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 hemodialysis.

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 patient had positive shoulder joint fluid aspirate. The thicknesses of the following structures were measured: the rotator cuff, the subacromial-subdeltoid bursa, and the long head of the biceps tendon and its synovial sheath. The presence of intra- or periarticular masses or nodules, hyperechoic areas, bony erosions, and calcifications was specifically assessed. Shoulder sonograms from dialysis patients were compared with normal sonograms obtained for 20 asymptomatic shoulders of patients 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 amyloidosis but none of the control subjects had a rotator cuff thickness greater than 7 mm. The synovial sheath of the long head of the biceps tendon was thickened in 10 shoulders of patients with amyloidosis and in one normal shoulder. The subacromial-subdeltoid bursa was thickened in seven shoulders of patients with amyloidosis but not in any shoulders in the control group. Eight shoulder sonograms from dialysis patients showed intra- or periarticular nodules.

Conclusion: Sonographic findings 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 nodules within or around the joint. Shoulder sonography may be useful as a noninvasive technique for the diagnosis of dialysis-related amyloidosis in the proper clinical setting.