Tophaceous gout-related carpal tunnel syndrome and flexor tendon involvement: a systematic review.
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, İstanbul Aydın University, İstanbul, Türkiye.
Abstract
Tophaceous gout is an uncommon but clinically important cause of secondary carpal tunnel syndrome (CTS), with lesions ranging from diffuse flexor tenosynovitis to intratendinous destruction and direct median nerve involvement. PubMed/MEDLINE, Scopus, and Web of Science Core Collection were searched through 23 July 2026, supplemented by Google Scholar, publisher-page verification, and citation searching. Human primary reports explicitly attributing CTS or wrist-level median neuropathy to gout, tophus, or monosodium urate deposition were eligible. Two reviewers independently screened records. Fifty-seven reports (27 complete/detailed and 30 limited clinical sources) formed the primary synthesis and underwent design-appropriate Joanna Briggs Institute appraisal; 12 bibliographic or translation-limited reports were retained as historical ancillary evidence. Primary reports were additionally classified post hoc by causal certainty. Of 478 database records, 302 unique records were screened, and 69 canonical reports were included. The 57-report primary synthesis comprised 44 case reports or clinical-image reports, 12 case series, and one nonrandomized comparative study, representing at least 120 patients, 152 CTS wrists, and 146 gout-attributable wrists. Sex was reportable for 117 patients, of whom 111 (94.9%) were male. Causal certainty was Tier 1 (direct local confirmation) in 41 reports, Tier 2 (anatomically supported) in 5, and Tier 3 (explicit report-level attribution) in 11. Post hoc sensitivity analyses retaining Tier 1 + 2 (n = 46) and then Tier 1 only (n = 41) did not change the principal qualitative interpretations. Open decompression with lesion treatment was the most frequently reported operative pattern, but evidence remained insufficient to determine a preferred tendon procedure. JBI findings are reported by design; 481 item-level judgments are retained only as an audit total. Gout should be considered in atypical, acute, severe, recurrent, bilateral, or mass-associated CTS. In surgically treated reports, decompression was commonly combined with individualized management of tophaceous and tendon disease. The evidence is predominantly case-based and hypothesis-generating and is insufficient to define a validated treatment pathway or preferred tendon procedure.
Related
- Ultrasound-guided needle knife release of the transverse carpal ligament for carpal tunnel syndrome: a prospective case series study
- Evaluation of Large Language Model Concordance With AAOS Clinical Practice Guidelines for Carpal Tunnel Syndrome
- Shear Wave Elastography of the Abductor Pollicis Brevis in Carpal Tunnel Syndrome: Relationship with Quantitative Motor Unit Potential and Nerve Conduction Parameters
- Wrist and Thumb Kinematics During Sustained Smartphone Typing in Patients with Carpal Tunnel Syndrome: A Cross-Sectional Comparative Study
- Constant Versus Ascending Radial Pressure Wave Therapy for Pain Management in Carpal Tunnel Syndrome: A Pilot Exploratory Study
BibTeX
@article{gunenc2026tophaceous,
title = {{Tophaceous gout-related carpal tunnel syndrome and flexor tendon involvement: a systematic review.}},
author = {Ali Can Gunenc and Mehmet Sefik Oruc},
journal = {Frontiers in surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1948883},
url = {https://europepmc.org/article/MED/42953639},
note = {CC BY},
}
RIS
TY - JOUR
TI - Tophaceous gout-related carpal tunnel syndrome and flexor tendon involvement: a systematic review.
AU - Ali Can Gunenc
AU - Mehmet Sefik Oruc
PY - 2026
DA - 2026/10/02
JO - Frontiers in surgery
DO - 10.3389/fsurg.2026.1948883
UR - https://europepmc.org/article/MED/42953639
AB - Tophaceous gout is an uncommon but clinically important cause of secondary carpal tunnel syndrome (CTS), with lesions ranging from diffuse flexor tenosynovitis to intratendinous destruction and direct median nerve involvement. PubMed/MEDLINE, Scopus, and Web of Science Core Collection were searched through 23 July 2026, supplemented by Google Scholar, publisher-page verification, and citation searching. Human primary reports explicitly attributing CTS or wrist-level median neuropathy to gout, tophus, or monosodium urate deposition were eligible. Two reviewers independently screened records. Fifty-seven reports (27 complete/detailed and 30 limited clinical sources) formed the primary synthesis and underwent design-appropriate Joanna Briggs Institute appraisal; 12 bibliographic or translation-limited reports were retained as historical ancillary evidence. Primary reports were additionally classified post hoc by causal certainty. Of 478 database records, 302 unique records were screened, and 69 canonical reports were included. The 57-report primary synthesis comprised 44 case reports or clinical-image reports, 12 case series, and one nonrandomized comparative study, representing at least 120 patients, 152 CTS wrists, and 146 gout-attributable wrists. Sex was reportable for 117 patients, of whom 111 (94.9%) were male. Causal certainty was Tier 1 (direct local confirmation) in 41 reports, Tier 2 (anatomically supported) in 5, and Tier 3 (explicit report-level attribution) in 11. Post hoc sensitivity analyses retaining Tier 1 + 2 (n = 46) and then Tier 1 only (n = 41) did not change the principal qualitative interpretations. Open decompression with lesion treatment was the most frequently reported operative pattern, but evidence remained insufficient to determine a preferred tendon procedure. JBI findings are reported by design; 481 item-level judgments are retained only as an audit total. Gout should be considered in atypical, acute, severe, recurrent, bilateral, or mass-associated CTS. In surgically treated reports, decompression was commonly combined with individualized management of tophaceous and tendon disease. The evidence is predominantly case-based and hypothesis-generating and is insufficient to define a validated treatment pathway or preferred tendon procedure.
SN - 2296-875X
ER -