Gaydarski Lyubomir, Petrova Kristina, Hadzhiyanev Asen, Landzhov Boycho, Georgiev Georgi P
Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, BGR.
Department of Clinical Laboratory, Medical University of Sofia, Sofia, BGR.
Cureus. 2024 Sep 30;16(9):e70493. doi: 10.7759/cureus.70493. eCollection 2024 Sep.
Carpal tunnel syndrome (CTS) is the most common nerve entrapment condition of the upper extremity, primarily caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. While various factors can lead to this condition, the accumulation of gouty tophi in the flexor tendons is a rare cause. This case involves a 57-year-old manual laborer who presented with progressively worsening symptoms in both hands, including numbness, pain, and muscle weakness, which were more severe in his right hand. He had a 20-year history of gout, managed with medication. On examination, significant findings included atrophy of the thenar muscles, gouty tophi in both hands and a palpable soft tissue mass in the right wrist. Diagnostic tests confirmed CTS in both hands, with more pronounced severity on the right side. Imaging studies revealed the presence of gouty tophi and soft tissue masses in both hands. Surgical decompression of the carpal tunnel was performed on each hand, with excision of the soft tissue mass in the right wrist, which was identified as synovitis of the flexor tendons. During surgery, an accessory flexor muscle of the fifth finger was discovered in the right hand. Postoperative recovery was smooth, and the patient showed significant improvement in symptoms at follow-up. This case underscores the complex and multifactorial nature of CTS, especially when associated with gout. The combination of gout and repetitive physical strain from the patient's occupation likely contributed to the development of the condition in his right hand. Although the accessory flexor muscle was not the primary cause of nerve compression, its presence highlights the importance of considering anatomical variations when diagnosing and managing CTS. This case enhances the current understanding of CTS and emphasizes the need for personalized diagnostic and treatment strategies in patients with underlying conditions such as gout.
腕管综合征（CTS）是上肢最常见的神经卡压病症，主要由正中神经在腕部通过腕管时受到压迫所致。虽然多种因素可导致这种病症，但屈肌腱中痛风石的积聚是一种罕见病因。本病例涉及一名57岁的体力劳动者，他双手症状逐渐加重，包括麻木、疼痛和肌肉无力，右手症状更严重。他有20年痛风病史，一直通过药物治疗。检查时，显著发现包括大鱼际肌萎缩、双手有痛风石以及右腕可触及软组织肿块。诊断测试证实双手均患有腕管综合征，右侧病情更严重。影像学研究显示双手均存在痛风石和软组织肿块。对每只手都进行了腕管减压手术，并切除了右腕的软组织肿块，该肿块被确定为屈肌腱滑膜炎。手术过程中，在右手发现了小指的一条副屈肌。术后恢复顺利，随访时患者症状有明显改善。本病例强调了腕管综合征的复杂性和多因素性质，尤其是与痛风相关时。痛风与患者职业中重复性体力劳损的结合可能导致了其右手病情的发展。虽然副屈肌不是神经受压的主要原因，但其存在凸显了在诊断和治疗腕管综合征时考虑解剖变异的重要性。本病例增进了当前对腕管综合征的理解，并强调了对患有痛风等基础疾病的患者采取个性化诊断和治疗策略的必要性。
