J Rheum Dis.  2015 Feb;22(1):29-33. 10.4078/jrd.2015.22.1.29.

Carpal Tunnel Syndrome Associated with Tophaceous Deposition in Flexor Digitorum Tendons

• Kwon SW
• Kim JH
• Kang WC
• Kim SJ
• Kim HY
• Kim HR
• Lee SH

• KMID: 2222924
• DOI: http://doi.org/10.4078/jrd.2015.22.1.29

Abstract

Carpal tunnel syndrome is the most common peripheral entrapment neuropathy. We report on the first Korean case of carpal tunnel syndrome induced by tophaceous deposition in flexor digitorum tendons of a patient with chronic gout. A 63-year-old male suffered from numbness, decreased sensation over both median nerve distribution, and weakness of thenar muscle for 3 years. Physical examinations revealed positive Tinel's sign and Phalen's test and thenar qjmuscle atrophy was found on both hands. In nerve conduction study, there was no action potential of the sensory and motor of the bilateral median nerve. Ultrasonography showed increased cross-sectional area of median nerve due to tophaceous deposition in flexor digitorum tendons in the carpal tunnel. Dual-energy computed tomography showed diffuse multifocal green color coding tophaceous deposition within the carpal tunnel. His neuropathic symptoms improved after injection of triamcinolone into the carpal tunnel and administration of oral medication including non-steroidal anti-inflammatory drugs and colchicine.

Keyword

Carpal tunnel syndrome; Gouty arthritis; Tophus; Ultrasonography; Computed tomography

MeSH Terms

Action Potentials
Arthritis, Gouty
Atrophy
Carpal Tunnel Syndrome*
Clinical Coding
Colchicine
Gout
Hand
Humans
Hypesthesia
Male
Median Nerve
Middle Aged
Neural Conduction
Physical Examination
Sensation
Tendons*
Triamcinolone
Ultrasonography
Colchicine
Triamcinolone

Figure

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  Figure 1. Both hands presents thenar muscle atrophy.

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  Figure 2. Ultrasonography shows increased cross sectional area of median nerve at the proximal carpal tunnel (*), tophaceous depositions of flexor digitorum tendons (T) with heterogenous hyperechogenicity, and compression of medial nerve at the distal carpal tunnel (arrow heads). Left carpal tunnel transverse view (A), left carpal tunnel longitudinal view (B), right carpal tunnel transverse view (C), and right carpal tunnel longitudinal view (D).

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  Figure 3. Dual-energy computed tomography of upper extremity shows diffuse multifocal green color coding tophaceous depositions of both flexor digitorum tendons, flexor pollicis longus tendons, transverse carpal ligament, metacarpophalangeal joints, subcutaneous tissue in carpal tunnel. Three-dimensional vol-ume-rendered image (A) and two-dimensional axial image of both hands (B).

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