Gouty Tophus of a Flexor Tendon at the Level of the Wrist

Gout is a rare cause of tenosynovitis and is difficult to diagnose based on clinical symptoms and imaging modalities. We present a case of gouty tenosynovitis of the proximal interphalangeal joint. A 32-year old male patient presented with a swollen, painful proximal interphalangeal joint of the 3rd digit on his right hand for 2 weeks with flexion contracture. Surgical exploration of the affected joint revealed a gouty tophus with extensive infiltration of the underlying flexor tendon. A tenosynovectomy and flexor tendon release was performed to treat the flexion contracture. Pathology disclosed urate crystals deposited within the tendon. Gouty infiltration of the flexor tendons of the hand can lead to extensive damage and compromised function. A high level of clinical suspicion is required as gouty tenosynovitis is a rare presentation and can often mimic an infectious etiology. Keywords: Gout; Tenosynovitis; Flexor tendon; Hand; Tophi.

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Digital flexion contracture caused by tophaceous gout in flexor tendon

SAGE Open Medical Case Reports ◽

10.1177/2050313x19844708 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1984470 ◽

Cited By ~ 1

Author(s):

Tsuyoshi Tajika ◽

Takuro Kuboi ◽

Tokue Mieda ◽

Noboru Oya ◽

Fumitaka Endo ◽

...

Keyword(s):

Flexor Tendon ◽

Full Range ◽

Rare Condition ◽

Metacarpophalangeal Joint ◽

Flexion Contracture ◽

Proper Treatment ◽

Histological Findings ◽

Tophaceous Gout ◽

Gouty Tophus ◽

White Substance

Gouty tophus is an unusual cause of digital flexion contracture. Awareness of this pathophysiology will lead to more confidence in proper treatment and surgical management of this rare condition. This report describes a case of digital flexion contracture by tophaceous gout distinguished between trigger finger and locking of the metacarpophalangeal joint. We found the flexor tendon with a deposited chalky white substance suggestive of gouty tophus intraoperatively. We performed tenosynovectomy and removed the chalky white substance to the greatest degree possible. Histological findings confirmed the diagnosis of gout. Postoperatively, the patient recovered nearly to a full range of motion of the affected digits. When meeting with the patient who has had hyperuricemia and who is unable to extend the affected digits suddenly, one must keep in mind digital flexion contracture caused by tophaceous gout.

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