Zhang Wenzhong, Feng Qingbo, Gu Jiaxiang, Liu Hongjun
Department of Hand and Foot Surgery, Northern Jiangsu People's Hospital, Clinic Medical College of Yangzhou University, Yangzhou, China.
Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, China.
Front Surg. 2023 Jan 6;9:942062. doi: 10.3389/fsurg.2022.942062. eCollection 2022.
Usually caused by compression of the wrist's median nerve, carpal tunnel syndrome (CTS) is one of the most common types of peripheral neuropathy. Tophi deposited under the epineurium of the median nerve compress the median nerve, leading to CTS, which is very rare.
We report a 64-year-old man with a history of tophaceous gout who presented with typical CTS symptoms and was admitted to our hospital. A physical examination revealed swelling over the right volar aspect of the carpal region, and he was unable to flex due to subcutaneous rigidity. Tinel's sign and Phalen's maneuver were positive. Electrophysiological studies confirmed the diagnosis of CTS. A carpal tunnel release and surgery to remove the gouty tophus of the right wrist were performed when serum uric acid levels were within normal limits (5.8 mg/dl). During the operation, tophi deposited under the epineurium of the median nerve were found, and the tophi were completely removed. Operative findings confirmed the diagnosis of CTS due to gout. The patient recovered uneventfully without signs of recurrence of gout and CTS symptoms during a 1-year follow-up period.
A gouty tophus is an uncommon cause of CTS, and CTS may be caused by gouty tophi if there is evidence of extrinsic compression of the median nerve or symptoms emanating from the carpal tunnel.
腕管综合征（CTS）通常由腕部正中神经受压引起，是最常见的周围神经病变类型之一。沉积在正中神经外膜下的痛风石压迫正中神经，导致腕管综合征，这种情况非常罕见。
我们报告一名64岁有痛风石性痛风病史的男性，他出现典型的腕管综合征症状并入院。体格检查发现腕部掌侧肿胀，由于皮下僵硬无法屈曲。Tinel征和Phalen试验呈阳性。电生理研究确诊为腕管综合征。当血清尿酸水平在正常范围内（5.8 mg/dl）时，进行了腕管松解术和切除右手腕痛风石的手术。手术中发现沉积在正中神经外膜下的痛风石，并将其完全切除。手术结果证实了痛风导致腕管综合征的诊断。在1年的随访期内，患者恢复顺利，没有痛风复发迹象和腕管综合征症状。
痛风石是腕管综合征的罕见病因，如果有正中神经外部受压的证据或腕管出现症状，腕管综合征可能由痛风石引起。
