Carpal Tunnel Syndrome Associated with Tophaceous Deposition in Flexor Digitorum Tendons

Se Woong Kwon; Ji Hye Kim; Won Chan Kang; Soo Jung Kim; Ho Yeon Kim; Hae Rim Kim; Sang Heon Lee

doi:10.4078/jrd.2015.22.1.29

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Kwon, Kim, Kang, Kim, Kim, Kim, and Lee: Carpal Tunnel Syndrome Associated with Tophaceous Deposition in Flexor Digitorum Tendons

Case Report

J Rheum Dis 2015;22(1):29-33.

Published online: 31 October 2015

DOI: https://doi.org/10.4078/jrd.2015.22.1.29

Carpal Tunnel Syndrome Associated with Tophaceous Deposition in Flexor Digitorum Tendons

Se Woong Kwon, Ji Hye Kim, Won Chan Kang, Soo Jung Kim, Ho Yeon Kim, Hae Rim Kim, Sang Heon Lee

Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea

Corresponding to: Sang Heon Lee, Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea. E-mail: shlee@kuh.ac.kr

Received 14 March 2014 Revised 11 April 2014 Accepted 15 April 2014

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Carpal tunnel syndrome, Gouty arthritis, Tophus, Ultrasonography, Computed tomography

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Figure 1.

Both hands presents thenar muscle atrophy.

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).

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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