European Journal of Biomedical and Pharmaceutical Sciences

CARPAL TUNNEL SYNDROME CAUSED BY GIANT GOUTY TOPHI WITH FLEXOR TENDON INVOLVEMENT: A CASE REPORT

*Motaz Al-qasaimeh MD, Saab Mestarihi MD, Ahmad Alzoubi MD, Ehab Azzam MD, Yousef Khair MD, Mohammad Alshorman MD

ABSTRACT

Carpal tunnel syndrome is the most common compressive neuropathy affecting the upper extremities. It can be idiopathic without any apparent cause or related to specific diseases such as rheumatoid arthritis, amyloidosis, hypothyroidism, diabetes mellitus or chronic renal disease. However, it can result from space-occupying lesions that compress the median nerve at the carpal tunnel. Deposition of gouty tophi in the flexor tendons at the carpal tunnel can cause compression of the median nerve, which is extremely rare, with a reported incidence of only 0.6%. This study presents a rare case of carpal tunnel syndrome caused by space-occupying lesions in a 44-year-old male patient diagnosed with gout in 2008. MRI images and intraoperative findings showed large multiple tophi arising from more than one flexor tendon and the wrist joint volar capsule that caused compression of the median nerve at the carpal tunnel and stretching of the nerve at the distal forearm level.

Keywords: Carpal tunnel syndrome; gouty tophi; median nerve.