Cardiac Amyloidosis Screening at Trigger Finger Release Surgery.

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.