[Carpal tunnel syndrome in chronic hemodialysis patients. An etiopathogenetic approach. Apropos of 31 surgically-treated cases]

Abstract

Thirty-one carpal tunnel syndromes were seen in 20 patients treated by haemodialysis for renal failure. At the time of operation, the duration of the haemodialysis was an average of 9 years. On 24 occasions, the syndrome existed in the limb of the arterio venous fistula but on 7 occasions it only appeared in the opposite limb. The syndrome is characterised by the development of, or the worsening of paraesthesiae during haemodialysis sessions. The degree and duration of the numbness in the fingers in the morning was particularly striking. At surgery, the nerve was always obviously narrowed. It was noted in 21 cases that there were greyish granulation in the synovium and sometimes intra tendinous nodules. All the operated cases improved. The pathogenesis is discussed in relation to amyloid deposits. The haemodynamic role of the fistula seems to be to make the development of the lesion more likely. Microscopic examination and biochemical studies give rise to the conclusion that this is an AL type of amyloidosis.