Understanding the carpal tunnel syndrome and ATTR-CM connection
Fact-checked by Tingling, numbness, and aching in the hands are the classic hallmarks of carpal tunnel syndrome (CTS). However, these symptoms can occur alongside transthyretin amyloid cardiomyopathy (ATTR-CM).
While ATTR-CM mainly affects your heart, the toxic amyloid deposits that cause the disease can build up in other areas, such as around the carpal tunnel in the wrist. Because the walls of the wrist cannot stretch, this extra material creates intense internal pressure. This pressure eventually pinches the median nerve, which carries signals to your hand, causing the classic numbness and pain of carpal tunnel syndrome.
For many, carpal tunnel syndrome serves as an early sign of ATTR-CM that appears years before heart-related symptoms surface. While these wrist symptoms can be the first clue to an ATTR-CM diagnosis, the connection isn’t universal. Not everyone with the heart condition will experience nerve compression, and the vast majority of standard carpal tunnel cases are unrelated to ATTR-CM.
ATTR-CM and carpal tunnel syndrome
ATTR-CM causes amyloid deposits to build up in different parts of the body. Amyloid buildup in and around tendons in the wrist can pinch the median nerve that runs through the narrow carpal tunnel, causing CTS.
Eventually, you may notice numbness, tingling, pain, burning, or weakness in your hands and forearms. The sensations may get worse when you hold something like a phone, steering wheel, or book.
You may also find that your grip is weaker. Items such as keys, cups, or utensils may slip from your hand more easily, making daily tasks challenging, especially when you’re already dealing with other ATTR-CM symptoms.
Carpal tunnel syndrome diagnosis
If your symptoms persist, ask someone on your healthcare team, such as your primary care doctor or your cardiologist, to test for CTS.
CTS diagnostic tests may include physical tests, such as:
- Tinel’s sign: Your doctor lightly taps over the wrist’s median nerve. Tapping a compressed nerve usually causes tingling in the fingers.
- Phalen’s test: Your doctor flexes your wrist, or you press the backs of your hands together, and hold for 30 to 60 seconds. If you have CTS, your fingers become numb or tingle.
While it’s possible to confirm CTS with a single test, the results can be inconclusive. In those cases, your doctor may refer you to a neurologist for a nerve conduction study or request additional imaging tests to look at the inside of your wrist and exclude other possible causes.
A nerve conduction study involves using small electrodes that release mild electrical pulses to stimulate the median nerve. The test then records how quickly signals travel across your wrist. Slower speeds may be a sign of nerve compression.
Steps for relief
If you have pain in one or both hands, talk to your healthcare team. While ATTR-CM medications can slow amyloid buildup, they cannot clear existing deposits.
Options for managing CTS include:
- splints
- reducing repetitive actions
- physical therapy
- corticosteroid injections
- surgery
At-home remedies that your doctor may recommend, especially if CTS symptoms are mild, include:
- wearing wrist splints at night to reduce pressure on the median nerve
- stopping or reducing activities that involve repetitive strain, such as prolonged typing, racquet sports, golf, tools with vibrating handles, driving (gripping steering wheels), and holding phones
- using ice packs or cold compresses to reduce swelling
- taking non-steroidal anti-inflammatory medicines to relieve pain and inflammation
If your hand weakness or pain is interfering with your daily life, including sleep, ask your doctor to refer you to an occupational or physical therapist.
An occupational or physical therapist can show you how to protect your wrists and keep your hands as strong and flexible as possible, making tasks feel more manageable.
Additional treatment options
When home remedies and conservative therapy aren’t relieving the pain or tingling, or if nerve damage is confirmed, your doctor may want to try a corticosteroid injection. The injections can reduce inflammation and swelling around the median nerve.
If the shots are not successful, surgery to release the compressed nerve may be recommended. During carpal tunnel release surgery, the surgeon may take a small piece of tissue from the carpal tunnel area to test for amyloid deposits in your wrists. It is also a way for doctors to confirm a diagnosis of ATTR-CM in its early stages.
Amyloidosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
