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Amyotrophic Lateral Sclerosis Among Patients Diagnosed With Compressive Mononeuropathy
Aaron Singh, BA
1; Travis Kotzur, BS
1; Blaire Peterson, BS
1; Lindsey Peng, BS
1; Jordan Carter, MD
1; Ryan Rose, MD
1; Christina Brady, MD
21UT Health San Antonio, San Antonio, TX; 2Audie L. Murphy Memorial Veterans' Hospital, San Antonio, TX
Introduction: Amyotrophic Lateral Sclerosis (ALS) is a rare progressive neurodegenerative disease that can masquerade as a variety of conditions - such as mononeuropathies such as carpal or cubital tunnel syndrome - particularly early in the disease course. Recent literature has demonstrated that hand surgeons are frequently among the first to evaluate these patients, and misdiagnoses may occur. This study aims to evaluate rates of ALS among patients diagnosed with carpal or cubital tunnel syndrome.
Methods: This retrospective study utilized the TriNetX platform, years 2009-2024, to identify all patients diagnosed with carpal or cubital tunnel syndrome. Patients with mononeuropathies were then matched patients from the general population and followed for five years, assessing for subsequent diagnosis with ALS as the outcome of interest. Rates of diagnosis of ALS between patients diagnosed with mononeuropathies and matched controls were compared.
Results: A total of 422,722 patients were successfully matched. A total of 469 (0.11%) patients in the mononeuropathy cohort were subsequently diagnosed with ALS, compared to 180 (0.04%) patients in the control cohort (RR 2.6 [95% CI 2.2-3.1] p<0.001).
Conclusion: This study demonstrates that subsequent diagnosis of ALS is approximately 2.6 times as likely in patients diagnosed with mononeuropathy. While ALS remains a relatively rare condition, surgeons should be cognizant of it, and carefully consider it as part of their differential. Atypical symptoms or ones refractory to treatment should warrant additional workup to avoid missing a potentially grave diagnosis.
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