Atypical musculoskeletal manifestations of gout in hyperuricemia patients

Subsequent bilateral acute carpal tunnel syndrome due to tophaceous infiltration: A case report

BACKGROUND

Acute carpal tunnel syndrome (ACTS) is commonly caused by repetitive strain, trauma, or inflammatory conditions. However, ACTS due to tophaceous gout is a clinical event that remains poorly understood and underreported. This rare manifestation necessitates prompt diagnosis and intervention to prevent irreversible complications.

CASE SUMMARY

A 51-year-old man who had poorly controlled hyperuricemia presented with ACTS secondary to tophaceous gout. Because of rapid symptom progression symptoms and severe median nerve compression within 3 mo, the patient underwent emergency decompression surgery for both wrists at different time points. Postoperatively, he exhibited complete recovery of sensory and motor functions, with no recurrence at long-term follow-up. Favorable outcomes were achieved through immediate decompression surgery, anti-inflammatory medications, postoperative active and passive range-of-motion exercises, and intermittent wrist splinting. Prompt diagnosis and surgical intervention, when necessary, are crucial for preventing long-term complications and obtaining favorable outcomes in patients with ACTS. An optimal gout management strategy involving pharmacologic therapy and lifestyle modifications may help minimize ACTS recurrence and improve clinical outcomes.

CONCLUSION

Prompt surgical intervention and optimal gout management are crucial for preventing irreversible nerve damage and ACTS recurrence.

Knee locking caused by osteochondroma of the proximal tibia adjacent to the pes anserinus: A case report

BACKGROUND

Osteochondroma is one of the most common benign bone tumors, and it may cause bone and joint deformities and limited range of motion of an adjacent joint. The pes anserinus region is one of the most frequent sites of osteochondroma, but knee locking caused by osteochondromas in the pes anserinus region is extremely rare.

CASE SUMMARY

We describe a 13-year-old Japanese girl's extra-articular knee locking that occurred when the semitendinosus tendon got caught in osteochondroma that had developed in the pes anserinus region. The osteochondroma was surgically resected. The postoperative outcome has been excellent, with no recurrence of knee locking or tumor one-year post-surgery.

CONCLUSION

When a young person develops knee locking, the possibility of extra-articular as well as intra-articular locking should be considered. Osteochondroma, one of the causes of extra-articular locking, can be treated with surgery with good postoperative results.

Atypical Presentation of Gouty Tophus as Posterior Cruciate Ligament Cyst: A Case Report

Introduction

Gouty tophi generally develop around 10 years after the first attack of gout in untreated patients and are commonly found around feet, hands, and elbows. However, tophi can also occur as first sign of disorder. Tophaceous gout presenting in young at the posterior cruciate ligament (PCL) is extremely rare and difficult to diagnose because of its atypical presentation and no hallmark features in magnetic resonance imaging (MRI).

Case Report

Here, we report a 25-year-old man manual worker with no prior history of gout has presented with left knee pain and locking episodes for 3 weeks, X-ray shows no abnormality, on advanced imaging with MRI, a well-defined cyst noted adjacent to PCL toward lateral aspect. During arthroscopy, a cyst was seen between anterior cruciate ligament and PCL with the extrusion of chalky paste-like material on puncturing the cyst. The tophus was biopsied and excised arthroscopically with excellent outcome.

Conclusion

This case report demonstrates that gout does not only always cause severe joint pain from inflammatory arthritis, but can also cause mechanical pain and locking of joint atypically presenting as intra-articular tophi. Hence, gout should also be considered in differential diagnosis of intra-articular cyst. Arthroscopic removal and continuous urate-lowering therapy provide excellent outcomes for such atypical presentations.

A Tennis Elbow, A First Presentation of Gout Disease

Gout is a common disease, which affects more than 8 million of patients in the US alone. Typically, gout present as articular surfaces are well described in literature. However, the extra articular manifestations are being increasingly reported in the last few years. The extra-articular manifestations of gout disease can present in several ways, including tenosynovitis, and most commonly affecting the lower limb. Here in, the authors are going to present a rare case of recurrent tennis elbow episodes. The only clinical explanation of this novel presentation was presence of high serum uric acid levels.

