer it urgently when the small joints of the hands are affected, even if blood tests are normal.
• Gout or a joint infection: a sudden, hot, red, swollen joint, with a high temperature in an infection.
• Paronychia: sore, red, swollen and warm skin around the nail, which can be an infection.
• A torn thumb tendon: weeks after a broken wrist, or with rheumatoid arthritis, the thumb suddenly can't be lifted off a flat table, sometimes after a 'ping'.
• A young child's trigger thumb: a thumb stuck bent, rarely painful, which usually gets better on its own within up to 2 years.

Sources 24, 25, 26, 27, 28, 29, 30, 31, 2

Tests and scansStrong evidence

NICE diagnoses osteoarthritis without an X-ray in people aged 45 or over with joint pain on activity and morning stiffness of 30 minutes or less, and doesn't use imaging to guide treatment. US orthopaedic surgeons use a grind test (pressing and turning the thumb base) and say X-rays can confirm arthritis, though some people with advanced changes have no symptoms.

After an injury it's different: the NHS says you'll probably need an X-ray, because a break, a dislocation and a bad sprain are hard to tell apart. For a possible torn ligament, the UK hand surgeons' guideline asks for a history, an examination and X-rays, and found too little evidence to recommend routine ultrasound or magnetic resonance imaging (MRI). A nerve test may be used for carpal tunnel syndrome, and blood tests and a specialist referral for possible rheumatoid arthritis.

Sources 32, 8, 33, 17, 24, 26

How it usually goesEmerging evidence

New thumb problems, or a flare-up of an old one, should begin to settle within 6 weeks, NHS inform says; the NHS asks you to see a GP if it hasn't improved after 2 weeks of treating it at home. Osteoarthritis doesn't necessarily get worse and can sometimes gradually improve, the NHS says, and thumb base arthritis may become less bothersome over time, with symptoms often settling over the long term.

Some mild trigger thumbs recover over a few weeks without treatment, and an injection relieves a trigger thumb or de Quervain's in about 7 in 10, hand surgeons say. A broken thumb usually heals in 6 to 8 weeks, with full strength by 3 to 4 months. Phone-related pain eased in students whose heavy phone habit eased. No one can promise a timescale.

Sources 2, 1, 34, 8, 9, 14, 11, 33, 35, 22

Thumb base arthritis: exercise and self-management come first, with modest gainsMixed evidence

NICE says offer therapeutic exercise to everyone with osteoarthritis, and warn that pain may rise at first. For the thumb base, a 2024 review of 14 trials (1,280 people) found exercise reduced pain more than no treatment in the short term, by about 22 points on a 0 to 100 scale, with no differences in the medium and long term (low to moderate certainty). Across hand osteoarthritis, a Cochrane review of 7 trials found exercise cut pain by about 0.5 points out of 10, a small effect, on low-quality evidence.

Adding exercise therapy to a splint didn't reduce pain at 3 months in 166 people, but improved daily activities, work ability, satisfaction and grip, and cost less. Six weeks of education, a splint, exercises and an anti-inflammatory gel improved hand function more than education alone in 204 people. The 2025 UK hand surgeons' guideline puts a self-management package first, and a UK review suggests about 20 minutes, 3 times a week, with rest days between, as a well-tolerated dose. The plan uses the exercise levels from the UK OTTER II trial's booklet.

Sources 32, 36, 37, 38, 39, 40, 41, 42

A splint added nothing to self-management in a UK trialMixed evidence

In the OTTER II trial (349 people with thumb base arthritis, 17 NHS hospital departments), adding a real or a placebo thumb splint to a therapist-supported self-management programme of education and exercise made no difference to hand pain at 8 weeks; all three groups improved. NICE says don't routinely offer splints or supports unless the joint is unstable, exercise alone isn't working and the device is likely to help.

An earlier review of 12 studies (1,353 people) found splints gave moderate to large pain relief over 3 to 12 months, on low-quality evidence. So the 2025 UK hand surgeons' guideline suggests considering a splint for people who haven't responded to a self-management package alone. NHS inform says a splint may help during repetitive activities, not all the time, often for just a few weeks.

