Carpal Tunnel Syndrome Secondary to Amyloidosis Deposition

Introduction Carpal tunnel syndrome (CTS) is the most common upper extremity compressive neuropathy found in roughly 4% of the population. Furthermore, up to 60% of those cases are found to have bilateral symptoms. Amyloid accumulation can cause carpal tunnel syndrome, bilateral in most cases. CTS is one of the earliest manifestations of amyloidosis. Prompt recognition and early intervention are critical for improving patients’ given the insidious and progressive nature of this disease. There are published recommendations for testing patients with CTS for amyloidosis, but no current guidelines on how to follow these patients, especially if they have no other symptoms or pathology related to deposition of amyloid. Case Presentation We present a 59-year-old, right-hand-dominant male with severe, ongoing right-hand pain, numbness, tingling, and weakness. The patient had been diagnosed previously with CTS and has progressed through conservative management. An electromyography (EMG) study was obtained from a prior visit, which resulted in severe right carpal tunnel syndrome. He was scheduled for open carpal tunnel release of his right carpal ligament, and due to high clinical suspicion, tenosynovial biopsy was sent to test for amyloidosis, which was read as positive for amyloid. Post-operatively, he returned to the clinic for suture removal of his right hand and presented with similar carpal tunnel symptoms in his left hand. Currently, no other clinical symptoms of systemic amyloidosis are present. He was referred to hematology and cardiology for further management and workup of amyloidosis. Discussion Bilateral CTS is a common, red flag manifestation of amyloidosis and can predate overt cardiac manifestations of amyloidosis by several years. Once symptomatic of cardiac involvement, the prognosis is poor. This case aims to highlight the importance of early detection using pathological specimen biopsies of the carpal tunnel and the importance of appropriate specialist referral to screen for organ involvement.