Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, University of Missouri-Kansas City, Kansas City, Missouri.
Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Am J Cardiol. 2021 Dec 1;160:96-98. doi: 10.1016/j.amjcard.2021.08.049. Epub 2021 Oct 4.
Cardiac amyloidosis is often preceded by orthopedic manifestations such as carpal tunnel syndrome, and 10% of patients who underwent idiopathic carpal tunnel release surgery will have biopsy-confirmed amyloid deposits in the tenosynovial sheath. Trigger finger is also commonly reported in patients with amyloidosis and involves the same tendon sheath as carpal tunnel syndrome, but the prevalence of amyloid deposition is unclear. This prospective cross-sectional study enrolled 100 patients aged ≥50 years at the time of surgery for idiopathic trigger finger. Patients underwent release surgery, and a sample of the tenosynovium of the affected finger was excised, stained with Congo red, and subtyped with mass spectrometry if amyloid was demonstrated. Further cardiac evaluation was performed in patients with amyloid deposition. Of the 100 patients (mean age 65.5 ± 8.1 years) enrolled, only 2 demonstrated amyloid deposits on Congo red staining. One patient with previous proteinuric kidney disease had fibrinogen A α-chain amyloidosis, and the other patient had untyped amyloidosis. Neither patient had cardiac involvement. A total of 13 of the 100 patients underwent concomitant carpal tunnel release surgery, and 2 of these patients had amyloid deposits in the carpal tunnel with "false-negative" samples from the trigger finger tenosynovium. In conclusion, biopsy during trigger finger release surgery demonstrated a 2% yield for amyloidosis, which is significantly lower than the previously published yield of 10% during carpal tunnel release surgery. This observation has important implications for the development of diagnostic algorithms to screen patients for amyloidosis during orthopedic operations.
心脏淀粉样变性常以前肢骨科表现为前驱症状，如腕管综合征，且 10%接受特发性腕管松解手术的患者，其腱鞘组织活检可证实有淀粉样物质沉积。 淀粉样变性患者也常出现扳机指，累及与腕管综合征相同的腱鞘，但淀粉样物质沉积的患病率尚不清楚。本前瞻性病例对照研究纳入了 100 名年龄≥50 岁的特发性扳机指患者。患者接受松解手术，切除受累手指的腱鞘组织样本，刚果红染色，如显示淀粉样物质则采用质谱法进行亚型鉴定。对有淀粉样物质沉积的患者进一步进行心脏评估。在纳入的 100 名患者（平均年龄 65.5±8.1 岁）中，仅 2 名患者刚果红染色显示有淀粉样物质沉积。其中 1 名有蛋白尿性肾病既往史的患者为纤维蛋白原 Aα链淀粉样变性，另 1 名患者为未定型淀粉样变性。两名患者均无心脏受累。100 名患者中共有 13 名同时行腕管松解术，其中 2 名患者腕管中有淀粉样物质沉积，但来自扳机指腱鞘的样本为“假阴性”。总之，在扳机指松解术中进行活检，淀粉样变性的检出率为 2%，明显低于先前报道的腕管松解术的 10%检出率。这一观察结果对开发在骨科手术期间筛查淀粉样变性患者的诊断算法具有重要意义。
