Gout is a form of inflammatory arthritis caused by hyperuricemia characterized by painful, hot and swollen joints. However, tophi involving carpal tunnel with concomitant presence of finger movement dysfunction as the first presentation of gout is rare. This suggests the involvement of flexor tendon inside the carpal tunnel. Here, we report a case of infiltration of tophi at the flexor tendon of the hand presented as the first clinical manifestation of gout causing trigger finger like symptoms. Patient underwent surgery to confirm the diagnosis and improve flexor tendon excursion. Our patient's finger movement improved dramatically after operation.

Melorheostosis is a rare form of sclerosing bone dysplasia that involves mainly the long bone of the limbs. However, the involvement of more than one long bone, either involving ipsilaterally or contralaterally, is extremely rare. The aetiology still remains unknown despite approximately 400 cases have been reported in the literature up to date. Diagnosis is mainly by conventional radiographic imaging such as plain X-ray, in which the typical melting wax dripping down a candle appearance is seen. The main treatment options are conservative management involving mainly analgesias, physiotherapy, braces, and possible nerve block and symphathectomies if indicated. The aim of this case report is to discuss the approach to a case of melorheostosis involving two long bones of the ipsilateral lower limb (polyostotic) that presented to us in our centre. Appropriate investigations and treatment modalities must be tailored according to the patient's complaints in order to achieve satisfactory treatment outcomes. With adequate analgesia complimenting with appropriate physiotherapy and rehabilitation, our patient's symptoms improved dramatically.