Acute Carpal Tunnel Syndrome Secondary to Gout Flare and Outcomes at 18 Months After Open Carpal Tunnel Decompression

Acute carpal tunnel syndrome is a rare condition that requires immediate surgery. Although numerous causes have been described in the literature, only 7 reports of acute carpal tunnel syndrome secondary to gout have been reported, all with short follow-ups. We report, to our knowledge, the first case of carpal tunnel syndrome presenting with total anesthesia of the fingers innervated by the median nerve and complete recovery of the sensory and motor function after carpal tunnel decompression, with no recurrence at the 18-month follow-up. To prevent irreversible damage to the nerve, treatment should not be delayed.

Gout tophus in transferred tendons after 33 years: A case report

Surgical site gout is an extremely rare complication that is difficult to diagnose, particularly in patients without a history of gout. A 57-year-old male patient was admitted with no previous history of gout, complaining of surgical site gout located at the junction where flexor carpi ulnaris tendon was transferred to extensor digitorum communis tendon after 33 years of the initial surgery. The patient was presented with a progressive swelling over the last three months which was located on the dorsoulnar side of the right wrist joint. Magnetic resonance imaging revealed an iso/hypointense mass. During the excisional biopsy, retained non-absorbable suture materials were observed within the mass. Histopathological examination result was reported as a typical gout tophus. No recurrence was observed after 18 months of follow-up. In conclusion, surgical site gout may be observed at transferred tendons years after the initial surgery.

Post-ACL Reconstruction Graft Failure in Severe Gout Arthritis Patient

Introduction

Pain and instability following an anterior cruciate ligament (ACL) reconstruction remain a significant issue. Common causes include infection and inflammation, and mechanical issues such as graft failure.

Case Presentation

A 36-year-old male with an ACL reconstruction six years prior was admitted due to pain and swelling. The ACL graft that had ruptured was found arthroscopically. Numerous gout crystals and tophus were observed inside. This finding is suggested as a cause of this kind of complication.

Discussion

Biological failure is one of the causes of graft failure. Gout arthritis is associated with internal derangement of the joint structures, which is reported in advanced case.

Conclusion

Severe gouty arthritis, even though rare, could be an etiology of graft failure following ACL reconstruction and cause significant morbidity.

Highly specific and label-free histological identification of microcrystals in fresh human gout tissues with stimulated Raman scattering

Gout is a common metabolic disease with growing burden, caused by monosodium urate (MSU) microcrystal deposition. In situ and chemical-specific histological identification of MSU is crucial in the diagnosis and management of gout, yet it remains inaccessible for current histological methods. Methods: Stimulated Raman scattering (SRS) microscopy was utilized to image MSU based on its fingerprint Raman spectra. We first tested SRS for the diagnosis capability of gout and the differentiation power from pseudogout with rat models of acute gout arthritis, calcium pyrophosphate deposition disease (CPDD) and comorbidity. Then, human synovial fluid and surgical specimens (n=120) were were imaged with SRS to obtain the histopathology of MSU and collagen fibers. Finally, quantitative SRS analysis was performed in gout tissue of different physiological phases (n=120) to correlate with traditional histopathology including H&E and immunohistochemistry staining. Results: We demonstrated that SRS is capable of early diagnosis of gout, rapid detection of MSU in synovial fluid and fresh unprocessed surgical tissues, and accurate differentiation of gout from pseudogout in various pathophysiological conditions. Furthermore, quantitative SRS analysis revealed the optical characteristics of MSU deposition at different pathophysiological stages, which were found to matched well with corresponding immunofluorescence histochemistry features. Conclusion: Our work demonstrated the potential of SRS microscopy for rapid intraoperative diagnosis of gout and may facilitate future fundamental researches of MSU-based diseases.

An Unusual Presentation of Gout Involving the Ankle Ligaments

Gout is the most common inflammatory arthritis due to deposition of monosodium urate (MSU) crystals in joints and connective tissues. In contrast to joint disease, the majority of extra-articular involvement remains asymptomatic in patients with gout. Achilles tendon is the most common site of involvement and the inflammation elicited by MSU crystals can be falsely attributed to injury or overuse. In addition, tendon or ligament damage secondary to MSU crystal deposition can lead to ligament tear or tendon rupture.

However, the diagnosis of gout in patients with extra-articular involvement is often delayed or even missed because tissue sampling is not feasible in routine clinical practice. Advanced imaging techniques using ultrasound and dual-energy computer tomography (DECT) can detect MSU crystal deposition in a non-invasive manner and confirm the diagnosis of gout in patients with extra-articular involvement.

The following case demonstrates an atypical presentation of gout causing multiple ligament tears in the ankle and highlights the role of DECT in the diagnosis of gout with extra-articular involvement.