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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 presented with progressive numbness and tingling in digits 1-3 of the right hand, along with wrist and hand pain. Physical exam demonstrated altered sensation in the median nerve distribution and thenar eminence atrophy. The atypical ultrasound findings during evaluation prompted further diagnostic workup, which ultimately led to a diagnosis of Transthyretin Amyloidosis (ATTR).

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



Unlabeled short axis view of the carpal tunnel inlet.


Labeled short axis view of the carpal tunnel inlet with an enlarged median nerve at the carpal tunnel inlet with cross-sectional area (CSA) measuring 25 mm² areas of relative hyperechogenicity within the median nerve itself (yellow arrows).


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


Unlabeled short axis view of the mid carpal tunnel.


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 (blue arrows).


Labeled short axis view of the mid carpal tunnel. with the median nerve becoming poorly visualized distally, consistent with severe compression and surrounding infiltrative tissue.
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.

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