Sources 43, 32, 44, 40, 45

Joint protection made more people betterEmerging evidence

In a UK trial of 257 adults with hand osteoarthritis, joint protection taught by occupational therapists in four group sessions (bigger grips, two hands, gadgets and pacing) 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 NHS points to an occupational therapist and gadgets such as tap turners, and NHS inform suggests changing hand position to make tasks easier.

Sources 46, 47, 45, 1

Gels, tablets and injectionsEmerging evidence

NHS inform says a gel containing ibuprofen is the most effective painkiller for hand osteoarthritis, and NICE suggests considering an anti-inflammatory gel for osteoarthritis outside the knee. The NHS says capsaicin cream may be prescribed for hand arthritis if anti-inflammatory gels haven't helped, and ibuprofen tablets aren't suitable for everyone.

NICE says steroid injections give short-term relief, for 2 to 10 weeks, and can support exercise. At the thumb base, a review of 9 trials (504 people) found no injection shown to be better than a placebo, another injection or no injection. NICE doesn't offer glucosamine or acupuncture for osteoarthritis.

Sources 45, 32, 47, 48, 1

De Quervain's and a trigger thumb: splints and injections do most of the workEmerging evidence

For de Quervain's, a review of 30 trials (1,663 people) found a steroid injection plus 3 to 4 weeks in a thumb splint had the best support, though the extra benefit of the splint was statistically but not clinically significant (moderate certainty). An injection relieves the pain in about 70%, and surgery to open the tunnel is for pain that persists.

For a trigger thumb in adults, the steps are a splint at night to hold the thumb straight, then an injection, which relieves it in about 70% (less often with diabetes), then a small operation if it keeps triggering. No trial has tested exercise for either condition; gentle movement keeps the hand from stiffening while the splint or injection works. In young children, NHS inform says there is no evidence that splints or exercise help a trigger thumb, and it usually settles on its own.

Sources 12, 11, 14, 15, 13, 31

A torn thumb ligament: a specialist decision within 2 weeksEmerging evidence

The UK hand surgeons' guideline asks for a shared decision on treatment within 2 weeks of referral to a specialist service, and says early surgery or a cast or rigid splint are both reasonable for a thumb that is loose, on very low-quality evidence. Their patient page says a complete tear is usually repaired and a partial tear treated in a splint or cast for about 6 weeks. The decision belongs to the hand team, which is why the first check matters.

Sources 17, 16, 33

Phone use: cutting down may help, though no trial has tested itEmerging evidence

The only follow-up evidence is one 6-month study of 477 students, in which pain eased and tendon changes regressed in those whose addictive phone use eased. The other studies are surveys and cohorts showing links, not effects. The NHS's advice for repetitive strain is to cut down the activity that causes it at first, then build activity back up. The phone changes on this page are sensible but untested, so they're labelled our suggestion.

Sources 22, 19, 21, 23

The NHS's first steps (written steps)

The NHS and NHS inform give the same first steps for most thumb pain. These aren't tested treatments, but they are consistent health-service advice.

• 1. Rest your thumb when you can, and stop or cut down what brings it on, such as typing, vibrating tools or playing an instrument.
• 2. An ice pack (or a bag of frozen peas) in a towel for up to 20 minutes every 2 to 3 hours. Don't use heat packs or hot baths for a few days after an injury or if the thumb is swollen.
• 3. Paracetamol or ibuprofen gel, or ibuprofen tablets if needed; ibuprofen tablets aren't suitable for everyone, so check with a pharmacist.
• 4. Take off rings if the thumb looks swollen.
• 5. A splint to support the thumb, especially at night; a pharmacist can advise, and flexible rubber splints let you keep using the thumb. A lollipop stick taped on can do until you get one.
• 6. Gadgets for jars and chopping, and don't lift heavy things or grip anything too tightly.
• 7. In the first 48 hours, move the hand gently for 10 to 20 seconds every hour while you're awake; after that, use it more (NHS inform).

