Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2018; 6(9): 279-283
Published online Sep 6, 2018. doi: 10.12998/wjcc.v6.i9.279
Chronic carpal tunnel syndrome caused by covert tophaceous gout: A case report
Peng-Bo Luo, Chang-Qing Zhang
Peng-Bo Luo, Chang-Qing Zhang, Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
Author contributions: All the two authors contributed to this manuscript.
Informed consent statement: Our hospital does not need patient consent to publish a single case.
Conflict-of-interest statement: None of the authors have any conflict of interest related to the article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Chang-Qing Zhang, MD, PhD, Full Professor, Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China.
Telephone: +86-1891-7233480 Fax: +86-21-64701361
Received: April 3, 2018
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
Case characteristics

A young man with a family history of tophaceous gout who presented with typical carpal tunnel syndrome symptoms.

Clinical diagnosis

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.

Differential diagnosis

Tophaceous gout.

Laboratory diagnosis

Complete blood count and electrolytes were normal. C-reactive protein, erythrocyte sedimentation rate and uric acid level were elevated.

Imaging diagnosis

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.

Pathological diagnosis

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.

Related reports

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.

Term explanation

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.

Experiences and lessons

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.