Trigger Finger and Amyloid Cardiomyopathy, Usual Suspect; Amyloid Deposition

Abstract

Objectives: The aim of this study was to investigate the amyloid deposition in patients with trigger finger disease, to analyze the factors affecting amyloid deposition. In addition, we aimed to research the presence of cardiac amyloidosis in patients with amyloid deposition in flexor pulleys. Methods: Consecutive 68 patients with trigger finger treated by open release between September 2018 and November 2019 in two different hospitals were included in this study. Idiopathic trigger fingers were solely included. Patients with systemic rheumatoid diseases, chronic renal failure under hemodialysis, gout, tuberculous synovitis and previously diagnosed systemic amyloidosis including familial amyloid poly- neuropathy or multiple myeloma, pregnant patients, patients who were previously had steroid injected injections were excluded. Demographic data, other concomitant diseases and previous carpal tunnel surgeries were recorded. Immunoperoxidase and immunofluorescence methods were used to determine the amyloid presence and subtype in pathological A1 pulley specimens. Patients with amyloid deposition in biopsy specimen were further evaluated for cardiac involvement of amyloidosis. Results: The study population consisted of 18 men and 50 women with a mean age of 57,6 ± 12,2 years. Of 68 patients with trigger finger, 6 (8,8%) showed amyloid deposition in the tenosynovial tissue; and all amyloid deposits were specifically immunolabeled only with the anti-TTR antibody. No evidence of cardiac amyloidosis is found in patients with localized amyloid deposition. Conclusion: Hand surgeons should be aware of the association trigger finger and amyloidosis and consider biopsy of tenosynovial tissue particularly in patients with older age, DM, prior carpal tunnel release surgery and multi-finger involvement. Tenosynovial biopsy is a low-risk procedure that may guide to cardiologic examination of patients with positive biopsy and it will contribute to early diagnosis of cardiac amyloidosis.