In a prospective multicenter cohort of 109 older patients undergoing surgery for idiopathic carpal tunnel syndrome, tenosynovial biopsy–guided screening identified amyloid deposition in 61 patients (56%), and among the 52 who completed cardiac evaluation, nine (17%) were diagnosed with transthyretin amyloid cardiomyopathy (ATTR-CM). Screening-detected cases were predominantly early stage, with 8 of 9 classified as National Amyloidosis Centre stage I and most patients asymptomatic, indicating that this surgical screening approach can detect ATTR-CM earlier than routine clinical pathways in a high-risk population.