Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2018; 6(9): 279-283
Published online Sep 6, 2018. doi: 10.12998/wjcc.v6.i9.279
Chronic carpal tunnel syndrome caused by covert tophaceous gout: A case report
Peng-Bo Luo, Chang-Qing Zhang
Peng-Bo Luo, Chang-Qing Zhang, Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
Author contributions: All the two authors contributed to this manuscript.
Informed consent statement: Our hospital does not need patient consent to publish a single case.
Conflict-of-interest statement: None of the authors have any conflict of interest related to the article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chang-Qing Zhang, MD, PhD, Full Professor, Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China. zhangcq@sjtu.edu.cn
Telephone: +86-1891-7233480 Fax: +86-21-64701361
Received: April 3, 2018
Peer-review started: April 3, 2018
First decision: May 21, 2018
Revised: May 26, 2018
Accepted: June 7, 2018
Article in press: June 8, 2018
Published online: September 6, 2018
Abstract

Carpal tunnel syndrome (CTS) is well recognized as the most common type of peripheral neuropathy. A rare cause of CTS is tophaceous gout. Tophi deposits can accumulate in various structures including the flexor tendons, tendon sheaths, the carpal tunnel floor, transverse carpal ligament, and even the median nerve, causing various symptoms such as pain, numbness, and weakness. Tophi forming in the carpal canal can compress the median nerve, leading to CTS. Here, we describe a 25-year-old male with a family history of tophaceous gout who presented with typical CTS symptoms. Although he had chronic numbness in his right hand, he failed to present with any obvious palpable masses on his forearm or hand. However, his family history, laboratory, clinical, and magnetic resonance imaging findings were consistent with tophi deposits. CTS symptoms were eased through surgical removal of tophi and decompression of the median nerve. No recurrences of gout and CTS symptoms were reported at a one-year follow-up. This case shows that CTS symptoms could be the initial manifestation of tophaceous gout. In patients with a family history of gout and with CTS symptoms, imaging examinations are critical for early diagnosis and selecting appropriate treatment. Surgical removal of “covert” tophi and decompression of the median nerve is an effective option for eliminating symptoms.

Keywords: Carpal tunnel syndrome, Tophaceous gout, Family medical history, Surgery, Flexor Tendon

Core tip: A rare cause of carpal tunnel syndrome (CTS) is tophaceous gout. This report represents the first case, to our knowledge, of a patient presenting with typical CTS symptoms, yet lacking any visible or palpable signs of gout in any part of his body. Only after magnetic resonance imaging, surgical inspection, and pathological analysis was it clear that the 25-year-old patient had a large gouty tophus attached to the surface of the distal volar radius adjacent to the digital flexor tendons. Surgical removal of the “covert” tophi and decompression of the median nerve is an effective option for eliminating CTS symptoms.