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Cardiac Amyloidosis Screening at Trigger Finger Release Surgery.

Brett W Sperry1, Rola Khedraki2, Andrej Gabrovsek2

  • 1Department 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.

The American Journal of Cardiology
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PubMed
Summary
This summary is machine-generated.

Biopsies during trigger finger release surgery found amyloidosis in 2% of patients, significantly lower than the 10% yield from carpal tunnel release surgery. This impacts screening strategies for cardiac amyloidosis in orthopedic patients.

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Area of Science:

  • Orthopedics
  • Cardiology
  • Pathology

Background:

  • Cardiac amyloidosis often presents with orthopedic symptoms like carpal tunnel syndrome.
  • Amyloid deposits are found in 10% of patients undergoing carpal tunnel release surgery.
  • The prevalence of amyloid in trigger finger tenosynovium is not well-established.

Purpose of the Study:

  • To determine the prevalence of amyloid deposition in patients undergoing surgery for idiopathic trigger finger.
  • To compare the diagnostic yield of trigger finger tenosynovium biopsy with carpal tunnel release surgery for amyloidosis detection.
  • To assess the implications for cardiac amyloidosis screening in orthopedic surgery.

Main Methods:

  • Prospective cross-sectional study of 100 patients (≥50 years) undergoing idiopathic trigger finger release surgery.
  • Excision and Congo red staining of tenosynovium samples; mass spectrometry for amyloid subtyping if positive.
  • Cardiac evaluation for patients with confirmed amyloid deposition.

Main Results:

  • Only 2% (2/100) of patients demonstrated amyloid deposits in the trigger finger tenosynovium.
  • One patient had fibrinogen A α-chain amyloidosis; the other had untyped amyloidosis. Neither had cardiac involvement.
  • Two patients with amyloid in the carpal tunnel had false-negative trigger finger samples, highlighting potential diagnostic gaps.

Conclusions:

  • Biopsy during trigger finger release surgery has a low yield (2%) for detecting amyloidosis compared to carpal tunnel release (10%).
  • This finding suggests trigger finger surgery is less effective for screening cardiac amyloidosis.
  • Diagnostic algorithms for orthopedic patients require refinement based on these prevalence data.