Ultrasound changes in the wrist and hand in hemodialysis patients

Dialysis related amyloidosis (DRA) is a common complication of chronic dialysis, but diagnosis can be difficult. Hand involvement, as carpal tunnel syndrome (CTS) or particularly amyloid hand, can affect dexterity. To investigate the prevalence and extent of hand involvement, ultrasound evaluation of the carpal tunnel and tendons of the hand was performed in 25 chronic hemodialysis patients. Clinical symptoms of CTS were present in 18/50 wrists (36%); symptomatic patients had undergone hemodialysis for a significantly longer period than those without symptoms (16 +/- 2.9 years vs 5.3 +/- 3.0 years). The ultrasound indicators suggestive of DRA in the wrist which correlated with CTS were 1) increased carpal tunnel depth (15 +/- 2.3 mm vs 11 +/- 1.5 mm), 2) increased displacement of flexor tendons from the radius (3.4 +/- 2.4 mm vs 11 +/- 0.6 mm), and 3) presence of hypoechoic masses, erosions and fluid collections (16% of wrists). There was no relationship between symptoms and either flexor retinaculum thickness or median nerve surface area index. Five patients (20%) had severe stiffness of their fingers; ultrasound revealed thickening of the tendons of the hand in all these cases. Ultrasound technology allows the non-invasive examination of the wrist and hand for DRA and may be valuable in diagnosis and planning surgery.