case_images: PMC10757969_01
case_images: Radiology showed that no obvious abnormalities were found in the bones and soft tissues of the wrist.
case_images: fsurg-10-1282202-g001.jpg
case_images: PMC10757969_01_fsurg-10-1282202-g001.jpg
case_images: F1
case_images: Radiographs showed no tophi deposition in the bone at his wrist and hands (Figure 1).
case_images: MRI showed that there was a fusiform mass on the palm side of the carpal bone (red arrow). (A-B) The mass was located under the transverse carpal ligament and in front of the carpal bone, and was in the shape of a pike, measuring approximately 0.66 cm 1.37 cm. (C) The mass can be seen in cross section compressing the median nerve. Given the patient's high uric acid levels and MRI findings, it was hypothesized that the mass could be tophi causing carpal tunnel syndrome.
case_images: fsurg-10-1282202-g002.jpg
case_images: PMC10757969_01_fsurg-10-1282202-g002.jpg
case_images: F2
case_images: Magnetic resonance imaging (MRI) showed a fusiform mass on the volar surface of the carpal bone, and this mass happens to be pressing on the median nerve (Figure 2).
case_images: (A) After cutting the transverse carpal ligament, the median nerve was fully exposed. At the point where the median nerve is far from the wrist (in the palm of the hand), there is a distinct impression on the nerve, and the local color of the nerve is dark red (white arrow). (B) The median nerve was retracted to the ulnar side to fully expose the superficial flexor of the index finger. At this time, the flexor tendon sheath was enlarged in a fusiform shape (white arrow), and the enlarged part caused compression on the median nerve. (C) When the flexor tendon sheath of the index finger was opened, it can be seen that there are large number of milky white soft tophi in the tendon sheath. The tophi are entirely surrounded by the tendon sheath, and there is no inflammation or ulceration on the surface of the tendon sheath. (D) The tophi were removed from the tendon sheath and tenosynovectomy was performed.
case_images: fsurg-10-1282202-g003.jpg
case_images: PMC10757969_01_fsurg-10-1282202-g003.jpg
case_images: F3
case_images: An indentation at the distal end of the median nerve could be seen, and the local color was dark red (Figure 3A). The median nerve was retracted to the ulnar side with a rubber strip, and the tendon sheath of the superficial flexor of the index finger was observed to be significantly swollen, squeezing the median nerve (Figure 3B). The surface of the tophi was soft and delicate (Figure 3C). Intraoperatively, tophi were flushed with large amounts of normal saline until there were no visible tophus deposits around the superficial flexor tendon (Figure 3D).