Prevalence of amyloid deposition and cardiac amyloidosis in shoulder disease compared to carpal tunnel syndrome

Eriku Yamada, MD; Tomoyuki Umemoto, MD, PhD; Towako Taguchi, MD, PhD; Iichiroh Onishi, MD, PhD; Akiko Yamamoto, MD; Kazuya Tsukamoto, MD; Takuya Ibara, PhD; Toru Sasaki, MD, PhD; Hidetoshi Kaburagi, MD, PhD; Yasuhiro Maejima, MD, PhD; Tetsuo Sasano, MD, PhD; Kenichi Ohashi, MD, PhD; Toshitaka Yoshii, MD, PhD; Akimoto Nimura, MD, PhD; Koji Fujita, MD, PhD

JSES International (Mar 2024)

Prevalence of amyloid deposition and cardiac amyloidosis in shoulder disease compared to carpal tunnel syndrome

Eriku Yamada, MD,
Tomoyuki Umemoto, MD, PhD,
Towako Taguchi, MD, PhD,
Iichiroh Onishi, MD, PhD,
Akiko Yamamoto, MD,
Kazuya Tsukamoto, MD,
Takuya Ibara, PhD,
Toru Sasaki, MD, PhD,
Hidetoshi Kaburagi, MD, PhD,
Yasuhiro Maejima, MD, PhD,
Tetsuo Sasano, MD, PhD,
Kenichi Ohashi, MD, PhD,
Toshitaka Yoshii, MD, PhD,
Akimoto Nimura, MD, PhD,
Koji Fujita, MD, PhD

Affiliations

Eriku Yamada, MD: Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Tomoyuki Umemoto, MD, PhD: Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Towako Taguchi, MD, PhD: Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Iichiroh Onishi, MD, PhD: Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Akiko Yamamoto, MD: Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Kazuya Tsukamoto, MD: Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Takuya Ibara, PhD: Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Toru Sasaki, MD, PhD: Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Hidetoshi Kaburagi, MD, PhD: Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Yasuhiro Maejima, MD, PhD: Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Tetsuo Sasano, MD, PhD: Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Kenichi Ohashi, MD, PhD: Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Toshitaka Yoshii, MD, PhD: Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Akimoto Nimura, MD, PhD: Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
Koji Fujita, MD, PhD: Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan; Division of Medical Design Innovations, Open Innovation Center, Institute of Research Innovation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan; Corresponding author: Koji Fujita, MD, PhD, Division of Medical Design Innovations, Open Innovation Center, Institute of Research Innovation, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.

Journal volume & issue: Vol. 8, no. 2
pp. 349 – 354

Abstract

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Background: Cardiac amyloidosis is a fatal disease of severe heart failure caused by the accumulation of amyloid in the myocardium. This disease is often advanced by the time cardiac symptoms appear; therefore, early detection and treatment are critical for a good prognosis. Recently, it has been suggested that cardiac amyloidosis is implicated in several orthopedic diseases, including carpal tunnel syndrome (CTS), which is often reported to precede cardiac dysfunction. Shoulder disease has also been suggested to be associated with cardiac amyloidosis; however, there have been no reports investigating the rate of amyloid deposition in shoulder specimens and the simultaneous prevalence of cardiac amyloidosis. Herein, we investigated the prevalence of intraoperative specimen amyloid deposition and cardiac amyloidosis in shoulder disease and CTS to determine the usefulness of shoulder specimen screening as a predictor of cardiac amyloidosis development. Methods: A total of 41 patients undergoing arthroscopic shoulder surgery and 33 patients undergoing CTS surgery were enrolled in this study. The shoulder group included rotator cuff tears, contracture of the shoulder, synovitis, and calcific tendonitis. In the shoulder group, a small sample of synovium and the long head of the biceps brachii tendon were harvested, while the transverse carpal ligament was harvested from the CTS group. The intraoperative specimens were pathologically examined for amyloid deposition, and patients with amyloid deposition were examined for the presence of cardiac amyloidosis by cardiac evaluation. Results: In the shoulder group, three cases (7.3%) of transthyretin amyloid deposition were found, all of which involved rotator cuff tears. None of these three cases with amyloid deposition were associated with cardiac amyloidosis. When examining the specimens, the amyloid deposition rate in the long head of the biceps brachii tendon was higher than that in the synovium. In the CTS group, 12 cases (36.4%) of transthyretin amyloid deposition were observed. Of these cases, seven underwent cardiac evaluation and two were identified with cardiac amyloidosis. Conclusion: While the prevalence of amyloid deposition and cardiac amyloidosis in the CTS group was consistent with previous reports, the shoulder group showed a lower deposition rate and no concomitant cardiac amyloidosis. Therefore, it remains debatable whether investigating amyloid deposition in samples obtained from shoulder surgery is beneficial for the early detection of cardiac amyloidosis.

Published in JSES International

ISSN: 2666-6383 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://www.journals.elsevier.com/jses-international

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