Intratendinous tophaceous gout rare secondary cause of Carpel tunnel syndrome: study

Dr Supreeth  D R

Intratendinous tophaceous gout rare secondary cause of Carpel tunnel syndrome: study

Written By : Dr Supreeth D R Published On 2025-12-31T21:00:17+05:30 | Updated On 31 Dec 2025 9:00 PM IST

Secondary carpal tunnel syndrome (CTS) caused by intratendinous tophaceous gout is rare. Preoperative diagnosis would be helpful and surgical management details are controversial.

Saw Sian Khoo et al conducted a retrospective review of CTS cases treated in their centre. 564 carpal tunnel releases (CTR) were carried out. Twelve patients (14 wrists) had CTS related to intratendinous gout. Case records were reviewed and hand function was assessed using the Michigan Hand Outcomes Questionnaire (MHQ) and grip strength using Jamar® dynamometer.

The key findings of the study were:

• All patients were male with a mean age of 51 years (SD 19.3, range 31–83). None of the patients was compliant with medication.

• 57% of wrists had volar swelling and 71% displayed restriction in finger motion.

• Surgical management apart from open CTR (14) included one or more tendon procedures. They were tenosynovectomy (3), debulking (9), and tendon excision with (2) or without reconstruction (6).

• FDS tendons, especially middle and ring finger, were most commonly affected, followed by FDP and FPL.

• Mean follow-up was 32.6 months (SD 23.7, range 12–82 months).

• There was a significant improvement in mean MHQ scores (41.5 (SD 20.4, range 23.9–78.6)) to postoperative (77.5 (SD 17.5, range 45.5–100.0, p < 0.001)).

The authors concluded – “A high index of suspicion should be maintained although intratendinous tophaceous gout is a rare secondary cause of CTS. Red flag signs include male gender, history of poorly treated gout, presence of gouty tophi elsewhere, firm volar wrist swelling and restriction in finger motion especially that of the middle and ring finger.

• Early diagnosis, timely surgical intervention and adequate control of serum uric acid level are important to avoid irreversible nerve injury and loss of tendon function.

• The clinical outcomes of tendon debulking and excision of diseased tendons were similar in small-scale studies. However, a larger study with validated outcome measures is required to determine the long-term outcome of tendon excision versus debulking in this group of patients.

• Surgery with hyperuricaemia may not induce an attack.

• With current evidence, we propose timely debulking of the diseased tendon with concomitant carpal tunnel release as the first-line management of intratendinous tophaceous gout causing restriction in finger motion and mass effect to the median nerve. The affected FDS tendons should be excised if they are heavily infiltrated and the FDP or FPL tendons should be reconstructed.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.