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Citation: Foulath M, Tarantino A. Gouty Tophi : A rare cause of Carpal Tunnel Syndrome.Jr.med.res.2021;4(2): 17-18.Foulath et al © All rights are
reserved. https://doi.org/10.32512/jmr.4.2.2021/17.18 Submit your manuscript: www.jmedicalresearch.com
Images in clinical practice
Folath Mohamad
1*
, Tarantino Alessio
2,3
.
Gouty Tophi : A rare cause of Carpal Tunnel Syndrome.
1: Department of orthopedic surgery, Al Emadi
Hospital, Doha Qatar
2: Public Hospital of Alatri ,Frosinone, Italy
3: University of L'Aquila, Abruzzo, Italy.
* Corresponding author
Correspondence to:
Folath74@yahoo.com
Publication Data:
Submitted: April 28,2021
Accepted: June 29,2021
Online: November 30,2021
This article was subject to full peer-review.
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a
b
c
d
a: Right hand X-rays showing soft tissues
swelling around the metacarpophalangeal joints
of the 2
nd
and the 5
th
fingers.
b: Ultrasound showed a diffuse soft tissue
thickening in the carpal tunnel with mass effect
on the median nerve as well as cystic mass
pointing cranially from the radio-carpal joint.
c: MRI showing a flattering of the median nerve
in a crowded carpal tunnel at the level of the
hamate with 1.3x0.5cm cystic mass at the level of
the distal radius.
d: Intraoperative findings
Gouty Tophi : A rare cause of Carpal Tunnel Syndrome
Citation: Foulath M, Tarantino A. Gouty Tophi : A rare cause of Carpal Tunnel Syndrome.Jr.med.res.2021;4(2): 17-18.Foulath et al © All rights are
reserved. Submit your manuscript: www.jmedicalresearch.com
18
Comments
A 36-year-old male patient with history of gout presented with recurrent right wrist pain and swelling of three months
duration. There were no associated symptoms. The examination showed swelling mass of the volar right wrist with
signs of median nerve compression. The radiological examinations done including X-rays , joint ultrasound and MRI
confirmed carpal tunnel syndrome with flattering of the median nerve in a crowded carpal tunnel due to thickened
soft tissues and 1.3x0.5 cm cystic mass at the level of the distal radius. Surgical decompression was indicated to control
the symptoms and to rule out the mass origin. The post operative course was uneventful with objective improvement
of the symptoms. Histopathologic examination of the resected specimen showed pale basophilic material surrounded
by histiocytes and foreign body type giant cells in favor of gouty tophi.
Gout is a disease featuring acute arthritis, joint deformity and severe pain caused by the deposition of monosodium
urate crystals in and around synovial tissue [1]. Carpal tunnel syndrome is a rare condition in these cases. It indicates
the severity of the disease and its delayed treatment [2]. Gouty tophi should be entertained as a cause of carpal tunnel
syndrome in the appropriate patient population [3]. Early tophi surgical excision combined with trioxypurine treatment
may improve the outcomes of carpal tunnel syndrome and allow to avoid irreversible complications [4].
Conflict of Interest: None
References
[1] Lee JK, Kim JW, Kim YS, Koo BS. A case of severe gouty tophi-induced carpal tunnel syndrome: Operative finding and its outcome. Handchir Mikrochir Plast Chir. 2018;50:19-21.
[2] Ge Y, Li F, Chen J, Tian J. Severe Carpal Tunnel Syndrome Caused by Gouty Tophi Diagnosed by Dual Energy Computed Tomography: Case Report. Arch Rheumatol. 2016;31:284-86.
[3] Chen CK, Chung CB, Yeh L, Pan HB, Yang CF, Lai PH, Liang HL, Resnick D. Carpal tunnel syndrome caused by tophaceous gout: CT and MR imaging features in 20 patients. AJR Am J
Roentgenol. 2000 ;175:655-9.
[4] Lu H, Chen Q, Shen H. A repeated carpal tunnel syndrome due to tophaceous gout in flexor tendon: A case report. Medicine (Baltimore). 2017 ;96:e6245.
