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Metacarpal Small Incision for Carpal Tunnel Syndrome

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Intratendinous Gout Causing Carpal Tunnel Syndrome: Clinical Characteristics and Proposed Surgical Algorithm.

Saw Sian Khoo¹, Yee Chan Chai¹, Xiu Wen Ling²

¹National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.

Indian Journal of Orthopaedics

|October 21, 2025

Summary

Secondary carpal tunnel syndrome (CTS) from intratendinous gout is rare but treatable. Surgical management, including tendon debulking, significantly improves hand function and outcomes in affected patients.

Keywords:

Carpal tunnel syndrome Tendon debulking Tendon resection Tophaceous gout

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Published on: May 26, 2023

Area of Science:

Orthopedics
Rheumatology
Hand Surgery

Background:

Intratendinous tophaceous gout is a rare cause of secondary carpal tunnel syndrome (CTS).
Preoperative diagnosis and standardized surgical management protocols are lacking.
This study investigates clinical characteristics and surgical outcomes for gout-related CTS.

Purpose of the Study:

To review cases of carpal tunnel syndrome (CTS) secondary to intratendinous gout.
To assess the effectiveness of surgical interventions on hand function.
To identify clinical indicators and propose management strategies for gouty CTS.

Main Methods:

Retrospective review of 564 carpal tunnel releases (CTR) from January 2013 to December 2021.
Identified 14 wrists with CTS related to intratendinous gout.
Assessed hand function using the Michigan Hand Outcomes Questionnaire (MHQ) and grip strength.

Main Results:

All 12 patients were male, with a mean age of 51. Most had poorly managed gout.
Volar wrist swelling and restricted finger motion were common (57% and 71%).
Surgical outcomes showed significant improvement in MHQ scores (41.5 to 77.5, p < 0.001) post-treatment.

Conclusions:

Male gender, history of gout, volar wrist swelling, and restricted finger motion are red flags for gouty CTS.
Tendon debulking and excision showed similar clinical outcomes.
Recommended first-line management is CTR with tendon debulking, followed by excision or reconstruction if necessary.