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June 20, 1977

Tophaceous GoutAn Unusual Cause of Bilateral Carpal Tunnel Syndrome

JAMA. 1977;237(25):2747-2748. doi:10.1001/jama.1977.03270520057026

THE CARPAL tunnel syndrome is a compression neuropathy of the median nerve caused by its entrapment in the carpal tunnel. The clinical diagnosis is based on the presence of thenar muscle weakness and atrophy and paresthesias in the distribution of the median nerve. The carpal tunnel syndrome was first described in 1854 and has been extensively defined by Phalen over the last two decades.1 Common causes of carpal tunnel syndrome are rheumatoid arthritis, diabetes mellitus, and trauma; gout is a rare cause.2 We report an unusual case of tophaceous gout causing bilateral carpal tunnel syndrome.

See also p 2746. 

Report of a Case  A 40-year-old man had a three-year history of gout. His initial attack, in 1972, was characterized by exquisitely painful swelling and redness of both first metatarso-phalangeal joints. He had one or two attacks of acute arthritis per month for the next year, and well-defined nodules