Musculoskeletal manifestations of amyloidosis. A review of 83 patients on haemodialysis for at least 10 years

Abstract

Long-term regular haemodialysis for chronic renal failure is associated with amyloidosis. In this condition excess amounts of the unexcretable plasma protein beta-microglobulin are laid down in tendons, joints and bones. Amyloidosis presents with various musculoskeletal disorders only after several years of dialysis. We reviewed 83 patients who had been dialysed for at least 10 years. The commonest complaint was severe joint pain in the absence of radiological changes of arthritis (41%), the shoulders usually being the most affected (33%). Carpal tunnel syndrome had developed in 26 patients, and was bilateral in 14 of them; at operation the presence of amyloid was confirmed. Six of these patients had recurrent symptoms after a further two to three years and required another decompression. Other manifestations of amyloidosis included trigger finger, flexor tendon contracture, spontaneous tendon rupture and pathological fracture through amyloid bone cysts. The frequency of symptoms was proportional to the duration of dialysis: all 13 patients on dialysis for over 20 years were affected. Symptoms developed earlier in older patients.

Carpal Tunnel Syndrome in the Mucopolysaccharidoses and Mucolipidoses

“…The usual treatment for these children is straightforward decompression, but the addition of external neurolysis has been advised. 11 This has been used in the treatment of carpal tunnel syndrome due to amyloidosis in patients on haemodialysis, [25][26][27] and we now routinely perform synovectomy and external neurolysis. An association between carpal tunnel syndrome and trigger finger has been described in two otherwise normal children, 28 and a similar association is reported in the mucopolysaccharidoses and mucolipidoses; 6,11 we saw this in six of our patients.…”

Anomalous flexor digitorum superficialis muscle transposition for vascular coverage of the median nerve in recurrent carpal tunnel syndrome

“…This scarring occurs in 0.5% to 1.1% of patients and typically presents one year following surgery (12)(13)(14). Inflammatory tenosynovitis occurs in 0.1% to 0.7% of patients and is associated with various systemic inflammatory diseases, metabolic disorders or infectious etiologies (3,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Most recurrences due to tenosynovitis occur within months of the primary release (1,2).…”

Shoulder Pain in Long-Term Haemodialysis Patients

“…Shoulder pain is often observed in such patients and is thought to be associated with amyloidosis (Kachel et al 1983;Charra et al 1984;Kurer, Baillod and Madgwick 1991), but details of the symptoms have not been reported. The cause of this pain is not clear, but it tends to be worse at night and during dialysis in a supine position, and improves in a sitting or standing position (Imai et al 1986;Okutsu et al 1991).…”