J Korean Orthop Assoc.  2019 Aug;54(4):372-376. 10.4055/jkoa.2019.54.4.372.

Carpal Tunnel Syndrome Caused by Pseudogout

• Kim E
• Chae SW
• Lee H
• Lee SW

• KMID: 2455507
• DOI: http://doi.org/10.4055/jkoa.2019.54.4.372

Abstract

Carpal tunnel syndrome (CTS) caused by pseudogout is an uncommon disease. The authors report a 65-year-old female who complained of sudden pain and neurological symptoms on her left hand. Surgical decompression was performed. In the histologic study, a calcium pyrophosphate dihydrate crystal deposit was confirmed. Her pain and neurological symptoms were relieved. Because CTS caused by pseudogout is rare, it is difficult to differentiate it from other diseases. This paper reports an uncommon case of CTS caused by pseudogout.

Keyword

carpal tunnel syndrome; pseudogout; chondrocalcinosis; median nerve

MeSH Terms

Aged
Calcium Pyrophosphate
Carpal Tunnel Syndrome*
Chondrocalcinosis*
Decompression, Surgical
Female
Hand
Humans
Median Nerve
Calcium Pyrophosphate

Figure

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  Figure 1 (A) Anteroposterior wrist radiograph reveals cyst formation (C), sclerosis (S), and radio-ulnar ligament calcification (CALC). (B) Lateral radiograph showing distal ulnar subluxation at the dorsal aspect of the wrist.

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  Figure 2 (A) In T1-weighted coronal magnetic resonance imaging, a large cystic mass through the flexor tendon sheath was observed, showing intermediate signal intensity. (B) The space-occupying cystic mass (dotted line) was a compressing median nerve (arrow), which caused carpal tunnel syndrome in T2-weighted axial magnetic resonance imaging. (C) Through the extensor tendon sheath, low signal intensity cystic mass was confirmed in T2-weighted sagittal magnetic resonance imaging.

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  Figure 3 (A) In the dorsal approach, disruption of the distal interosseous membrane at the forearm was observed. In the palmar approach, bloody fluid containing a whitish-chalky substance was noted. (B) The transverse carpal ligament was thickened and some flexor tendons were frayed.

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  Figure 4 Histologic section showed deposits of eosinophilic fibrinoid materials with partly loose basophilic degenerative changes in the synovial tissue (A: H&E, ×10). Polarized light view showed small and rhomboid crystal deposits which exhibited weak positive birefringence on polarized light microscopy (B: ×40, ×95).

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