Purpose
Tenosynovial biopsy during carpal tunnel release (CTR) leads to an earlier diagnosis
of amyloidosis. Surgery for trigger digit—trigger release (TR)—may provide a similar
opportunity. We sought to characterize the risk of amyloidosis diagnosis after TR
and/or CTR.
Methods
We conducted a retrospective cohort study of adults without diagnosed amyloidosis
undergoing TR and/or CTR in the Veterans Health Administration from 1999 to 2019,
including matched controls. We used competing-risks methodology to estimate the cumulative
incidence and adjusted subdistribution hazard ratios (sHRs) of amyloidosis, heart
failure, and death after TR and/or CTR.
Results
Among the 126,788 patients undergoing TR and/or CTR, amyloidosis was diagnosed in
52 of 26,757 patients undergoing TR alone at a median of 4.7 years after surgery (10-year
cumulative incidence: 0.26%, 95% CI: 0.18% to 0.34%), 396 of 91,384 patients undergoing
CTR alone at a median of 5.1 years after surgery (10-year cumulative incidence: 0.60%,
95% CI: 0.53% to 0.67%), 50 of 8,647 patients undergoing both TR and CTR at a median
of 3.1 years after surgery (10-year cumulative incidence: 0.80%, 95% CI: 0.54% to
1.1%), and 54 of 113,452 controls at a median of 5.0 years after the index date (10-year
cumulative incidence 0.053%, 95% CI: 0.037% to 0.070%). In the adjusted analysis,
patients who underwent TR and/or CTR had a higher risk of amyloidosis (TR: sHRadj 4.80, 95% CI: 3.33–6.92; CTR: sHRadj 10.2, 95% CI: 7.74–13.6; TR and CTR: sHRadj 14.9, 95% CI: 9.87–22.5) and heart failure (TR: sHRadj 1.91, 95% CI: 1.83–1.99; CTR: sHRadj 2.02, 95% CI: 1.97–2.07; TR and CTR: sHRadj 2.18, 95% CI: 2.04–2.33) but not death compared with the controls. Among the patients
who underwent TR, age, Black race, prior CTR, heart failure, and the number of digits
released were independent risk factors for amyloidosis.
Conclusions
Patients undergoing TR and/or CTR are at increased risk of incident amyloidosis and
heart failure compared to controls.
Type of study/level of evidence
Prognostic II.
Key words
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References
- Systemic amyloidosis.Lancet. 2016; 387: 2641-2654
- Diagnosis and treatment of cardiac amyloidosis. A position statement of the European Society of Cardiology Working Group on myocardial and pericardial diseases.Eur J Heart Fail. 2021; 23: 512-526
- Cardiac amyloidosis: an underdiagnosed/underappreciated disease.Eur J Intern Med. 2019; 67: 1-13
- Transthyretin amyloid cardiomyopathy: JACC state-of-the-art review.J Am Coll Cardiol. 2019; 73: 2872-2891
- A machine learning model for identifying patients at risk for wild-type transthyretin amyloid cardiomyopathy.Nat Commun. 2021; 12: 2725
- Carpal tunnel syndrome: a common initial symptom of systemic wild-type ATTR (ATTRwt) amyloidosis.Amyloid. 2016; 23: 58-63
- Tenosynovial and cardiac amyloidosis in patients undergoing carpal tunnel release.J Am Coll Cardiol. 2018; 72: 2040-2050
- Diagnosing systemic amyloidosis presenting as carpal tunnel syndrome: a risk nomogram to guide biopsy at time of carpal tunnel release.J Bone Joint Surg Am. 2021; 103: 1284-1294
- Carpal tunnel syndrome: a potential early, red-flag sign of amyloidosis.J Hand Surg Am. 2019; 44: 868-876
- Orthopaedic manifestations of amyloidosis.J Am Acad Orthop Surg. 2021; 29: e488-e496
- Musculoskeletal pathology as an early warning sign of systemic amyloidosis: a systematic review of amyloid deposition and orthopedic surgery.BMC Musculoskelet Disord. 2021; 22: 51
- Trigger digits: principles, management, and complications.J Hand Surg Am. 2006; 31: 135-146
- Flexor tendon entrapment of the digits (trigger finger and trigger thumb).J Occup Environ Med. 2000; 42: 526-545
- Use and associated spending for anesthesiologist-administered services in minor hand surgery.Plast Reconstr Surg. 2018; 141: 960-969
- Idiopathic carpal tunnel syndrome and trigger finger: is there an association?.J Hand Surg Eur Vol. 2009; 34: 58-59
- Epidemiology of carpal tunnel syndrome in patients with single versus multiple trigger digits.J Hand Surg Am. 2013; 38: 49-55
- Relationship of carpal tunnel release and new onset trigger finger.J Hand Surg Am. 2019; 44: 28-34
- Carpal tunnel release: lifetime prevalence, annual incidence, and risk factors.Muscle Nerve. 2018; 58: 497-502
- Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis.Diabet Med. 2016; 33: 10-16
- Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: a systematic review.Clin Chem. 2003; 49: 1437-1444
- The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies.Obes Rev. 2015; 16: 1094-1104
- Hypothyroidism and carpal tunnel syndrome: a meta-analysis.Muscle Nerve. 2014; 50: 879-883
- Trigger finger and amyloid cardiomyopathy, usual suspect; amyloid deposition.Hand Microsurg. 2020; 9: 120-127
- The tenosynovitis of fingers associated with transthyretin amyloidosis.J Hand Surg Asian Pac Vol. 2020; 25: 340-344
- Association of carpal tunnel syndrome with amyloidosis, heart failure, and adverse cardiovascular outcomes.J Am Coll Cardiol. 2019; 74: 15-23
- Prevalence of the amyloidogenic transthyretin (TTR) V122I allele in 14 333 African-Americans.Amyloid. 2015; 22: 171-174
- Screening for ATTR amyloidosis in the clinic: overlapping disorders, misdiagnosis, and multiorgan awareness.Heart Fail Rev. 2022; 27: 785-793
- Trigger finger as an initial manifestation of familial amyloid polyneuropathy in a patient with Ile107Val TTR.Intern Med. 2007; 46: 501-504
- Musculoskeletal manifestations of amyloidosis. A review of 83 patients on haemodialysis for at least 10 years.J Bone Joint Surg Br. 1991; 73: 271-276
- Characteristics of dialysis-related amyloidosis in patients on haemodialysis therapy for more than 30 years.Nephrol Dial Transplant. 2009; 24: 1593-1598
- Trigger finger and thumb, secondary to amyloidosis.Plast Reconstr Surg. 1980; 65: 68-69
- Applying the Bradford Hill criteria in the 21st century: how data integration has changed causal inference in molecular epidemiology.Emerg Themes Epidemiol. 2015; 12: 14
Appendix E1. Additional Sources
- How many imputations are really needed? Some practical clarifications of multiple imputation theory.Prev Sci. 2007; 8: 206-213
Article info
Publication history
Published online: March 25, 2022
Accepted:
January 19,
2022
Received:
June 21,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
