Chronic carpal tunnel syndrome caused by covert tophaceous gout: A case report

Figure 1 Radiograhic posteroanterior projection images of the patient’s hands. Radiographs showed no bone erosion or tophi deposition.

Figure 2 Magnetic resonance images of the patient’s right hand and wrist. A: Lateral projection; B: Posteroanterior projection; C: Transverse projections. Magnetic resonance imaging revealed a giant mass adhering to the surface of the distal volar radius. The base of the mass was wide (A, B, white arrows). There was also a mass adjacent to the digital flexor tendons at the level of the proximal carpal tunnel. These were pressing on the median nerve (C, red asterisks).

Figure 3 Photomicrograph of the surgical field. After exposing the transverse carpal ligament, we identified the median nerve. The section of the median nerve coursing through the carpal canal had a significant bulge (white arrow) and a distal impression (black arrow).

Figure 4 Photomicrograph of the surgical field, with the wrist rotated medially. An impressive large mass (3.2 cm in diameter; black arrow) was observed on the ulnar side of the median nerve (MN); in the flexor digitorum superficialis and flexor digitorum profundus tendon sheaths of the middle finger, ring finger; and in the digitus minimus. With the median nerve and flexor tendons protected by the drainage tubes, we observed another large mass (7.0 cm in diameter; white arrows) embedded deep into the distal volar radius. The masses were irregularly shaped and their surface was soft but without inflammation or ulceration.

Figure 5 Synovectomy of all affected flexor tendons was performed and deep masses were removed.

Figure 6 Chalk-like liquid was found in the gouty mass.

Figure 7 Magnetic resonance imaging of lateral projection of the patient’s right wrist. Magnetic resonance imaging showed no recurrence of gouty tophi 12 mo after synovectomy of all the affected flexor tendons, removal of deep gouty tophi, and epineurium neurolysis of the median nerve of the patient’s right wrist.