Clinico-pathological studies on the tendon lesions in the rheumatoid hand
Part III Pathohistological studies on tendon lesions in the rheumatoid hand
1975 Volume 27 Issue 4 Pages 757-777
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1975 Volume 27 Issue 4 Pages 757-777
As for the tendon lesions of the rheumatoid hand the reports of pathohistological studies are very limited except the works of Kellgren and Ball, Ehrlich et al and Potter and Kuhns. There still remain several problems not yet settled in the field of pathohi- stology, especially in the pathogenesis of tendon nodule and its relation to the development of tenosynovitis.
The author made a pathohistological research using specimens removed from thirty-two patients operated on by himself, which includes the treatment of 22 hands of extensor tenosynovitis,18 fingers of digital flexor tenosynovitis and three cases of flexor tenosynovitis of the wrist. Ordinary staining such as H. E., Azan-Marolly, van Gieson, Toluidin-blue, Weigert-fibrin and Silver stainings were performed for microscopic examinat ion.
The following conclusions were drawn not only from pathological findings but also from clinical features and operative findings.
1. From the findings of forty-three tendon lesions the lesions could be classified into the following three groups: 1) tenosynovitis in 34,2) tendinitis in one,3) co-existence of tenosynovitis and tendinitis in 8. This suggests that the tendinitis does not always occur as a secondary product from the tenosynovitis.
2. Microscopic manifestations of the findings of tenosynovitis are in many respects very similar to the synovitis of the joint of rheumatoid arthritis, but the findings of tenosynovitis are rather simple in histological manifestation as compared to joint synovitis.
3. Histologically a nodule-like swelling or a nodule formation in the tissue of tendon substance is most characteristic. These nodule-like tendon lesions were classified into three types by the author,1) proliferated granuloma in epitendineum which is seen in 4 tendons,2) a. proliferated granuloma in peritendineum which is seen in 4 tendons,2) b. degenerative changes in tendon substance in one tendon. In addition to the above findings the author noticed that the inflammatory findings both in epitendineum and peritendineum were very similar to those in articular synovial tissue.
