[An unusual manifestation of osteo-articular, tendinous and nervous involvement secondary to tophaceous gout of the hand. A report of two cases].
Tophaceous gout of the hand is a rare condition, but possible in chronic cases. We report two cases (three hands) with a long history of hyperuricemia and serious lesions due to deposition of sodium urate crystals. In these cases we point out several fundamental aspects: the abnormal size of the tophi, the destruction of triquetum and pisiform, the digital joint instability due to ligamentous lesions, the tenosynovitis and digital flexion contracture secondary to intratendinous deposition of urates, and the presence of a double ipsilateral tunnel syndrome of the median and ulnar nerves at the wrist. After neurolysis and tophus resection, a rapid and very substantial relief of paraesthesiae was seen. Recovery of partial active wrist and finger movements required a variety of surgical interventions. The results are analysed after 2 years for the first case, and 8 months for the second.
Martínez-Villén
G
G
Service de chirurgie orthopédique et traumatologie, unité de main-microchirugie, hôpital universitaire Miguel-Servet, 1, 3, place Isabel-la-Católica, 5009 Zaragoza, Spain. gmarvil@terra.es
Canales
V
V
Hernández-Rossi
A
A
Herrera
A
A
D002349:Carpal Tunnel Syndrome / Q000209:etiology*; D003286:Contracture / Q000209:etiology; D003460:Crystallization; D020430:Cubital Tunnel Syndrome / Q000209:etiology*; D004576:Electromyography; D005384:Finger Joint / Q000473:pathology; D005500:Follow-Up Studies; D006073:Gout / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D006225:Hand / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D033461:Hyperuricemia / Q000150:complications; D007593:Joint Instability / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D000074402:Synovectomy; D013717:Tenosynovitis / Q000209:etiology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014527:Uric Acid / Q000378:metabolism
D014527:Uric Acid