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Why Do Corticosteroids Help In Stenosing Tenosynovitis? - A Histologic Examination of the Tenosynovium
Emmanuel Atiemo, MD1, Jennings Jennings2, Jasvir, S. Khurana, MD3, John Gaughan, PhD2; Asif M. Ilyas, MD4
1Orthopaedics, Temple University Hospital, Philadelphia, PA; 2School of Medicine, Temple University, Philadelphia, PA; 3Pathology, Temple University Hospital, Philadelphia, PA; 4Rothman Institute, Thomas Jefferson University, Philadelphia, PA

Hypothesis: Trigger Fingers and DeQuervain’s disease represent a stenosing tenosynovitis that is readily treated with corticosteroid injections. However, previous histological studies in patients with these pathologies have identified non-inflammatory fibrocartilaginous metaplasia of the tendon sheaths putting into question the mechanism of symptom improvement following corticosteroid injections. Although previous studies have examined the histology of tendon sheaths, to the best of our knowledge, no study has examined the histology of the surrounding tenosynovium of the involved tendon to better understand the positive response to corticosteroids.

Methods: The enveloping tenosynovium of 20 consecutive patients with the diagnosis of either a Trigger Finger or DeQuervain’s disease undergoing surgical release were debrided during surgery and sent to the lab for histopathologic examination. As a control, 11 cadaveric specimens consisting of 1 cm flexor tendon segments taken at the A1 pulley level were excised and similarly examined. All samples were graded on a scale of 0-3 to the amount of inflammation, myxoid changes, and neovascularization by histologic examination.

Results: Of the 20 initial patients whose cases were reviewed, a total 15 patients were included in the study with a total of 16 specimens (one patient had surgical release of both a Trigger finger and DeQuervain's synovitis). Five patients were excluded because of insufficient samples for histological analysis. In the surgical group, the mean grade for inflammation, myxoid and neovascularization was 1.31, 1.06, and 1.94 respectively versus 0.09, 1.82, and 0.00 respectively for the cadaveric control group. Using the Wilcoxon Rank Sum Test the data was found to be statistically significant with p-values of p<0.0001, p<0.05, and p<0.0001 for inflammation, myxoid, and vascularity. There was no statistical difference in histologic findings between the tenosynovium of the trigger fingers versus DeQuervain’s disease.

Summary: Previous studies examining the histopathology of patients with stenosing tenosynovitis describe a mucoid degeneration with fibrovascular changes involving the A1 pulley and tendon sheath without evidence of inflammation. Our study of the tenosynovium in patients with stenosing tenosynovitis indicates that there is indeed a degree of inflammation present in these patients. This finding helps to explain why many patients might respond positively to corticosteroid injections.

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