Published online Sep 6, 2018. doi: 10.12998/wjcc.v6.i9.279
Peer-review started: April 3, 2018
First decision: May 21, 2018
Revised: May 26, 2018
Accepted: June 7, 2018
Article in press: June 8, 2018
Published online: September 6, 2018
Carpal tunnel syndrome (CTS) is well recognized as the most common type of peripheral neuropathy. A rare cause of CTS is tophaceous gout. Tophi deposits can accumulate in various structures including the flexor tendons, tendon sheaths, the carpal tunnel floor, transverse carpal ligament, and even the median nerve, causing various symptoms such as pain, numbness, and weakness. Tophi forming in the carpal canal can compress the median nerve, leading to CTS. Here, we describe a 25-year-old male with a family history of tophaceous gout who presented with typical CTS symptoms. Although he had chronic numbness in his right hand, he failed to present with any obvious palpable masses on his forearm or hand. However, his family history, laboratory, clinical, and magnetic resonance imaging findings were consistent with tophi deposits. CTS symptoms were eased through surgical removal of tophi and decompression of the median nerve. No recurrences of gout and CTS symptoms were reported at a one-year follow-up. This case shows that CTS symptoms could be the initial manifestation of tophaceous gout. In patients with a family history of gout and with CTS symptoms, imaging examinations are critical for early diagnosis and selecting appropriate treatment. Surgical removal of “covert” tophi and decompression of the median nerve is an effective option for eliminating symptoms.
Core tip: A rare cause of carpal tunnel syndrome (CTS) is tophaceous gout. This report represents the first case, to our knowledge, of a patient presenting with typical CTS symptoms, yet lacking any visible or palpable signs of gout in any part of his body. Only after magnetic resonance imaging, surgical inspection, and pathological analysis was it clear that the 25-year-old patient had a large gouty tophus attached to the surface of the distal volar radius adjacent to the digital flexor tendons. Surgical removal of the “covert” tophi and decompression of the median nerve is an effective option for eliminating CTS symptoms.