Arthritis affecting the trapezio-metacarpal joint (TMJ) of the thumb is a very common condition, and in the upper limb represents the site most often requiring surgery for symptomatic osteoarthritis. The condition predominantly affects women, especially those who are post menopausal. Management of the condition initially entails the use of conservative measures. Many of these are administered in the community by general practitioners as well as occupational therapists, surgery being reserved for disabling symptoms and loss of function resistant to these measures. From a review of the currently available literature, we present an overview of this common condition, commenting on its clinical presentation, pathophysiology and the treatment options available. A treatment algorithm is presented, to aid practitioners in the management and referral of patients with symptomatic thumb TMJ arthritis.