AMYLOIDOSIS OF THE SHOULDER IN PATIENTS ON CHRONIC-HEMODIALYSIS - SONOGRAPHIC FINDINGS

OBJECTIVE. The purpose of this study was to determine the sonographic findings of amyloidosis in shoulders of patients on chronic hemodialys is. SUBJECTS AND METHODS. Sonograms were obtained for 19 shoulders of 11 patients on chronic hemodialysis with clinical findings suggestive of amyloidosis. Five patients had biopsy-proven amyloidosis, and one p atient had positive shoulder joint fluid aspirate, The thicknesses of the following structures were measured: the rotator cuff, the subacrom ial-subdeltoid bursa, and the long head of the biceps tendon and its s ynovial sheath. The presence of intra- or periarticular masses or nodu les, hyperechoic areas, bony erosions, and calcifications was specific ally assessed. Shoulder sonograms from dialysis patients were compared with normal sonograms obtained for 20 asymptomatic shoulders of patie nts without renal disease. RESULTS. The mean rotator cuff thickness in the patients with amyloidosis was significantly greater than that in the normal group (p <.0001). Ten shoulders of six patients with amyloi dosis but none of the control subjects had a rotator cuff thickness gr eater than 7 mm, The synovial sheath of the long head of the biceps te ndon was thickened in 10 shoulders of patients with amyloidosis and in one normal shoulder, The subacromial-subdeltoid bursa was thickened i n seven shoulders of patients with amyloidosis but not in any shoulder s in the control group. Eight shoulder sonograms from dialysis patient s showed intra- or periarticular nodules. CONCLUSION. Sonographic find ings associated with amyloidosis of the shoulder include thickening of the rotator cuff, the synovial sheath of the long head of the biceps tendon, and the subacromial-subdeltoid bursa and the presence of nodul es within or around the joint. Shoulder sonography may be useful as a noninvasive technique for the diagnosis of dialysis-related amyloidosi s in the proper clinical setting.