Severe Destructive Tendinopathy in the Wrist Due to Dialysis-Related Amyloidosis

Abstract

Dialysis-related amyloidosis (DRA) is a specific subtype of amyloidosis with several clinical presentations. Herein we report a case of severe destructive tendinopathy around the wrist associated with long-standing hemodialysis (HD). A 63-year-old female patient who had been on regular HD for 23 years suffered from symptoms of pain and a palpable mass around the wrist. Magnetic resonance imaging showed an ill-defined soft tissue mass around the extensor tendons that partially invaded the wrist joint. We performed surgical excision and tenolysis for the mass. The operative finding revealed an ill-defined yellowish soft tissue mass extensively invading the extensor tendons and wrist joint. The tendon fibers were severely fibrillated and showed impending rupture due to the infiltrated mass. Histological examination showed DRA. Amyloidosis-induced tendinopathy should be considered when a patient on long-term HD complains of an unusual mass-like lesion in the extremity and/or nonspecific joint stiffness. Early surgical intervention improves patient’s disability and decreases the risk of spontaneous tendon rupture.

Quantitative evaluation of the Achilles tendon and supraspinatus tendon in end‐stage kidney disease patients: A potential tool for predicting spontaneous tendon rupture

“…In addition, there are many other hypotheses about the etiology of tendinopathy in ESKD and dialysis patients. For example, some studies suggested that β2-microglobulin introduced amyloidosis in the tendon of dialysis patients may be the cause of tendon thickening and other symptoms of nerve damage [31][32][33]. Our results revealed that the tendon thickness in ESKD patients tends to be higher than in normal people; however, the observed difference was not statistically different, which may be partly due to the insufficient number of cases in our groups, and partly due to the possible differences in the degree of systemic tendon amyloidosis.…”