Carpal tunnel syndrome associated with amyloidosis

BATISTA, KATIA TORRES; SERRÃO-DE-ARAUJO, GABRIEL COSTA; Y-SCHWARTZMAN, ULISES PRIETO; MONTEIRO, GABRIELA BERNARDA

doi:10.5935/2177-1235.2019RBCP0011-EN

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Revista Brasileira de Cirurgia Plástica

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Original Article • Rev. Bras. Cir. Plást. 34 (01) • 2019 • https://doi.org/10.5935/2177-1235.2019RBCP0011-EN copy

Carpal tunnel syndrome associated with amyloidosis

Authorship SCIMAGO INSTITUTIONS RANKINGS

▪ ABSTRACT

Introduction:

Amyloidosis features protein deposition in the organs and tissues and has been associated with carpal tunnel syndrome (CTS) when it occurs in the wrist. The objective is to describe a case series of patients undergoing surgery for CTS associated with amyloidosis.

Methods:

The study included 12 patients who underwent surgery to treat CTS in whom amyloidosis was proven by biopsy; the follow-up period was 5 years. The patients were evaluated by clinical tests, electroneuromyography, radiological images, and biopsy.

Results:

All patients presented with musculoskeletal complaints, severe symptoms of median nerve compression, and changes on neurophysiological tests. Surgery, synovectomy, and biopsy were performed. In the postoperative period, five patients (41%) developed chronic pain and reflex sympathetic dystrophy.

Conclusion:

A higher frequency of postoperative pain was observed in the patients, demonstrating the need for caution in the approach and treatment of this association.

Keywords:
Amyloidosis; Carpal tunnel syndrome; Reconstructive surgical procedures; Orthopedic procedures; Delivery of health care.

Age	Sex	Musculoskeletal change	Clinical score	EMG score	Surgical score	Time between symptom onset and treatment	Follow-up	Postoperative evolution
38	F	Wrist, elbow, and shoulder	III	6	III	17 years	9 years	Dystrophy
74	F	Elbow and shoulder	II	6	II	2 years	3 years	Dystrophy
72	F	Knee	II	5	III	2 years	6 years	Normal
62	F	Cervical spine	III	5	III	1 year	3 years	Improvement
71	M	Shoulder	III	5	II	6 months	4 years	Improvement
56	F	Tenosynovitis	III	5	III	2 years	1 year	Dystrophy
48	M	Tenosynovitis	III	5	I	1 year	3 years	Chronic pain and atrophy
50	F	Cervical spine	I	5	II	2 years	5 years	Normal
64	M	Column and polyarthralgia	II	5	III	1 year	1 year	Normal
53	F	Cervical and dorsal	III	5	III	3 years	6 years	Improvement
73	F	Tenosynovitis	III	5	III	5 years	1 year	Improvement
72	F	Shoulder, knee, and cervical	III	5	III	5 years	5 years	Neuropathic pain, Polineuropatiapolyneuropathy

Sociedade Brasileira de Cirurgia Plástica Rua Funchal, 129 - 2º Andar / cep: 04551-060, São Paulo - SP / Brasil, Tel: +55 (11) 3044-0000 - São Paulo - SP - Brazil
E-mail: rbcp@cirurgiaplastica.org.br

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[1] Institution: Rede Sarah de Hospitais de Reabilitação, Brasília, DF, Brasil.

Degree
0	Normal
I	Very mild; demonstrable only with more sensitive tests
II	Mild; sensory nerve conduction slow velocity, normal motor latency
III	Moderate; sensory potential preserved with motor slowing, motor latency of the abductor pollicis brevis (APB) < 6.5ms
IV	Severe; sensory potential absent, but motor response preserved, distal motor latency to APB < 6.5 ms
V	Very severe; terminal latency to APB > 6.5 ms
V	Extremely severe; sensory and motor potentials unrecordable (surface motor potential from APB < 0.2 mV amplitude)

Grading of symptoms
Grade I	Intermittent symptoms of pain and paresthesia, nocturnal paresthesia in the distribution of the median nerve, motor and sensory exam normal.
Grade II	Constant symptoms with a reduction of the fine pincer grasp and sensory alterations in the Semmes-Weinstein Monofilament test with weakness of the thenar muscles.
Grade III	Extensive sensory loss and atrophy of the thenar muscles.
Perioperative findings
I - Normal	Thickening and flattening of the nerve with normal vascularization and structures of the epineurium, without fibrosis.
II - Moderate	Moderate decrease in vascularization, mild to moderate fibrosis in some part of the nerve, mild to moderate synovial thickening.
III - Severe	Loss of vascularization, diffuse fibrosis around the nerve, large synovial thickening, and appearance of pseudoneuroma.
Histopathological findings	Fibrosis, thickening of the collagen bundles, hyaline degeneration, proliferation of the synovia, edema and vascular lesions, amyloid deposits.

KTB	Conception and design study, data curation, project administration.
GCSA	Analysis and/or data interpretation, final manuscript approval, writing - original draft preparation.
UPS	Investigation, methodology, supervision.
GBM	Methodology, project administration, writing - review & editing.

KTB	Coleta de dados, concepção e desenho do estudo, gerenciamento do projeto.
GCSA	Análise e/ou interpretação dos dados, aprovação final do manuscrito, redação - preparação do original.
UPS	Investigação, metodologia, supervisão.
GBM	Gerenciamento do projeto, metodologia, redação - revisão e edição.