Cardiac Amyloidosis Screening at Trigger Finger Release Surgery

Sperry, Brett W.; Khedraki, Rola; Gabrovsek, Andrej; Donnelly, J.P.; Kilpatrick, Scott E.; Shapiro, David; Evans, Peter; Maschke, Steven; Cotta, Claudiu V.; Nakashima, Megan O.; Seitz, William H.; Hanna, Mazen

doi:10.1016/j.amjcard.2021.08.049

Cited by 14 publications

(11 citation statements)

References 4 publications

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“…7 Wrist tissue biopsy is simple and fast with minimal added morbidity compared to CTR alone, with a high yield for amyloidosis (100% in our series of patients) and a lower risk of serious complications compared to endomyocardial (cardiac, complication rate 6%), liver, abdominal subcutaneous fat (yield 15% in patients with ATTRwt), rectal (yield 85% in patients with systemic AL amyloidosis), bone marrow (yield 50%-60% in patients with systemic AL amyloidosis), salivary gland (yield 86% in patients with systemic AL amyloidosis), and trigger finger (yield 2% in idiopathic cases) biopsies. 8,[23][24][25] The cost of wrist tissue biopsy is low.…”

Section: Discussionmentioning

confidence: 99%

Amyloidosis and Carpal Tunnel Syndrome: Surgical Technique for Extended Carpal Tunnel Release with Tenosynovium and Transverse Carpal Ligament Biopsies

Elzinga

Khayambashi

Hahn

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Carpal tunnel syndrome (CTS) is common in patients with transthyretin amyloidosis (ATTR), and many experience residual symptoms and/or develop recurrent disease following routine carpal tunnel release (CTR). An extended CTR with median nerve neurolysis is recommended for thorough nerve decompression. Tissue confirmation of amyloidosis can be performed at the time of CTR with biopsies of the transverse carpal ligament and/or tenosynovium. Methods: We describe a retrospective, single-center experience performing an extended CTR technique including unilateral and bilateral cases for 13 consecutive patients (18 wrists) with ATTR and symptomatic median neuropathy at the wrist. Results: The mean patient age was 83 (range 67–90) years and 11 (85%) were men. Notable intraoperative findings in all cases included thickened tenosynovium and median nerve epineurium, and adherence of the median nerve to the deep surface of transverse carpal ligament. Pathology findings were positive for amyloidosis from both the transverse carpal ligament and the tenosynovium biopsies in all patients. Conclusions: Extended CTR with simultaneous wrist tissue biopsy can be safely performed for ATTR patients with CTS. Characteristic intraoperative findings should increase clinical suspicion for undiagnosed ATTR and prompt performance of biopsy for diagnostic confirmation. Volar wrist tenosynovial biopsy is our preferred tissue for confirmation of ATTR, for patients with and without CTS, given its safety profile and 100% pathological yield in our series.

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Section: Discussionmentioning

confidence: 99%

Amyloidosis and Carpal Tunnel Syndrome: Surgical Technique for Extended Carpal Tunnel Release with Tenosynovium and Transverse Carpal Ligament Biopsies

Elzinga

Khayambashi

Hahn

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…Prior investigations have demonstrated a wide range of amyloid positivity in various musculoskeletal tissues. 10 , 17 , 28 Sueyoshi et al 17 noted amyloid deposition in rotator cuff tendon tissue 38% of the time in patients with a mean age of 62 years. They also noted amyloid deposition during CTR and lumbar spinal stenosis procedures at rates of 37% and 53%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…They also noted amyloid deposition during CTR and lumbar spinal stenosis procedures at rates of 37% and 53%, respectively. 17 Additionally, 10% of patients undergoing CTR were found to have a positive biopsy result for amyloid in a study by Sperry et al, 10 which included men aged ≥50 years and women aged ≥60 years with bilateral symptoms. In contrast, in a group of patients undergoing trigger finger release, amyloid deposition was identified at a rate of 2%.…”

Section: Discussionmentioning

confidence: 99%

“…Prior investigations have reported an association between systemic amyloidosis and carpal tunnel syndrome (CTS). 8 , 9 , 10 A recent systematic review reported a 14% prevalence of amyloid within biopsied tenosynovium from the carpal tunnel in 1,753 CTS cases. 11 Furthermore, Sood et al 12 reported that a history of carpal tunnel release (CTR) or trigger digit release was independently associated with an increased risk of developing amyloidosis or heart failure.…”

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confidence: 99%

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Prevalence of Amyloid Deposition in Patients Undergoing Surgical Repair of Traumatic Distal Biceps Tendon Ruptures

Baylor

Nester

Olsen

et al. 2022

Journal of Hand Surgery Global Online

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“… 3 Several common clinical conditions, including carpal tunnel syndrome, lumbar spinal stenosis, trigger finger, and bicep tendon rupture, are documented extracardiac manifestations of ATTRwt-CA. 29 , 30 , 31 , 32 , 33 , 34 Bilateral carpal tunnel syndrome and lumbar spinal stenosis can precede the cardiac diagnosis by several years. A recent study found that bilateral carpal tunnel syndrome was present in approximately 50% of individuals with ATTRwt-CM in the 5 to 7 years preceding the diagnosis.…”

Section: Part I: Developing Clinical Suspicion For Attr-cmmentioning

confidence: 99%

Opportunities for Earlier Diagnosis and Treatment of Cardiac Amyloidosis

Martyn

Rubio

Estep

et al. 2022

Methodist DeBakey Cardiovascular Journal

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Despite the rapid expansion of noninvasive (nonbiopsy) diagnosis, contemporary patients with cardiac amyloidosis too often present with advanced features of disease, such as diminished quality of life, elevated natriuretic peptides, and advanced heart failure. Therapeutics for transthyretin cardiomyopathy (ATTR-CM) are most effective when administered before significant symptoms of cardiac dysfunction manifest, making early identification of affected individuals of paramount importance. Community engagement and ensuring that a broad range of clinicians have working knowledge of how to screen for ATTR-CM in everyday practice will be an important step in moving disease identification further upstream. However, reliance on the appropriate and timely diagnosis by individual clinicians may continue to underperform. This review highlights how targeted screening of special populations may facilitate earlier diagnosis. Systems of care that operationalize screening of high-risk subpopulations and prospective validation of novel approaches to ATTR-CM identification are needed.

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Cardiac Amyloidosis Screening at Trigger Finger Release Surgery

Cited by 14 publications

References 4 publications

Amyloidosis and Carpal Tunnel Syndrome: Surgical Technique for Extended Carpal Tunnel Release with Tenosynovium and Transverse Carpal Ligament Biopsies

Amyloidosis and Carpal Tunnel Syndrome: Surgical Technique for Extended Carpal Tunnel Release with Tenosynovium and Transverse Carpal Ligament Biopsies

Prevalence of Amyloid Deposition in Patients Undergoing Surgical Repair of Traumatic Distal Biceps Tendon Ruptures

Opportunities for Earlier Diagnosis and Treatment of Cardiac Amyloidosis

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