Shockwave Therapy for Thumb CMC Osteoarthritis: What Does the Evidence Show?

Thumb CMC osteoarthritis has direct clinical shockwave evidence, but the literature remains small. The most detailed comparative study randomized 58 patients to focused ESWT or intra-articular hyaluronic acid and followed pain, function and strength through six months. Both groups improved, and the ESWT group had a greater average pain improvement later in follow-up. A second randomized study of 72 patients compared focused ESWT with exercise and also found improvement in both groups.

A newer single-patient case report should be treated as hypothesis-generating rather than proof.

The correct conclusion is therefore that focused ESWT is a promising noninvasive option for selected symptomatic thumb CMC osteoarthritis, not that it has been proven to regenerate cartilage or reverse osteoarthritis.

Start with the right diagnosis

The studies below enrolled patients with thumb CMC osteoarthritis, the joint between the first metacarpal and the trapezium. Thumb-base pain is not automatically CMC arthritis: De Quervain tenosynovitis, the STT joint, the flexor carpi radialis tendon, the thumb MCP joint, the superficial radial nerve and the scaphoid can all produce pain in the same area. The differences are covered in thumb CMC arthritis vs De Quervain's and thumb-base pain: CMC vs STT vs FCR.

The 2018 randomized study

Ioppolo and colleagues randomized 58 patients with first CMC osteoarthritis to focused ESWT or intra-articular hyaluronic acid (HA), published in Annals of Rehabilitation Medicine (Ioppolo, 2018).

• ESWT group: 28 patients (16 women, 12 men), mean age 68.03 ± 9.04 years
• HA group: 30 patients (18 women, 10 men), mean age 66.67 ± 8.06 years
• ESWT protocol: once weekly for three consecutive weeks, 2,400 pulses per session at 4 Hz and an energy-flux density of 0.09 mJ/mm². The focused shockwaves were generated electromagnetically and applied under ultrasound guidance across the joint.
• HA protocol: three weekly injections of 0.5 cm³
• Outcomes: pain on a visual analog scale (VAS) and hand function on the Duruoz Hand Index (DHI) as primary outcomes, with grip and pinch strength as secondary outcomes
• Assessments: baseline, end of treatment, three months and six months

Pain

Both groups improved significantly over time. In the ESWT group, pain decreased significantly from baseline to the end of treatment (p < .001), to three months (p < .001) and to six months (p = .012). The HA group also improved from baseline at each time point, but its pain increased significantly between the three- and six-month visits.

The change from the end of treatment to six months differed significantly between groups (p < .001), reflecting a greater average pain improvement in the ESWT group at the six-month follow-up.

That does not mean ESWT outperformed HA at every time point.

Function and strength

Both groups improved significantly on the DHI, and the authors reported no significant difference between groups in hand-function improvement.

Pinch strength improved significantly in the ESWT group from the end of treatment through six months, while the HA group showed a significant change only at six months. Grip strength also improved in both groups. The authors reported no significant between-group differences for pinch or grip.

Focused ESWT was associated with improved hand disability and earlier pinch improvement, but the strength results should be read as within-group gains rather than proof that ESWT produced more strength than HA.

Safety

No treatment-related adverse effects were reported in the trial. That is reassuring, but one small trial cannot establish that a treatment carries zero clinical risk.

Limitations

Because the trial did not include a sham-shockwave group, it supports comparative clinical effectiveness but cannot isolate the specific treatment effect as cleanly as a placebo-controlled trial. Other limitations include the small sample, a single center and six months of follow-up.

The 2024 randomized study against exercise

Covelli and colleagues randomized 72 patients with thumb CMC arthritis to focused ESWT or a therapeutic exercise program, 36 per group, and followed them for six months (Covelli, 2024). Every patient in both groups also used a thumb splint.

Focused ESWT was given once weekly for three sessions, 2,000 pulses at 4 Hz and 0.03 to 0.08 mJ/mm², under ultrasound guidance. The exercise group followed a four-week thumb stretching, stabilization and strengthening program.

