Arthroscopic assessment of the CMC joint allows direct visualization of all components of the joint, including synovium, articular surfaces, ligaments, and the joint capsule. It also allows for the extent of joint pathology to be evaluated and staged with intraoperative management decisions made based on this information. The author recommends this arthroscopic staging to ensure better judgment of this condition in order to provide the most adequate treatment option to patients who have this disabling condition. Future studies assessing the clinical long term results using arthroscopy will likely ensure its place in the treatment armamentarium for trapeziometacarpal osteoarthritis.