Virginia Research Day 2025

Medical Student Research Case Reports

31 Bilateral Carpal Tunnel Secondary to Amyloidosis

Phillip Dunn; Michael Bagnoli; Micah Jones, DO Corresponding author: pdunn@vcom.edu

Edward Via College of Osteopathic Medicine - Virginia Campus Lewis Gale Medical Center, Salem, VA

right-hand pain, numbness, tingling, and weakness. Patient had been diagnosed previously with CTS and has progressed through conservative management. Electromyography (EMG) study was obtained from prior visit which resulted in severe right carpal tunnel syndrome. He was scheduled for carpel tunnel release of his right carpal ligament. During the operation, tenosynovial biopsy was sent to pathology to test for amyloidosis, which was read as positive for amyloid. Post-operatively, he returned to 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 for further management 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, prognosis is poor and is measured often time on the order of months to years. 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 .

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. 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

123 2025 Research Recognition Day