Both groups improved significantly from baseline to six months. Mean VAS pain fell by 4.81 points in the ESWT group and 2.75 points in the exercise group. Patient-perceived improvement was better in the ESWT group at one, three and six months.

This trial also had no sham group, the report does not describe blinding, and everyone wore a splint, so it compares ESWT plus splinting with exercise plus splinting.

The 2026 case report

A case report published in January 2026 described a 64-year-old woman with radiographically confirmed bilateral thumb CMC osteoarthritis whose symptoms had persisted despite earlier conservative care (Gustafsson, 2026). She received three weekly focused ESWT sessions, with energy individually adjusted to tolerance.

• QuickDASH improved from 20.5 at baseline to 2.3 at 52 weeks
• Right grip strength rose from 13.2 kg to 17.1 kg (+29.5%)
• Left grip strength rose from 15.5 kg to 18.2 kg (+17.4%)
• Follow-up at 2, 8, 26 and 52 weeks, with no adverse events reported

A 2026 case report described sustained improvement through one year after three focused ESWT sessions in one patient with bilateral thumb CMC OA. This is a single-patient report and cannot establish treatment efficacy.

Shockwave and cartilage

The available clinical studies evaluate pain, function, grip and pinch, not regeneration of articular cartilage. None measured cartilage repair, joint-space restoration or reversal of arthritis.

Preclinical and other joint-osteoarthritis research provides a biologic rationale for shockwave, but those mechanisms should not be converted into a claim of human thumb-cartilage regeneration.

Focused, not radial

Both randomized thumb CMC trials and the case report used focused shockwave, directed at the joint under ultrasound guidance in the trials. Radial shockwave has not been studied in the same way for this joint, so the focused-ESWT results should not be assumed to apply to radial treatment.

Protocols are study-specific

The two trials used three weekly sessions but different pulse counts and energy levels, and the case report adjusted energy to tolerance. A protocol describes what was tested in one study, not a universal prescription.

Where shockwave fits in conservative care

Shockwave should be considered alongside an evidence-based conservative program. Current high-level evidence supports exercise, multimodal care and splinting for symptomatic thumb CMC OA.

A network meta-analysis published online in 2024 included 22 studies, 21 randomized and one quasi-randomized, with 1,631 women and 331 men, (Thakker, 2025).

• Short term: multimodal treatment (mean difference −5.3; 95% CI −7.6 to −3.0) and hand exercise (−5.0; 95% CI −8.5 to −1.5) produced clinically important pain reduction versus control.
• Medium term: only the rigid CMC-MCP splint was superior to control for pain (−1.9; 95% CI −3.1 to −0.6) and function (DASH −11; 95% CI −21 to −1).
• Grip: hand exercise improved short-term grip strength by 21 lb (95% CI 11 to 31).

Network estimates represent average comparative effects across study populations and do not predict the exact response of an individual patient.

A separate network meta-analysis of 11 randomized trials and 619 patients found all splint types superior to control for pain (Marotta, 2021). Randomized evidence supports thumb orthoses as part of conservative CMC care, although the optimal design depends on the patient's symptoms and functional goals.

Exercise and mechanical support remain foundational nonoperative treatments for symptomatic thumb CMC OA. Shockwave does not replace them.

Injections and surgery

Injections remain part of the broader thumb CMC treatment landscape, although comparative evidence varies by injectable, follow-up period and patient population. A 2025 systematic review of 17 studies covering 1,166 thumbs found that no surgical procedure was superior to another, and among injection comparisons, platelet-rich plasma outperformed corticosteroid on several outcomes (Bhat, 2025).

What about electromagnetic therapy?

A recent randomized trial has evaluated pulsed electromagnetic-field therapy (PEMF) for thumb CMC pain. In this double-blind study of 61 participants, a home-use PEMF device or an identical sham device was worn each night for four weeks. Both groups improved at four weeks without a significant difference between them, while at six weeks the PEMF group showed a significantly greater reduction in average pain than sham (Durtschi, 2026).

