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Histopathologic Changes in DeQuervain's Tendinosis: A Correlation Between Clinical and Pathologic Severity
Rowena McBeath, MD, PhD; A. Lee Osterman, MD
The Philadelphia Hand Center, Thomas Jefferson University, Philadelphia, PA

DeQuervain’s tendinosis is a common, debilitating condition of the wrist. Although cure rates in excess of 83% have been derived from cortisone injection and/or surgical release of the first dorsal compartment, no study to date has determined the precise pathophysiology responsible for DeQuervain’s disease development. Interestingly, comparisons have been drawn between stenosing tenovaginitis, or ‘trigger finger’, and DeQuervain’s tendinosis. Histopathologic analysis of stenosing tenovaginitis specimens has demonstrated increased chondroid metaplasia in both tendon and pulley, suggesting that tenocytes undergo transdifferentiation to a chondroid phenotype. We hypothesized that histopathologic analysis of patients with DeQuervain’s tendinosis would, similarly, demonstrate chondroid metaplasia of the inner first dorsal compartment as well as intercompartmental septum. Furthermore, we hypothesized that increased disease severity -- based on objective as well as subjective measurements -- would result in increased areas and extent of chondroid transdifferentiation.

Purpose: The purpose of this study was to investigate the histopathologic changes of DeQuervain’s tendinosis and correlate these changes to disease severity as detected by subjective and objective findings.

Methods: Patients with DeQuervain’s tendinosis were selected based on subjective (pain, response to steroid injection) as well as objective (presence of Finkelstein’s test, tenderness to palpation of first dorsal compartment, crepitus, elevated wrist circumference) findings, and classified into either mild or severe categories. Tissue samples (tenosynovium, inner compartment, intercompartmental septum) taken from these patients undergoing surgical release of the first dorsal compartment were analyzed via histopathologic staining, and areas of chondroid metaplasia were detected using H&E and alcian blue staining, as well as immunofluorescence of chondroid markers aggrecan and collagen II.

Results and Conclusions: Patients with severe disease had documented disease recurrence after steroid injection with positive Finkelstein’s test, crepitus and elevated wrist circumference compared to the contralateral wrist. Tissue analysis from these patients, as compared to those patients with mild disease, demonstrated dramatic chondroid metaplasia by H&E and alcian blue staining, as well as positive immunofluorescence of chondroid markers aggrecan and collagen II. These findings demonstrate for the first time a histopathologic similarity of DeQuervain’s tendinosis with other stenosing tenovaginitis conditions, and suggests that the presence of chondroid metaplasia is the mechanism responsible for increased disease severity.

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