Carpal Tunnel Syndrome Secondary to Intratendinous Infiltration by Tophaceous Gout

Abstract

Carpal tunnel syndrome caused by gout is rare. We describe a case of entrapment of the median nerve secondary to intratendinous infiltration by gouty tophi in a 54-year-old man. The tophus was excised from the profundus tendon but the superficialis was too infiltrated and destroyed to be saved. The patient made an uneventful recovery with relief of his symptoms. This case illustrates the potential consequences this could have for hand function.

Sonographic description and classification of tendinous involvement in relation to tophi in chronic tophaceous gout

“…The term “intratendinous infiltration” includes many aspects of the relationship between tophi and the tendon, as seen in reports that show that gout can affect the tendons through intratendinous infiltration [10, 11] causing compressive syndromes [12–14]. The term “infiltration” can encompass tophi within the tendon, those leading to extrinsic compression and those enveloping the tendon.…”

Atypical Triggering at the Wrist Due to Intratendinous Infiltration of Tophaceous Gout

“…In the past reports, all intratendinous infiltrations of tophaceous gout occurred at the wrist and existed with carpal tunnel syndrome [4][5][6]. In our case, since the main torus of the tophus existed proximally to the flexor retinaculum in resting position of the hand, triggering of the torus against the flexor retinaculum occurred in extension of the middle finger instead of carpal tunnel syndrome.…”

“…Although tophaceous gout is caused by poorly controlled long-lasting hyperuricemia, there have been only a few case reports of intratendinous infiltration of tophaceous gout affecting tendons of the hand [4][5][6]. In the past reports, all intratendinous infiltrations of tophaceous gout occurred at the wrist and existed with carpal tunnel syndrome [4][5][6].…”

Gouty flexor tenosynovitis of the hand mimicking atypical mycobacterial infection

“…Also, gouty tenosynovitis of the hand may present with a variety of signs and symptoms including compression neuropathy, 16 infection, soft tissue mass, joint stiffness, 17 or signs of tendon rupture. 18,19 These conditions require drainage, tenosynovectomy, neurolysis, mass resection, joint mobilization, and tendon repair or tendon transfer.…”