Carpal Tunnel Syndrome May Be an Early Manifestation of Amyloidosis

An amyloidosis diagnosis among patients undergoing carpal tunnel release (CTR) surgery suggests that carpal tunnel syndrome (CTS) may be an early manifestation of amyloidosis, according to study results presented at the 2023 American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Annual Meeting, held from November 1 to 4 in Phoenix, Arizona.

Previous research has found that approximately 11% of patients undergoing CTR have amyloid deposits. For the current study, researchers sought to determine the prevalence of amyloidosis in this patient population.

Using the Geisinger Health System, patients undergoing CTR and tenosynovial biopsy were identified between January 2021 and September 2022. Patients were diagnosed with amyloidosis using various screening methods, including genetic testing, electrodiagnostic (EDx) studies, skin biopsies, and technetium pyrophosphate scintigraphy.

The researchers included a total of 183 patients who underwent 194 tenosynovial biopsies in the study. Of these, 36 (20%) had a positive result for amyloidosis.

With regard to screening methods, 67% (n=24) received genetic testing, 53% (n=19) had EDx studies, 6% (n=2) had skin biopsies, and 81% underwent technetium pyrophosphate scintigraphy (n=29).

Overall, 61% of those who received genetic testing had wild-type transthyretin amyloidosis (wtATTR) and the remaining had hereditary transthyretin amyloidosis (hATTR). Of the patients who had EDx testing, a portion were diagnosed with large-fiber polyneuropathy (25%). Patients who had skin biopsies had small-fiber polyneuropathy (3%), and those who had technetium pyrophosphate scintigraphy had grade 1 cardiac amyloidosis (3%).

The researchers noted patients with hATTR (n=2) also had polyneuropathy and 1 had cardiac amyloidosis.

Overall, of the patients who underwent CTR surgery, 20% received an amyloidosis diagnosis, the majority of which was wtATTR.

“These findings support that CTS is an early manifestation of amyloidosis,” the researchers concluded. “We strongly recommend obtaining tenosynovial biopsies in patients undergoing CTR for early detection of amyloidosis.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.