Sources 1, 2

The OTTER II thumb exercises (written steps)

The 3D figure can't show the thumb's separate joints, so these come as written steps, from the UK OTTER II trial's exercise booklet. Do them at least 3 times a week for at least 20 minutes, and move up a level only when the current one is easy. Keep the thumb joints slightly bent, never bent backwards: the booklet notes that pressure at the tip of the thumb in a pinch is multiplied about 12 times at its base.

• 1. Warm-up: put your hand in a bowl of warm water and gently circle your thumb one way for a minute, then the other way, for at least 2 minutes.
• 2. Level 1, thumb lift: rest your forearm and hand on a table on the little-finger side, thumb on top. Without help from the other hand, lift the thumb up as far as you can, joints slightly bent. Hold 10 seconds; repeat up to 10 times.
• 3. Level 1, lift away: in the same position, keep the thumb as far from your palm as you can while lifting it towards the ceiling. Hold 10 seconds; up to 10 times.
• 4. Level 1, the O-sign: with your elbow or the back of your hand on the table, touch your thumb to each fingertip in turn, making an O, thumb joints slightly bent.
• 5. Level 2, against a band: with the strongest rubber band you can comfortably stretch around your hand and the middle of your thumb, lift the thumb up without bending the wrist forwards; hold 5 seconds and lower slowly, up to 10 times. Then lift the thumb towards your opposite shoulder, away from the palm; hold 5 seconds, up to 10 times.
• 6. Level 3, pinch and turn tasks, thumb slightly bent and wrist slightly back: write your name and address 5 times; tear a sheet of paper in half 20 times; squeeze a clothes peg or clip 5 times; pick up and hold a serving plate 5 times; turn a key as if unlocking a door 10 times; undo and do up a bottle top 5 times.
• 7. With de Quervain's, start with the assisted lift instead: the other hand lifts the thumb away from the index finger and lowers it, then the thumb returns on its own, 10 times, never into pain (our de Quervain's guide). With a trigger thumb, ease a stuck thumb straight gently, ideally after warming the hand, and never force it.

Source 42

Phones, tablets and controllers (written steps)

Time on the phone, how it's held, frequent thumb movements and the screen's size and weight all go with thumb and hand pain in students, and texting predicted new hand symptoms over a year. No trial has tested phone changes, so these steps are our suggestion.

• 1. Shorter spells: put the phone down every 15 to 20 minutes and open and close your hand a few times.
• 2. Share the work: hold the phone in both hands, or rest it on a stand or a table, and swap the scrolling thumb.
• 3. Use voice typing or a finger for long messages, and a keyboard for long writing.
• 4. A phone grip or ring can take the weight off the thumb.
• 5. Bring longer sessions back gradually, as long as the thumb is no worse the next morning.

Sources 19, 22, 21

Grips, gadgets and splints (written steps)

Joint protection made more people with hand arthritis better in a UK trial, and the NHS suggests gadgets. The exact list below is our suggestion, built on those sources.

• 1. Bigger grips: foam tubing on handles, thicker pens, larger cutlery and padded tool handles.
• 2. Two hands, and the load close to your body, instead of one hand pinching.
• 3. Gadgets: jar openers, a key turner, tap turners and an electric tin opener.
• 4. Pace the heavy hand jobs: spread them through the day and the week.
• 5. A splint for the tasks that hurt, or at night, rather than all day. For thumb base arthritis, a self-management programme comes first; a splint is a next step if that alone hasn't helped.

Sources 46, 1, 47, 45, 43, 40

Pinching, gripping, tools and sport come back (written steps)

No trial has tested how to bring these back after thumb pain. These steps are our suggestion unless a source is named.

• 1. Daily pinching and turning: the OTTER II level 3 tasks are the practice (the booklet).
• 2. Writing and keyboards: a thicker pen, and a break every 30 to 60 minutes.
• 3. Kitchen, DIY and gardening: gadgets and two hands first, padded handles, and the heaviest jobs last.
• 4. Gym and sport: carries and curls come back last, with thick handles; NHS inform says avoid sport or heavy lifting until there is less discomfort and good movement, and warm up fully first.
• 5. After a ligament injury or a break, contact sport, skiing and ball sports follow the hand clinic's timing (our skier's thumb and broken thumb guides).

Sources 42, 2, 46