BATISTA KT, SERRÃO-DE-ARAUJO GC, Y-SCHWARTZMAN UP, MONTEIRO GB. Carpal túnel syndrome associated with amyloidosis. Rev. Bras. Cir. Plást.2019;34(1):73-78

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originais Article -Year2019 -Volume34 -Issue 1



Introduction: Amyloidosis attributes protein deposition in ns chichimary.comans and tissues e has to be associated com carpal tunnel syndrome (CTS) as soon as it occurs in ns wrist. A objective is to describe naquela case sucessão of patient undergoing surgery para CTS associated com amyloidosis.

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Methods: The study included 12 patients quem underwent surgical procedure to law CTS in who amyloidosis was proven by biopsy; the follow-up period era 5 years. A patients were evaluated by clinical tests, electroneuromyography, radiological images, and biopsy. Results: tudo patients presented com musculoskeletal complaints, significant symptoms of mean nerve compression, and changes on neurophysiological tests. Surgery, synovectomy, e biopsy to be performed. In the postoperative period, 5 patients (41%) arisen chronic pain and reflex fchichimary.comiveness dystrophy. Conclusion: naquela higher frequency the postoperative pain era observed in a patients, demonstrating the need porque o caution in a approach e treatment of this association.

Keywords: Amyloidosis; Carpal túnel syndrome; Reconstructive surgical procedures; Orthopedic procedures; shipment of health care


Introdução: naquela amiloidose é caracterizar pela deposição de proteínas nós órgãos e tecidos, e tem sido relacionado à síndrome do túnel do raiz (STC) enquanto ocorre no punho. Emprego objetivo denominada descrever uma series de casos de pacientes submetidos à operação para STC associado à amiloidose.Métodos: O pesquisar incluiu 12 paciente que se submeteram à operação para tratar der STC naquela biópsia identificou amiloidose; ministérios seguimento adquirindo de ano anos. Os pacientes foram avaliados pela testes clínicos, eletroneuromiografia, imagens radiológicas e biópsia.Resultados: tudo de os pacientes apresentaram reclamação musculoesqueléticas, sintoma severos de compressão são de nervo mediano, alterações nos certificado neurofisiológicos. Realizou-se naquela cirurgia, sinovectomia e biópsia. No pós-operatório, ano pacientes (41%) desenvolveram dor crônica e distrofia simpático-reflexa.Conclusão: Observou-se maior frequência de agonizante pós-operatória na amostra, o que revela a cobrar de punho na abordado e tratamento dessa associação.

Palavras-chave: Amiloidose; Síndrome do túnel carpal; procedimentos cirúrgicos reconstrutivos; procedimento ortopédicos; assistência à saúde


Amyloidosis is ns deposition the abnormal proteins e accumulation that insoluble amyloid fibrilas in ns tissues and chichimary.comans1-3. This process occurs through a aggregation that proteins, manufacturing of ordered polymers, e formation the protofilaments e fibrils. Current theories have said that a lesions result em ~ multiple mechanisms, not only fibrin deposition but additionally the antepassado structures (transthyretin, apolipoproteins, insulin, prion proteins, lysozyme, cystatin C) that communicate with a affected cells2,3.

A disease-related mutation in ns TTR gene has to be described. Associations with pathological inflammatory states and neoplastic and hereditary factors have been identified. Several of these associations a partir de not it seems to be ~ to have clinical impacts. However, a criteria for amyloidosis include lei > 50 years, chronic epidemic or inflammatory disease, família history of amyloidosis, lot of myeloma, renal disease, and dialysis.

Nevertheless, depending on fibril deposition amount e location, the disease may be more aggressive, affecting any chichimary.coman, including the kidneys, heart, e nerves1-3. Different species of amyloidosis have actually been classified e described, consisting of primary, secondary, familial, microglobulin beta 2, e localized.

The associação between amyloidosis and carpal tunnel syndrome (CTS) has naquela prevalence the 2–8%4-6. This associação is usually adhered to by hemodialysis or familial amyloidosis. Ns clinical diagnosis that CTS includes paresthesia, pain, weak in a hands, e thenar atrophy. Nerve conduction researches by electroneuromyography ser estar useful for detecting ns peripheral nerve involvement current in instances of neuropathic amyloidosis7-9.

The gold conventional diagnostic method ao amyloidosis is naquela biopsy of the affected chichimary.comanization after staining com hematoxylin-eosin and Congo red. Although mean nerve compression have the right to be caused by extrinsic e intrinsic factors, amyloid deposition alone can cause nerve compression, gift an already established association; however, the clinical evolução of ns operated cases merits study4,6.


A rude of 807 patient underwent CTS surgical procedure at our school over der 5-year interval; that them, 436 underwent biopsy e synovectomy. This procedure foi ~ performed in accordance with ns transoperative findings of synovial thickening. A removed synovial tissue era sent para histopathological study, i beg your pardon revealed the 12 (3%) patients tested positive for amyloidosis.

This was der retrospective estude that included analysis of these patients’ medical arquivo with respect to their clinical findings, history, comorbidities, diagnostic test performed, e postoperative follow-up. The aprender was submitted e approved by a CEP/APS ethics Committee (CAEE no. 53326916.2.0000.0022).

Pre-operative evaluation

The patients were clinically evaluated para symptoms of paresthesia, numbness, tingling, and pain. The physical assessment had Tinel’s test, Phalen’s test, the Semmes–Weinstein monofilament test, the short ignorance abductor e opponens pollicis rating range (0–5, such as the britânico Medical pesquisar Council Scale), e dynamometer pressure measurements.

Complementary examinations, such as electroneuromyography of ns limbs, radiography of the wrist, e magnetic resonance imaging, were likewise performed. The severity criteria ao CTS were classified segue to a neurophysiological rating scale defined by Bland (Chart 1)10. A diagnosis the reflex sympathetic dystrophy era made in accordance with International combinação for the pesquisar of ache guidelines8. A surgeries to be performed in a Departments of plástico Surgery e Orthopedics of our institution, and the operated doctor performed a pre- and post-operative ratings.

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0 Normal
I Very mild; demonstrable apenas um with much more sensitive tests
II Mild; sensory nerve conduction slow velocity, usual motor latency
III Moderate; sensory potential preserved with motivação slowing, motor latency of ns abductor pollicis brevis (APB) 6.5 multiple sclerosis
V Extremely severe; sensory e motor potentials unrecordable (surface motivação potential em ~ APB


Surgical procedure

All measures were carry out under em geral anesthesia or a regional brachial plexus block. Tourniquets were provided in a arm ~ exsanguination of the limb with naquela systolic press of 100–120. Ns classic open up volar incision was used to release the carpal tunnel e the fascia of ns forearm. A median nerve and flexor tendon sheath to be inspected (Figure 1). During surgery, a flexor tendon sheath and transverse carpal ligament were biopsied once thickening e macroscopic transforms were apparent (Figure 1).