Occult Amyloid Deposition in Older Patients Presenting with Bilateral Carpal Tunnel Syndrome or Multiple Trigger Digits
Aaron Gray, MD, PhD1; F. Thomas Kaplan, MD2; Gregory A Merrell, MD1; Amit Patel, MD1,3; Jeffrey A. Greenberg, MD, MS1
1Indiana Hand to Shoulder Center, Indianapolis, IN; 2Indiana Hand Center, Indianapolis, IN; 3Ascension Medical Group, Indianapolis, IN
Purpose: Diagnosis of amyloidosis is key for early intervention and disease monitoring and prevention. Carpal tunnel syndrome (CTS) and trigger digit (TD) are two common conditions associated with early disease. The purpose of this study is to define disease prevalence among patients with bilateral CTS and multiple TD and assess for enhanced diagnosis in the presence of both.
Methods: Men over 50 years and women over 60 years diagnosed with bilateral CTS, multiple TD, or a combination of the two were prospectively enrolled in our study. Tenosynovial biopsies taken at the time of surgery, were tested for the presence of amyloid with Congo red staining. Demographic and medical covariates were also collected and analyzed for differences among amyloid positive and negative patients.
Results: 56 patients were enrolled in the study with an overall amyloid prevalence of 16%. There were no significant differences in demographic or medical comorbidities between amyloid positive and negative patients. Among patients with bilateral CTS, prevalence was 13%. For multiple TD patients, prevalence was 24%. Among patients with multiple TD, only males tested positive for amyloid and were, on average, younger than those testing negative (61 and 73 years, respectively, p<0.05). Patients presenting with a combination of CTS and TD did not exhibit increased amyloid discovery.
Conclusions: Hand surgeons should consider tenosynovial biopsy in men over 50 and women over 60 presenting with either bilateral CTS or multiple TD. Specifically, males with multiple TD are more at risk for amyloidosis then females.
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