Purpose
The purpose of this study was to determine the prevalence and subtypes of amyloid
in tenosynovial biopsies of patients undergoing carpal tunnel release (CTR).
Methods
A retrospective review was performed involving patients who underwent CTR from June
2020 to July 2021. Prior to this period, a protocol had been established to obtain
routine intraoperative tenosynovial biopsies. Tenosynovium was preserved in formalin
and stained with Congo red for amyloid. Positive specimens were sent to an external
laboratory for confirmation and subtyping by mass spectrometry. Men 50 years or older
and women 60 or older were included for analysis. Acute, traumatic, and revision cases
were excluded.
Results
Of 185 patients who underwent CTR with tenosynovial biopsy, 54 (29%) demonstrated
positive Congo red stain, confirmed by the external laboratory. A subtype analysis
revealed wild-type transthyretin (TTR) in 44 patients (80%), mixed wild-type TTR with
κ light chains in 1 patient, and hereditary TTR in 1 patient. Patients with positive
specimens were significantly older than those who tested negative (77 vs 68 years,
respectively), and positivity increased by decade for both sexes. Male sex, atrial
fibrillation, and spinal stenosis were significantly more prevalent among positive
cases. There were no complications from the biopsies.
Conclusions
We confirmed evidence of amyloidosis in the tenosynovium of 29% of men 50 years or
older and women 60 or older who underwent CTR. The majority demonstrated wild-type
TTR. As these patients are at risk of developing cardiomyopathy, there is an opportunity
for early detection, monitoring, and interventions known to improve outcomes. Considering
the low cost of Congo red staining and the potential value of subtyping with regard
to treatment of cardiomyopathy, our findings support routine tenosynovial biopsy during
CTR in patients who meet the age criteria.
Type of study/level of evidence
Differential diagnosis or symptom prevalence study II.
Key words
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Article info
Publication history
Published online: April 22, 2022
Accepted:
February 16,
2022
Received:
August 10,
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.
