Can tendonitis of the thumb cause redness, swelling, and tenderness?

Thumb Tendonitis and Associated Symptoms

Yes, tendonitis of the thumb can cause redness, swelling, and tenderness, which are classic signs of inflammation in the affected area. 1, 2

Clinical Presentation of Thumb Tendonitis

Tendonitis of the thumb typically presents with:

• Local inflammation signs:
  • Redness (erythema) around the affected tendon
  • Swelling or induration of the area
  • Tenderness or pain with movement or palpation
  • Local warmth of the affected area 1

These inflammatory signs are part of the body's response to tendon injury or irritation. According to the International Working Group classification system, the presence of at least two of these signs (swelling/induration, erythema, tenderness/pain, warmth, or purulent discharge) indicates an inflammatory process 1.

Pathophysiology

The traditional view of tendonitis involves:

1. Mechanical factors: Repetitive loading or overuse of the tendon
2. Inflammatory response: The body's reaction to tendon injury
3. Tissue changes: Degenerative changes may occur in chronic cases 3, 4

However, it's important to note that histopathologic studies have shown that many chronic tendon conditions actually demonstrate degenerative lesions (tendinosis) rather than true inflammation, with inflammation often limited to the peritendinous tissues (peritendinitis) 4.

Specific Types of Thumb Tendonitis

Thumb tendonitis can affect various tendons:

• Extensor pollicis longus
• Extensor pollicis brevis
• Abductor pollicis longus (De Quervain's tenosynovitis)
• Flexor pollicis longus 5, 6

Each may present slightly differently based on the affected tendon's location, but all can exhibit the cardinal signs of inflammation.

Management Approach

Initial Conservative Management

1. Activity modification: Reduce activities that cause pain
2. Relative rest: Avoid complete immobilization
3. Appropriate orthoses or splinting: To reduce stress on the affected tendon
4. Cryotherapy: For acute pain relief 2

Medication Options

• NSAIDs: Can provide short-term pain relief
  • Ibuprofen 1.2-2.4g daily
  • Naproxen 500mg twice daily 2

Rehabilitation

A phased rehabilitation approach is recommended:

• Initial phase (0-4 weeks): Pain control and protected range of motion
• Intermediate phase (4-8 weeks): Progressive strengthening exercises
• Advanced phase (8-12 weeks): Occupation-specific training 2

Eccentric strengthening exercises have shown the highest evidence-based effectiveness for tendon rehabilitation 2.

Common Pitfalls to Avoid

1. Overuse of imaging for initial diagnosis when clinical assessment is sufficient
2. Corticosteroid injections near certain tendons (particularly the Achilles tendon) can lead to tendon weakening or rupture
3. Prolonged immobilization beyond 3 weeks can lead to stiffness and weakness 2
4. Delayed referral for surgical evaluation when conservative measures fail 2

When to Consider Advanced Interventions

Consider referral to a specialist if:

• No improvement after 6-8 weeks of conservative treatment
• Pain persists despite 3-6 months of well-managed conservative treatment 2

Surgical intervention may be necessary for cases that fail to respond to conservative measures, with excellent outcomes reported when the affected tendon is treated directly 4.