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De Quervain's disease. An ultrastructural study.

E Ippolito, F Postacchini, E Scola

    International Orthopaedics
    |January 1, 1985
    PubMed
    Summary
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    De Quervain's disease involves thickened tendon sheaths (EPB and APL). This thickening results from increased extracellular matrix, larger collagen fibrils, and metaplasia within the sheath layers.

    Area of Science:

    • Orthopedics
    • Histopathology
    • Rheumatology

    Background:

    • De Quervain's disease affects the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons.
    • Tendon sheath thickening is a hallmark of this condition.

    Purpose of the Study:

    • To investigate the microstructural changes in the tendon sheaths of patients with de Quervain's disease.
    • To elucidate the cellular and extracellular matrix alterations contributing to sheath thickening.

    Main Methods:

    • Light and electron microscopy were used to examine EPB and APL tendon sheaths from four de Quervain's disease patients.
    • Histopathological analysis focused on collagen fibril diameter, cellular composition, and tissue architecture.

    Main Results:

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    • Tendon sheaths were significantly thicker than normal, exhibiting three distinct layers.
    • The inner sheath layer showed chondroid and myxomatous changes, with collagen fibrils up to 2100 nm in diameter.
    • Myofibroblast-like cells were prevalent throughout the thickened sheath.

    Conclusions:

    • Tendon sheath thickening in de Quervain's disease is attributed to increased extracellular matrix synthesis.
    • Enhanced collagen fibril thickness and myxomatous/chondroid metaplasia are key pathological features.
    • These microstructural changes contribute to the characteristic hardening of the affected tendon sheaths.