Physical Therapy for Thumb Osteoarthritis

Evidence-Based Recommendations

The European League Against Rheumatism (EULAR) recommends exercises to improve function and muscle strength, as well as to reduce pain, for every patient with hand osteoarthritis, including thumb base (CMC-1 joint) involvement 1, 2
The American Geriatrics Society suggests that therapeutic exercises should target three specific goals: joint mobility improvement, muscle strength enhancement, and thumb base stability 1, 2, 3

Muscle strength enhancement should be achieved through strengthening exercises for thumb stabilization, with a focus on isometric strengthening when joints are acutely inflamed or unstable, and progressing to isotonic (dynamic) exercises as inflammation subsides 3
Exercise resistance must remain submaximal, with muscles not being exercised to fatigue, and joint pain lasting >1 hour after exercise or joint swelling indicating excessive activity 2, 3

The initial phase of treatment should begin with isometric strengthening exercises, with only a few repetitions, and without resisting movements, applying superficial moist heat before exercises 2, 3
The progressive phase should advance to isotonic (dynamic) strengthening, focusing on exercises that correspond to everyday activities, including static stretching, and performing daily when pain and stiffness are minimal 3, 4
The maintenance phase should continue exercises indefinitely, as beneficial effects are not sustained when patients stop exercising, and combine with orthotic use for optimal outcomes 1, 2

Physical therapy can be delivered through physical therapists specializing in hand therapy, occupational therapists, trained nurses with specialized hand therapy training, or home-based programs after initial instruction 1, 2

Physical therapy should be combined with thumb base orthoses for long-term use (≥3 months) to provide additional pain relief and functional improvement 1

Exercising to fatigue increases inflammation and pain, and benefits disappear without continued exercise 1, 2, 3
Using only passive modalities is not essential for sustained benefit, and ignoring the need for long-term orthotic use shows no benefit 1, 2