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
A young man with a family history of tophaceous gout who presented with typical carpal tunnel syndrome symptoms.
Numbness in the thumb, index finger, middle finger, and half of the ring finger of the right hand. The symptoms worsened with extension of the wrist. Normal hand function activities with decreased grip strength.
Complete blood count and electrolytes were normal. C-reactive protein, erythrocyte sedimentation rate and uric acid level were elevated.
Radiographs showed no bone erosion or tophi deposition in the hands. Magnetic resonance imaging showed a sizable mass adhering to the surface of the distal volar radius, and a mass adjacent to the digital flexor tendons at the level of the proximal carpal tunnel.
Tophaceous gout in the digital flexor tendons.
Surgical removal of the gouty tophi, synovectomy of all the affected flexor tendons, and decompression of the median nerve were performed.
To our limited knowledge, this is the first case report to describe tophi-associated chronic carpal tunnel syndrome without visible signs of tophi but has a family medical history of gout.
Carpal tunnel syndrome is the most commonly diagnosed compression neuropathy of the upper limb, which is usually caused by excessive pressure on the median nerve by many causes. Deposition of gouty tophi in flexor tendons is a rare cause.
Tophaceous gout is a rare cause of carpal tunnel syndrome (CTS). Physicians need to be familiar with tophi-associated CTS and aware of the patient’s family history of gout. Prompt imaging examinations including computed tomography or magnetic resonance imaging are necessary to identify the specific causes of CTS.