An inusual 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. (c) 2007 Elsevier Masson SAS. Tons droits reserves.