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Risk of Amyloidosis and Heart Failure Among Patients Undergoing Surgery for Trigger Digit or Carpal Tunnel Syndrome: A Nationwide Cohort Study With Implications for Screening

  • Ravi F. Sood
    Correspondence
    Corresponding author: Ravi F. Sood, MD, MS, Department of Orthopedics and Sports Medicine, University of Washington, 4245 Roosevelt Way NE, Seattle, WA 98105.
    Affiliations
    Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA
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  • Angelo B. Lipira
    Affiliations
    Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR

    Operative Care Division, Portland VA Medical Center, Portland, OR
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Published:March 25, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.01.022

      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

        • Wechalekar A.D.
        • Gillmore J.D.
        • Hawkins P.N.
        Systemic amyloidosis.
        Lancet. 2016; 387: 2641-2654
        • Garcia-Pavia P.
        • Rapezzi C.
        • Adler Y.
        • et al.
        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
        • Manolis A.S.
        • Manolis A.A.
        • Manolis T.A.
        • Melita H.
        Cardiac amyloidosis: an underdiagnosed/underappreciated disease.
        Eur J Intern Med. 2019; 67: 1-13
        • Ruberg F.L.
        • Grogan M.
        • Hanna M.
        • Kelly J.W.
        • Maurer M.S.
        Transthyretin amyloid cardiomyopathy: JACC state-of-the-art review.
        J Am Coll Cardiol. 2019; 73: 2872-2891
        • Huda A.
        • Castaño A.
        • Niyogi A.
        • et al.
        A machine learning model for identifying patients at risk for wild-type transthyretin amyloid cardiomyopathy.
        Nat Commun. 2021; 12: 2725
        • Nakagawa M.
        • Sekijima Y.
        • Yazaki M.
        • et al.
        Carpal tunnel syndrome: a common initial symptom of systemic wild-type ATTR (ATTRwt) amyloidosis.
        Amyloid. 2016; 23: 58-63
        • Sperry B.W.
        • Reyes B.A.
        • Ikram A.
        • et al.
        Tenosynovial and cardiac amyloidosis in patients undergoing carpal tunnel release.
        J Am Coll Cardiol. 2018; 72: 2040-2050
        • Sood R.F.
        • Kamenko S.
        • McCreary E.
        • et al.
        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
        • Donnelly J.P.
        • Hanna M.
        • Sperry B.W.
        • Seitz Jr., W.H.
        Carpal tunnel syndrome: a potential early, red-flag sign of amyloidosis.
        J Hand Surg Am. 2019; 44: 868-876
        • Zhang D.
        • Makhni M.C.
        • Kang J.D.
        • Blazar P.
        Orthopaedic manifestations of amyloidosis.
        J Am Acad Orthop Surg. 2021; 29: e488-e496
        • Wininger A.E.
        • Phelps B.M.
        • Le J.T.
        • Harris J.D.
        • Trachtenberg B.H.
        • Liberman S.R.
        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
        • Ryzewicz M.
        • Wolf J.M.
        Trigger digits: principles, management, and complications.
        J Hand Surg Am. 2006; 31: 135-146
        • Moore J.S.
        Flexor tendon entrapment of the digits (trigger finger and trigger thumb).
        J Occup Environ Med. 2000; 42: 526-545
        • Kamnerdnakta S.
        • Huetteman H.E.
        • Chung K.C.
        Use and associated spending for anesthesiologist-administered services in minor hand surgery.
        Plast Reconstr Surg. 2018; 141: 960-969
        • Kumar P.
        • Chakrabarti I.
        Idiopathic carpal tunnel syndrome and trigger finger: is there an association?.
        J Hand Surg Eur Vol. 2009; 34: 58-59
        • Wessel L.E.
        • Fufa D.T.
        • Boyer M.I.
        • Calfee R.P.
        Epidemiology of carpal tunnel syndrome in patients with single versus multiple trigger digits.
        J Hand Surg Am. 2013; 38: 49-55
        • Zhang D.
        • Collins J.
        • Earp B.E.
        • Blazar P.
        Relationship of carpal tunnel release and new onset trigger finger.
        J Hand Surg Am. 2019; 44: 28-34
        • Pourmemari M.H.
        • Heliövaara M.
        • Viikari-Juntura E.
        • Shiri R.
        Carpal tunnel release: lifetime prevalence, annual incidence, and risk factors.
        Muscle Nerve. 2018; 58: 497-502
        • Pourmemari M.H.
        • Shiri R.
        Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis.
        Diabet Med. 2016; 33: 10-16
        • van Dijk M.A.
        • Reitsma J.B.
        • Fischer J.C.
        • Sanders G.T.
        Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: a systematic review.
        Clin Chem. 2003; 49: 1437-1444
        • Shiri R.
        • Pourmemari M.H.
        • Falah-Hassani K.
        • Viikari-Juntura E.
        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
        • Shiri R.
        Hypothyroidism and carpal tunnel syndrome: a meta-analysis.
        Muscle Nerve. 2014; 50: 879-883
        • Çatal B.
        • Akgün U.
        • Çimen O.
        • Türkmen İ.
        • Azboy İ.
        Trigger finger and amyloid cardiomyopathy, usual suspect; amyloid deposition.
        Hand Microsurg. 2020; 9: 120-127
        • Hara Y.
        • Tajiri Y.
        • Kawano K.
        • Hoshikawa S.
        • Kita Y.
        The tenosynovitis of fingers associated with transthyretin amyloidosis.
        J Hand Surg Asian Pac Vol. 2020; 25: 340-344
        • Fosbøl E.L.
        • Rørth R.
        • Leicht B.P.
        • et al.
        Association of carpal tunnel syndrome with amyloidosis, heart failure, and adverse cardiovascular outcomes.
        J Am Coll Cardiol. 2019; 74: 15-23
        • Jacobson D.R.
        • Alexander A.A.
        • Tagoe C.
        • Buxbaum J.N.
        Prevalence of the amyloidogenic transthyretin (TTR) V122I allele in 14 333 African-Americans.
        Amyloid. 2015; 22: 171-174
        • Nativi-Nicolau J.N.
        • Karam C.
        • Khella S.
        • Maurer M.S.
        Screening for ATTR amyloidosis in the clinic: overlapping disorders, misdiagnosis, and multiorgan awareness.
        Heart Fail Rev. 2022; 27: 785-793
        • Uotani K.
        • Kawata A.
        • Nagao M.
        • Mizutani T.
        • Hayashi H.
        Trigger finger as an initial manifestation of familial amyloid polyneuropathy in a patient with Ile107Val TTR.
        Intern Med. 2007; 46: 501-504
        • Kurer M.H.
        • Baillod R.A.
        • Madgwick J.C.
        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
        • Otsubo S.
        • Kimata N.
        • Okutsu I.
        • et al.
        Characteristics of dialysis-related amyloidosis in patients on haemodialysis therapy for more than 30 years.
        Nephrol Dial Transplant. 2009; 24: 1593-1598
        • Young L.
        • Holtmann B.
        Trigger finger and thumb, secondary to amyloidosis.
        Plast Reconstr Surg. 1980; 65: 68-69
        • Fedak K.M.
        • Bernal A.
        • Capshaw Z.A.
        • Gross S.
        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

        • Graham J.W.
        • Olchowski A.E.
        • Gilreath T.D.
        How many imputations are really needed? Some practical clarifications of multiple imputation theory.
        Prev Sci. 2007; 8: 206-213