From the Department of Physical Medicine & Rehabilitation, Rutgers - New Jersey Medical School, Newark, New Jersey.
Am J Phys Med Rehabil. 2018 Feb;97(2):143-146. doi: 10.1097/PHM.0000000000000774.
Extra-articular manifestations of gout can present in several ways, including tenosynovitis. We present a rare case of acute tibialis posterior gouty tenosynovitis. An 82-year-old man with a history of well-controlled gout presented with acute onset of left ankle pain, occurring without inciting event. The medial ankle was slightly erythematous with moderate dorsal-medial swelling and mild dorsal-lateral swelling, with severe tenderness to palpation over the medial retro-malleolar region. Range of motion and manual muscle testing were pain limited throughout. Ultrasound examination revealed a left posterior tibialis tendon sheath tenosynovitis with effusion and overlying soft tissue edema. Tendon sheath aspirate revealed sodium urate crystals and a white blood cell count of 6400/μL. Tendon sheath injection with a mixture of 1% lidocaine and dexamethasone 4 mg resulted in symptom resolution. Repeat ultrasound examination demonstrated no evidence of tibialis posterior tendon sheath effusion. This case is unique not only because acute gouty posterior tibialis tenosynovitis is very rare, particularly in a normouricemic individual, but also because the sonographic evidence of gouty infiltration into the posterior tibialis tendon and overlying subcutaneous tissue considerably aided in arriving at the correct diagnosis in a timely manner.
痛风的关节外表现有多种形式，包括腱鞘炎。我们报告一例罕见的急性胫后肌痛风性腱鞘炎。一名 82 岁男性，有控制良好的痛风病史，突发左踝关节疼痛，无诱发事件。内踝轻度红斑，伴有中度背内侧肿胀和轻度背外侧肿胀，内侧后踝区域压痛明显。活动度和手动肌肉测试均因疼痛受限。超声检查显示左后胫肌腱鞘腱鞘炎伴积液和覆盖的软组织水肿。腱鞘抽吸显示尿酸钠晶体和白细胞计数 6400/μL。鞘内注射 1%利多卡因和 4mg 地塞米松混合液后症状缓解。重复超声检查显示后胫肌腱鞘无积液。本例不仅因为急性痛风性后胫肌腱鞘炎非常罕见，尤其是在正常尿酸血症个体中，而且因为超声显示痛风浸润后胫肌腱和覆盖的皮下组织，有助于及时作出正确诊断，因此具有独特性。
