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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Subsequent bilateral acute carpal tunnel syndrome due to tophaceous infiltration: A case report
Soon-Chin Yeoh, Wen-Tien Wu, Jui-Tien Shih, Wen-Chin Su, Kuang-Ting Yeh
Soon-Chin Yeoh, Wen-Tien Wu, Kuang-Ting Yeh, School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
Wen-Tien Wu, Wen-Chin Su, Kuang-Ting Yeh, Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
Jui-Tien Shih, Department of Orthopaedic Surgery, Taoyuan Armed Forces General Hospital, Taoyuan 325208, Taiwan
Kuang-Ting Yeh, Department of Clinical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
Kuang-Ting Yeh, Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970374, Taiwan
Author contributions: Yeh KT contributed to conceptualization, methodology, data curation, and writing—review and editing; Wu WT contributed to validation and visualization; Shih JT contributed to validation and supervision; Yeoh SC contributed to investigation and writing—original draft preparation; Su WC contributed to resources; All authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from all subjects prior to any study procedure. The study was conducted following the Declaration of Helsinki and approved by the Medical Ethics Committee of Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (No. IRB111-016-B; date of approval: 2022/01/01).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Kuang-Ting Yeh, MD, PhD, Associate Chief Physician, Associate Professor, Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707 Chung-Yang Road, Section, 3, Hualien 970473, Taiwan. micrograft@tzuchi.com.tw
Received: October 18, 2023
Peer-review started: October 18, 2023
First decision: December 7, 2023
Revised: December 18, 2023
Accepted: December 26, 2023
Article in press: December 26, 2023
Published online: January 16, 2024
BACKGROUND
Acute carpal tunnel syndrome (ACTS) is commonly caused by repetitive strain, trauma, or inflammatory conditions. However, ACTS due to tophaceous gout is a clinical event that remains poorly understood and underreported. This rare manifestation necessitates prompt diagnosis and intervention to prevent irreversible complications.
CASE SUMMARY
A 51-year-old man who had poorly controlled hyperuricemia presented with ACTS secondary to tophaceous gout. Because of rapid symptom progression symptoms and severe median nerve compression within 3 mo, the patient underwent emergency decompression surgery for both wrists at different time points. Postoperatively, he exhibited complete recovery of sensory and motor functions, with no recurrence at long-term follow-up. Favorable outcomes were achieved through immediate decompression surgery, anti-inflammatory medications, postoperative active and passive range-of-motion exercises, and intermittent wrist splinting. Prompt diagnosis and surgical intervention, when necessary, are crucial for preventing long-term complications and obtaining favorable outcomes in patients with ACTS. An optimal gout management strategy involving pharmacologic therapy and lifestyle modifications may help minimize ACTS recurrence and improve clinical outcomes.
CONCLUSION
Prompt surgical intervention and optimal gout management are crucial for preventing irreversible nerve damage and ACTS recurrence.
Core Tip: Acute carpal tunnel syndrome (ACTS) secondary to tophaceous gout is a rare but severe condition that necessitates immediate and comprehensive treatment. Prompt surgical decompression is crucial for alleviating symptoms and preventing irreversible nerve damage. In addition, effective postoperative management strategies involving anti-inflammatory medications and active and passive range-of-motion exercises are required for full recovery. The underlying gout condition must be managed through urate-lowering agents and lifestyle modifications to prevent the recurrence of ACTS and other gout-related complications. Our case report emphasizes the need for a multidisciplinary approach for successful treatment and recurrence prevention.
