CONSENSUS RECOMMENDATION Amyloidosis has various clinical manifestations that can include cardiac dysfunction. Carpal tunnel is often one of the earliest clinical manifestations of amyloidosis (Nakagawa 2016). A recent cross-sectional study of patients with carpal tunnel syndrome undergoing carpal tunnel release showed that 10.2% exhibited amyloid deposits on tenosynovial biopsy, leading 4% to disease-modifying treatment. Although the diagnosis of amyloidosis is rare, given the lack of high-quality evidence to guide the decision to perform pathological analysis of tenosynovium, it is the opinion of the workgroup that this decision should be guided by patient preference and risk factors (Sood 2021).
Benefits/Harms of Implementation
The benefits of tenosynovial analysis include the possible detection and possible treatment of amyloidosis. The harms include the downstream care cascade that may result from a positive biopsy (e.g., lab testing, echocardiograms) that may be negative.
Cost Effectiveness/Resource Utilization
There are costs associated and resources utilized in the pathological analysis of tenosynovium. There are also downstream care cascades that may result from a positive sampling.
Acceptability
Accepted practice but may vary based upon risk factors and patient preference.
Feasibility
No feasibility issues beyond limitations in access to appropriate labs.
Future Research
Future research should involve the cost effectiveness of pathological analysis of tenosynovium based upon various risk profiles and the impact of downstream care cascades that may result from a positive sample.