CARPAL-TUNNEL SYNDROME, AMYLOID TENOSYNOVITIS, AND PERIODIC HEMODIALYSIS

  • 1 January 1981
    • journal article
    • research article
    • Vol. 137  (10) , 613-624
Abstract
Ten patients on chronic hemodialysis developing 15 carpal tunnel syndromes (5 unilateral and 5 bilateral) are reported. Various causes for the renal failure were present, and clinical signs of the carpal tunnel syndrome developed at a laste stage. The arteriovenous fistula required for extrarenal epuration was antebrachial and of the laterolateral type, except in 1 case when it was lateroterminal. The carpal tunnel syndrome was always on the same side as the fistula, developing at a later stage on the contralateral side in the 5 cases of bilateral disorders. Lesions were severe in 11 of the 15 cases. Some patients noted fluctuations in pain symptoms during hemodialysis, either improving or becoming worse. Gross pathological findings during operation (13 cases) were tensynovitis with epineural hypervascularization on the side of the fistula, and a similar lesion although without hypervascularization on the opposite side. In 9 cases atypical hypertrophic tenosynovitis was observed. Histological examination in 12 cases demonstrated typical tenosynovitis in 3 patients, but granulomatous tenosynovitis with amyloid deposits was reported in 9. Lesions were bilateral in 2 cases, on the side opposite the fistula. Ultrastructural study confirmed the amyloid nature of the deposits in 3 cases, the microfibrillary appearance (80-100 .ANG.) being characteristic of amyloid substance. This rare complication does not represent a common carpal tunnel syndrome, and 3 mechanisms may be involved in its induction: peripheral uremic neuropathy, hemodynamic modifications resulting from the antebrachial arteriovenous shunt and amyloid formation in the flexor synovial sheaths. In the latter case, the type of amyloid disease may be a primary systemic amyloidosis not previously detected, or an elective amyloid process localized to the tenosynovial and periarticular tissues.