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Screening for amyloidosis in trigger finger release and Dupuytren's fasciectomy
Matthias Holzbaue1,2, Julian Diepold1,2, Julian A Mihalic1,2
1Department of Orthopaedics and Traumatology, Kepler University Hospital, Linz, Austria.
Introduction:
This study investigated the prevalence of amyloid deposition in tissue obtained during trigger finger release and limited fasciectomy for Dupuytren's disease and whether these procedures may allow early detection of cardiac amyloidosis.
Methods:
This prospective, explorative study enrolled men aged >50 years and women >60 years undergoing trigger finger release or limited fasciectomy at two centres, excluding patients with known amyloidosis. Surgical specimens (A1 pulley or Dupuytren cord/nodule) were histologically analysed using Congo red staining. Positive samples underwent immunohistochemistry for amyloid subtyping and patients were referred for cardiological assessment.
Results:
Among 100 trigger finger release patients (50% women; median age 67 years), 10 specimens were Congo red positive, with amyloid confirmed in five (four transthyretin, one undifferentiated). No patient showed clinical cardiac amyloidosis. Amyloid positivity correlated with pre-existing heart failure. Among 100 limited fasciectomy patients (23% women; median age 66 years), eight specimens were Congo red positive, but none were immunohistochemically confirmed, and no clinical cardiac amyloidosis was identified.
Conclusion:
Tissue obtained at trigger finger release may represent a site for early recognition of transthyretin amyloidosis, whereas tissue from limited fasciectomy appears unsuitable for screening.
Level Of Evidence:
IV.
