A Complex Case of Bilateral Carpal Tunnel Syndrome in a Patient With Gout: A Case Report and Review of Literature

Carpal tunnel syndrome (CTS) is the most common nerve entrapment condition of the upper extremity, primarily caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. While various factors can lead to this condition, the accumulation of gouty tophi in the flexor tendons is a rare cause. This case involves a 57-year-old manual laborer who presented with progressively worsening symptoms in both hands, including numbness, pain, and muscle weakness, which were more severe in his right hand. He had a 20-year history of gout, managed with medication. On examination, significant findings included atrophy of the thenar muscles, gouty tophi in both hands and a palpable soft tissue mass in the right wrist. Diagnostic tests confirmed CTS in both hands, with more pronounced severity on the right side. Imaging studies revealed the presence of gouty tophi and soft tissue masses in both hands. Surgical decompression of the carpal tunnel was performed on each hand, with excision of the soft tissue mass in the right wrist, which was identified as synovitis of the flexor tendons. During surgery, an accessory flexor muscle of the fifth finger was discovered in the right hand. Postoperative recovery was smooth, and the patient showed significant improvement in symptoms at follow-up. This case underscores the complex and multifactorial nature of CTS, especially when associated with gout. The combination of gout and repetitive physical strain from the patient's occupation likely contributed to the development of the condition in his right hand. Although the accessory flexor muscle was not the primary cause of nerve compression, its presence highlights the importance of considering anatomical variations when diagnosing and managing CTS. This case enhances the current understanding of CTS and emphasizes the need for personalized diagnostic and treatment strategies in patients with underlying conditions such as gout.