Carpal Tunnel Syndrome Caused by Gout: Clinical Presentations, Surgical Findings, and Outcomes after Surgery

Abstract

Background/Purpose Carpal tunnel syndrome caused by gout is rare. We presented our experience in treating these patients. Methods We conducted a retrospective review of cases treated from 2010 to 2013. Eight patients were identified out of 348 carpal tunnel releases performed. Results All patients were male. All patients had gouty tophi on the same hand and other locations on the body. Open carpal tunnel release was performed on all patients. There was gouty tenosynovitis in all patients but no encasement of the median nerve. The mean follow-up was 16 months. Numbness improved in seven out of eight patients. Conclusion Gout should be considered a cause of carpal tunnel syndrome, particularly in patient with a history of gout. Early surgical outcome is promising. Longer follow-up is needed to detect recurrence.

Acute Carpal Tunnel Syndrome Secondary to Gout Flare and Outcomes at 18 Months After Open Carpal Tunnel Decompression

“… 3 Unlike acute CTS, chronic cases may present with thenar muscle wasting and firm masses representing mature tophi. 4 To our knowledge, our case was the first to report paresthesia in the distribution of the median nerve that progressed to total anesthesia of the involved fingers before surgery. The intraoperative findings and interventions are similar to those reported in other studies.…”

“…Median nerve compression Excision of the nodular tophus 1 mo - Carr et al 3 2015 - 32 R - 4 d Tenderness, swelling, and erythema of the palm and volar wrist; progressive paresthesias in the thumb, index, and long fingers; and inability to actively flex and extend fingers. Positive Tinel sign over the carpal tunnel Median nerve bulging, liquefied gout, a large 2.5–3-cm tophaceous gouty mass adherent to the proximal floor of the carpal tunnel and distal edge of the pronator quadratus Synovectomy of all 9 flexor tendons, removal of the tophaceous mass 6 mos - Joseph et al 4 2015 (case A) M 41 R 0.73 2 mos Numbness in the distribution of the median nerve. Finger stiffness, volar swelling, dorsal ulnar mass, and wrist pain Tenosynovitis, tophi from floor Tenosynovectomy, floor clearance - - Joseph et al 4 2015 (case B) M 28 R 0.75 2 mos Numbness in the distribution of the median nerve.…”

“…Positive Tinel sign over the carpal tunnel Median nerve bulging, liquefied gout, a large 2.5–3-cm tophaceous gouty mass adherent to the proximal floor of the carpal tunnel and distal edge of the pronator quadratus Synovectomy of all 9 flexor tendons, removal of the tophaceous mass 6 mos - Joseph et al 4 2015 (case A) M 41 R 0.73 2 mos Numbness in the distribution of the median nerve. Finger stiffness, volar swelling, dorsal ulnar mass, and wrist pain Tenosynovitis, tophi from floor Tenosynovectomy, floor clearance - - Joseph et al 4 2015 (case B) M 28 R 0.75 2 mos Numbness in the distribution of the median nerve. Thumb locked in flexion, volar mass, and wrist pain Tenosynovitis, tophi infiltrating flexor pollicis longus Neurolysis, tenosynovectomy, debulking flexor pollicis longus - - Rand et al 5 2010 - 38 R - Signs of acute carpal tunnel syndrome Clinical diagnosis of carpal tunnel, soft tissue mass palpable on the volar aspect of the wrist, and grade 4 triggering of the middle finger Compression of the medial nerve.…”

“…The intraoperative findings and interventions are similar to those reported in other studies. 2 , 3 , 4 , 5 , 6 , 7 The few cases published to date show that open carpal tunnel release has good early clinical outcomes ( Table ). According to some reports, an onset after 4 days may be considered a late release.…”

“…1 A PubMed query on October 22, 2021 using the key word “acute carpal tunnel gout” revealed 7 cases published to date (Table). 2 , 3 , 4 , 5 , 6 , 7 Cases of chronic CTS (symptoms lasting more than 3 months) were excluded. 4 …”