Amyloidosis and Carpal Tunnel Syndrome: An Update on Diagnostic and Management Considerations

In the past decade, hand and upper-extremity surgeons have become increasingly aware of the relationship between carpal tunnel syndrome and cardiac amyloidosis. Recent advances in medical management of cardiac amyloidosis in the form of disease-modifying therapies that improve survival have aided decreasing morbidity and in some cases, hand surgeons can detect evidence of amyloid deposition prior to clinical manifestations of cardiac disease. Despite improvements in biopsy techniques and analysis, there remain a number of controversies related to this condition that directly impact upper-extremity surgeons. At present, the number needed to screen for biopsy procedures during carpal tunnel release remains poorly defined relative to routine cancer screening protocols and there are a paucity of prior investigations assessing the costs associated with biopsy during carpal tunnel release. This narrative review aims to provide an update on diagnostic and management considerations for hand surgeons evaluating patients with carpal tunnel syndrome.