This supports continued investigation of electromagnetic approaches, but PEMF and EMTT are distinct technologies and should not be treated as interchangeable evidence. The trial used a home-use device worn overnight, which is a different technology and delivery from in-clinic EMTT. Direct EMTT-specific clinical evidence for thumb CMC arthritis has not been established.

Who may be a candidate

Focused shockwave may be reasonable for a patient whose examination shows that the CMC joint is producing the familiar pain, whose symptoms persist despite a reasonable trial of exercise, load modification and splinting, and who prefers a noninvasive option or wants to avoid or delay injection. It is considered alongside those foundations, not instead of them.

It is not a first step for undiagnosed thumb-base pain, and fracture, infection, substantial instability or severe deformity need assessment or referral first.

Key studies at a glance

The bottom line

Focused ESWT has direct randomized comparative evidence in thumb CMC osteoarthritis. A 58-patient trial found improvement in pain, disability and strength through six months, with a greater late pain improvement in the ESWT group than with hyaluronic acid, and a 72-patient trial found improvement alongside exercise and splinting. The evidence remains limited, however, and neither trial included a sham control. Focused shockwave should therefore be positioned as a promising noninvasive option within a broader conservative program, not as a cartilage-regeneration treatment or proven cure.

At Novo, we first confirm that the CMC joint is the symptomatic structure, build a program around pinch, grip and hand function, and discuss focused shockwave when the exam supports it. See how we approach thumb CMC arthritis and thumb-base pain, or read more about focused shockwave therapy.

References

• Ioppolo F, Saracino F, Rizzo RS, Monacelli G, Lanni D, Di Sante L, Cacchio A, Santilli V, Venditto T. Comparison between extracorporeal shock wave therapy and intra-articular hyaluronic acid injections in the treatment of first carpometacarpal joint osteoarthritis. Annals of Rehabilitation Medicine. 2018;42(1):92-100. PMID 29560329. (link)
• Covelli I, De Giorgi S, Di Lorenzo A, Pavone A, Salvato F, Rifino F, Moretti B, Solarino G, Notarnicola A. Extracorporeal shock wave therapy (ESWT) vs. exercise in thumb osteoarthritis (SWEX-TO): prospective clinical trial at 6 months. Life (Basel). 2024;14(11):1453. PMID 39598251. (link)
• Gustafsson T, Ryman Augustsson S. Case report: focused shockwave therapy (fESWT) in thumb carpometacarpal joint osteoarthritis: a single case study. Frontiers in Rehabilitation Sciences. 2025;6:1716305. PMID 41602581. (link)
• Thakker A, Ramchandani JP, Divall P, Sutton A, Johnson N, Dias J. What are the most clinically effective nonoperative interventions for thumb carpometacarpal osteoarthritis? An up-to-date systematic review and network meta-analysis. Clinical Orthopaedics and Related Research. 2025;483(4):719-736. PMID 39560669. (link)
• Marotta N, Demeco A, Marinaro C, Moggio L, Pino I, Barletta M, Petraroli A, Ammendolia A. Comparative effectiveness of orthoses for thumb osteoarthritis: a systematic review and network meta-analysis. Archives of Physical Medicine and Rehabilitation. 2021;102(3):502-509. PMID 32668206. (link)
• Bhat S, Weeda L, Seth I, Rozen WM. Comparison of surgical techniques and joint injections for base of thumb osteoarthritis: a systematic review. Journal of Hand Surgery Global Online. 2025;7(2):212-218. PMID 40182877. (link)
• Durtschi MS, Rajakumar V, Kenney DE, Pham NS, Ladd AL, Chou RC. Clinical efficacy of pulsed electromagnetic field therapy on thumb carpometacarpal joint pain: a double-blind, randomized, controlled trial. Hand (N Y). 2026;21(7):1149-1156. PMID 41015912. (link)
• Shapiro LM, McQuillan TJ, Kerkhof FD, Ladd A. Radiographic progression of thumb CMC osteoarthritis: a systematic review. Journal of Hand Surgery Global Online. 2020;2(6):343-348. PMID 35415524. (link)