Thumb carpo-metacarpal osteoarthritis is a degenerative disorder that mostly affects post-menopausal women. We report here the case of a retired woman with advanced thumb carpo-metacarpal osteoarthritis which prevented her from being fully independent in daily living activities. After informing the patient about the likely unfavorable evolution and progressive worsening of the condition, we suggested conservative management aimed at pain control and improving hand functioning, in order to avoid or postpone the possible need for surgery.