Chronic carpal tunnel syndrome caused by covert tophaceous gout: A case report

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 pal-pable masses on his forearm or hand. However, his family history, laboratory, clinical, and magnetic re-sonance 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.

Bilateral carpal tunnel syndrome and motor dysfunction caused by gout and type 2 diabetes:A case report

BACKGROUND Carpal tunnel syndrome(CTS)has been associated with gout and type 2 diabetes mellitus(T2DM).However,due to insufficient clinical understanding of goutrelated CTS and reliance on the diagnostic importance of elevated serum uric acid levels,such cases are prone to missed diagnosis,misdiagnosis,and delayed treatment.In addition,the effect of T2DM on gout-induced carpal tunnel syndrome has not been reported.CASE SUMMARY Herein,we present an unusual case of CTS and motor dysfunction caused by miliary tophaceous gout and T2DM.The patient presented to the hand and foot clinic with paresthesia of the fingers of both hands,especially at night.The patient was diagnosed with type 2 diabetes a month ago.Ultrasonography revealed bilateral transverse carpal ligament thickening with median nerve compression during hospitalization.The patient was successfully treated with carpal tunnel decompression and tendon release.The postoperative pathological examination revealed typical gout nodules.This case suggests that the presence of T2DM could accelerate tophi formation and worsen CTS symptoms,although no definitive proof in this regard has been described previously.CONCLUSION Tophi formation may most likely cause the co-occurrence of CTS and flexor dysfunction in gout and incipient diabetes patients.

Quantification of uric acid in vasculature of patients with gout using dual-energy computed tomography

BACKGROUNDGout, caused by hyperuricemia and subsequent deposition of aggregatedmonosodium urate crystals (MSU) in the joints or extra-articular regions, is themost common inflammatory arthritis. There is increasing evidence that gout is anindependent risk factor for hypertension, cardiovascular disease progression andmortality.AIMTo evaluate if dual energy computed tomography (DECT) could identify MSUwithin vessel walls of gout patients, and if MSU deposits within the vasculaturediffered between patients with gout and controls. This study may help elucidatewhy individuals with gout have increased risk for cardiovascular disease.METHODS31 gout patients and 18 controls underwent DECT scans of the chest andabdomen. A material decomposition algorithm was used to distinguish regions ofMSU (coded green), and calcifications (coded purple) from soft tissue (uncoded). Volume of green regions was calculated using a semi-automated volumeassessment program. Between-group differences were analyzed using Mann-Whitney U exact test and nonparametric rank regression.RESULTSGout patients had significantly higher volume of MSU within the aorta comparedto controls [Median (Min-Max) of 43.9 (0-1113.5) vs 2.9 (0-219.4), P = 0.01].Number of deposits was higher in gout patients compared to controls [Median(Min-Max) of 20 (0-739) vs 1.5 (0-104), P = 0.008]. However, the difference wasinsignificant after adjustment for age, gender, history of cardiovascular diseaseand diabetes. Increased age was positively associated with total urate volume (rs =0.64;95% confidence interval: 0.43-0.78).CONCLUSIONThis pilot study showed that DECT can quantify vascular urate deposits withvariation across groups, with gout patients possibly having higher deposition.This relationship disappeared when adjusted for age, and there was a positiverelationship between age and MSU deposition. While this study does not provethat green coded regions are truly MSU deposition, it corroborates recent studiesthat show the presence of vascular deposition.

Atypical Trigger Finger: First Manifestation of Gout

Gout is a form of inflammatory arthritis caused by hyperuricemia characterized by painful, hot and swollen joints. However, tophi involving carpal tunnel with concomitant presence of finger movement dysfunction as the first presentation of gout is rare. This suggests the involvement of flexor tendon inside the carpal tunnel. Here, we report a case of infiltration of tophi at the flexor tendon of the hand presented as the first clinical manifestation of gout causing trigger finger like symptoms. Patient underwent surgery to confirm the diagnosis and improve flexor tendon excursion. Our patient’s finger movement improved dramatically after operation.

Calcium pyrophosphate deposition disease of the temporomandibular joint invading the middle cranial fossa:Two case reports

BACKGROUND Pseudogout is a benign joint lesion caused by the deposition of calcium pyrophosphate dihydrate crystals,but it is invasive.Pseudogout of the temporomandibular joint(TMJ)is uncommon,and it rarely invades the skull base or penetrates into the middle cranial fossa.The disease has no characteristic clinical manifestations and is easily misdiagnosed.CASE SUMMARY We present two cases of tophaceous pseudogout of the TMJ invading the middle cranial fossa.A 46-year-old woman with a history of diabetes for more than 10 years was admitted to the hospital due to swelling and pain in the right temporal region.Another patient,a 52-year-old man with a mass in the left TMJ for 6 years,was admitted to the hospital.Maxillofacial imaging showed a calcified mass and severe bone destruction of the skull base in the TMJ area.Both patients underwent excision of the lesion.The lesion was pathologically diagnosed as tophaceous pseudogout.The symptoms in these patients were relieved after surgery.CONCLUSION Tophaceous pseudogout should be considered when there is a calcified mass in the TMJ with or without bone destruction.A pathological examination is the gold standard for diagnosing this disease.Surgical treatment is currently the recommended treatment,and the prognosis is good after surgery.