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Case Reports
. 2025 May 13:12:1503085.
doi: 10.3389/fsurg.2025.1503085. eCollection 2025.

Case Report: Sliding gouty tophi: a case of dynamic ultrasound diagnosis of carpal tunnel syndrome

Chenchen Qu  1 , Heping Deng  1 , Bo Lu  2 , Yaru Mi  1 , Hui Ye  1 , Yaru Zhu  1
Affiliations
Case Reports

Case Report: Sliding gouty tophi: a case of dynamic ultrasound diagnosis of carpal tunnel syndrome

Chenchen Qu et al. Front Surg. .

Abstract

Carpal tunnel syndrome (CTS) caused by gouty tophi is a rare clinical condition. In this case, ultrasonography clearly identified gouty tophi deposited within the superficial flexor tendon of the right middle finger, resulting in tendon thickening. The thickened tendon was constrained by the transverse carpal ligament, leading to restricted finger movement. Additionally, when the finger was extended, the thickened tendon slid beneath the transverse carpal ligament, triggering severe symptomatic episodes of CTS. This observation provided direct evidence of the underlying etiology of CTS in this patient.

Keywords: carpal tunnel syndrome; flexor tendon; gouty tophi; median nerve; musculoskeletal ultrasound.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A–C) Flexor tendon and median nerve images of the middle finger in flexed position. (A) Transverse section of the proximal carpal tunnel showing the thickest part of the proximal carpal tunnel tendon and swelling of the median nerve. (B) Transverse section of the carpal tunnel showing thickening of the tendon and thinning of the median nerve. (C) Longitudinal section of the proximal carpal tunnel showing the thickest part of the tendon. (D–F) Images of the flexor tendon of the middle finger and the median nerve in the extended position. (D) Cross section of the proximal carpal tunnel showing thickening of the tendon and swelling of the median nerve. (E) Horizontal transverse section of the carpal tunnel showing the thickest portion of the tendon in the carpal tunnel and significant compression of the median nerve. (F) Horizontal longitudinal section of the carpal tunnel showing compression of the thickest part of the tendon and the nerve. (In Figure (A) numbers 1.2.3 are the flexor pollicis Longus tendon, flexor digitorum profundus tendon of the index finger and flexor digitorum profundus tendon of the middle finger, respectively. MN, median nerve; TCL, transverse carpal ligament; FDS and S, flexor digitorum superficialis tendon of the middle finger; FDP and D, flexor digitorum profundus tendon of the middle finger).
Figure 2
Figure 2
MRI presentation of the patient's right wrist. Part of the superficial flexor tendon of the fingers of the right wrist is significantly thickened (white arrow), with increased T2WI signal and a maximum cross-sectional area of approximately 1.7 cm × 1.3 cm, and the adjacent median nerve is locally compressed with increased signal (black arrow).
Figure 3
Figure 3
Surgical finding. (A) After dissection of the transverse carpal ligament, the superficial flexor tendon of the middle finger was completely exposed, and the tendon sheath was pike shaped. (B) Dissection of the tendon sheath of the superficial flexor tendon of the middle finger revealed a large number of milky-white goncholiths within the tendon sheath, and the goncholiths were completely encapsulated by the tendon sheath.
Figure 4
Figure 4
Postoperative pathology suggestive of gout.
See this image and copyright information in PMC

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