Purpose
Many patients with amyloidosis undergo carpal tunnel release (CTR) before amyloidosis
diagnosis and before developing cardiac or other serious disease manifestations. The
purposes of this study were to examine if our patient population had a similar prevalence
of positive amyloidosis diagnoses to that in prior studies and to describe the results
of implementing a screening program for amyloidosis.
Methods
We retrospectively reviewed the biopsy results and subsequent interventions for all
patients who underwent screening tenosynovial biopsy during CTR from March 2020 through
December 2021. Amyloid screening was offered to patients who met the criteria for
increased risk of disease using an appropriateness screening algorithm.
Results
Seventy-five (48%) of 156 patients who underwent CTR met the eligibility criteria
for amyloidosis testing. Of the 62 patients who agreed to undergo tenosynovial biopsy,
14 had amyloid-positive biopsy specimens (10 men and 4 women). All patients with positive
tenosynovial biopsies had bilateral carpal tunnel syndrome and wild-type transthyretin
amyloid subtype. One patient was diagnosed and started treatment for otherwise asymptomatic
cardiac amyloidosis.
Conclusions
The incidence of amyloid-positive tenosynovial biopsy results from CTR was 22.5% in
patients using the criteria from an appropriateness screening algorithm, which was
higher than previously reported. Implementation of a screening program for patients
undergoing CTR requires a multidisciplinary approach and may result in early diagnosis
and lifesaving interventions for patients with amyloidosis.
Type of study/level of evidence
Differential diagnosis/symptom prevalence study, II.
Key words
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Article info
Publication history
Published online: January 14, 2023
Accepted:
September 12,
2022
Received:
April 25,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
