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Carpal Tunnel Syndrome Secondary To Transthyretin Amyloidosis
 

Author: Adam Girmann, MD
Affiliation: Inertia Medical
Co Author(s): Jeremy Girmann, DO, RMSK
Senior Editor: Laura Mattson, DO

Clinical Vignette: A 79-year-old male presents with progressive numbness and tingling in digits 1-3 of the right hand, along with wrist and hand pain. Physical exam demonstrates altered sensation in the median nerve distribution and thenar eminence atrophy. The atypical ultrasound findings during evaluation prompts further diagnostic workup, which ultimately leads to a diagnosis of transthyretin (ATTR) amyloidosis.

Type of Probe Used: 4-12 MHz high frequency linear array transducer



Unlabeled short axis view of the mid carpal tunnel.
View Video

Video demonstrates scanning of the median nerve in short axis as it traverses the carpal tunnel from the inlet to the distal portion in a case of carpal syndrome secondary to transthyretin amyloidosis. As the nerve courses distally, there is abrupt tapering and compression within the carpal tunnel, with the median nerve becoming poorly visualized distally. The nerve is surrounded throughout the tunnel by diffuse, homogeneous isoechoic soft tissue.


Labeled long axis view of the median nerve at the wrist demonstrating progressive distal tapering of the median nerve within the carpal tunnel, with surrounding homogeneous isoechoic soft tissue.


Unlabeled long axis view of the median nerve at the wrist.


Labeled short axis view of the proximal carpal tunnel with an enlarged median nerve at the carpal tunnel inlet with cross-sectional area (CSA) measuring 25 mm². Normal CSA is <10 mm², borderline is 10-12 mm², abnormal is >12 mm².


Unlabeled short axis view of the proximal carpal tunnel.

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