Managing Carpal Tunnel Syndrome if You Have ATTR-CM

Here’s what experts know so far: When you have ATTR-CM, your body deposits proteins called amyloids into the heart muscle, making it thicker and stiffer. This brings on symptoms such as shortness of breath and fatigue, says Michelle Kittleson, MD, PhD, chair of the writing group for the 2020 American Heart Association Scientific Statement on Cardiac Amyloidosis and a professor of medicine at the Smidt Heart Institute at Cedars-Sinai in Los Angeles. But these proteins have an impact on more than the heart. They travel to other places in the body, as well, she says.

Amyloid buildup can affect the gastrointestinal system, the peripheral nervous system, and the musculoskeletal system, in addition to the heart, says Maureen Geary, a nurse practitioner in the amyloidosis program at New York University Langone in New York City.

This type of testing became more prevalent once healthcare providers started to recognize a pattern: After looking back at the medical histories of people with ATTR-CM, it became clear that many adults who were diagnosed with cardiac amyloidosis after presenting with heart problems had been treated for bilateral carpal tunnel syndrome five to 10 years earlier, Geary says.

If your orthopedist or surgeon suspects your carpal tunnel syndrome could be related to amyloidosis, you’ll be referred to a cardiologist (if you don’t see one already). They’ll monitor you for symptoms of ATTR-CM. That way, “You’ll catch the disease as soon as there are heart-related manifestations, and that affords you the opportunity for early initiation of therapy,” Kittleson says. The earlier you treat ATTR-CM, the longer your life expectancy with the condition will be — and the better your quality of life during those years, she adds.

If you’re diagnosed with carpal tunnel syndrome and have ATTR-CM, you’ll be treated the same way as anyone else with the wrist condition. “There’s no amyloid-specific treatment for any of the musculoskeletal manifestations of TTR amyloidosis,” Kittleson says.

On top of injections and surgery, you might try wearing hand splints at night, as carpal tunnel pain tends to be worse in the morning, Geary says. Your doctor may also recommend working with a physical or occupational therapist, who can teach you some helpful exercises to maintain wrist strength and mobility and limit pain, she adds.

And it’s important to stay on top of your ATTR treatment plan. Current amyloidosis treatment can’t cure the disease, but it can slow its progression. While there isn’t currently any clinical research examining the effects of ATTR-CM treatment on carpal tunnel syndrome, it’s possible your amyloidosis medication could reduce your wrist symptoms, too. “It stands to reason that if it helps the heart, it [might] help other areas,” Kittleson hypothesizes.

• People with ATTR-CM tend to develop carpal tunnel syndrome in both wrists about five to 10 years before their amyloidosis diagnosis. (Not everyone with carpal tunnel syndrome will develop ATTR-CM, though.)
• Treatments for carpal tunnel syndrome include steroid injections and surgery to relieve pressure on the median nerve.
• Since carpal tunnel syndrome can return in people who have ATTR-CM, your doctor may also recommend lifestyle changes, such as wearing hand splints at night.