Gouty Tophi within the Carpal Tunnel Leading to Severe Finger Flexion Contracture A Case Report and Short-Term Follow-Up

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It is often misdiagnosed or delayed in treatment, seriously affecting hand function. CASE SUMMARY: This article reports a 47-year-old male patient who presented with a mass on the palmar side of his right wrist and ring finger flexion deformity. Imaging and intraoperative findings revealed that tophi extensively involved the flexor tendon and caused tendon adhesion and carpal tunnel entrapment. Through surgical removal of tophi, loosening of adhesions, and decompression of the carpal tunnel, as well as continuous post-operative uric acid-lowering treatment, the patient's hand function recovered significantly. CONCLUSION: Based on the literature review, it is suggested that for unexplained hand deformities, we need to be alert to the possibility of tophi. Early diagnosis and comprehensive treatment can improve the prognosis. tophi carpal tunnel syndrome flexor tendon flexion contracture surgical treatment Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Although gout is common, it is rare to cause carpal tunnel syndrome and fixed flexion contracture. Gout is a metabolic disease caused by disordered uric acid metabolism, leading to the deposition of urate crystals. In the late stage, tophi can form, which is common in joints, soft tissues, and kidneys [ 1 – 3 ] . Typical clinical manifestations of gout include acute arthritis attacks and subcutaneous tophi formation [4], but cases involving the carpal tunnel and compressing the flexor tendons are rare, and treatment and short-term outcomes are even less well described [ 5 – 6 ] . The carpal tunnel serves as a fibrous tube, and its contents include the median nerve and multiple flexor tendons. When tophi invade the flexor tendon and can lead to tendon adhesion, entrapment, and secondary deformity, it is easily misdiagnosed as stenosing tenosynovitis or tumor, resulting in delayed treatment [ 7 ] . This article reports a case of finger flexion contracture deformity caused by tophi involving the flexor tendons in the carpal tunnel. Through comprehensive intervention, including preoperative imaging evaluation, surgical removal of tophi, tendon release, and postoperative rehabilitation, recent follow-up showed significant improvement in deformity correction and hand function. This report aims to explore the clinical characteristics, diagnostic points, and individualized treatment strategies of this special case, combined with a review of the literature, to provide a reference for the management of similar cases. CASE PRESENTATION Clinical trial number: not applicable. Ethical Approval and accordance : The Ethics Committee of Lixin County People's Hospital approved this study, which was conducted in accordance with the guidelines of the Ethics Committee of Lixin County People's Hospital. Chief complaints The patient, a 47-year-old male, a farmer, visited our department because of "a mass on the palmar side of the right wrist accompanied by flexion deformity of the right ring finger for 8 months." History of present illness The patient accidentally discovered a mass on the palmar side of his right wrist 8 months ago. The mass gradually increased in size and was accompanied by excessive flexion of the ring finger and difficulty in extending the finger. The diagnosis was not confirmed after multiple visits to other hospitals, and the symptoms gradually worsened. History of past illness The patient had a history of hyperuricemia. He visited Lixin County People's Hospital many times in the past year and was diagnosed with hyperuricemia without standardized treatment. Personal and family history The patient has been engaged in agricultural work and construction site labor all year round. The history of hyperuricemia in his parents is unknown in the family history. Physical examination A mass of about 7 cm × 2 cm was palpable under the skin on the volar side of the right wrist, with a tough texture, clear boundaries, no tenderness, and normal skin temperature; the right ring finger showed extreme flexion deformity, and tenderness on the volar side of the fourth metacarpophalangeal joint; the flexion and extension of the wrist joint was slightly limited, and the extension activities of the fingers were limited. Blood supply and sensation were normal. Laboratory examinations A uric acid test was performed at Lixin County People's Hospital from 2024-07-11 to 2025-3-27, and the uric acid level reached (680.38 ± 166.79) umol/L. After surgery and anti-uric acid treatment, the uric acid level gradually decreased from 2025-07. See Table 1 and Fig. 3 . Table 1 Changes in uric acid levels. Date Uric acid value (umol/L) Reference range (umol/L) 2024/7/11 2024/7/17 2024/8/30 2025/1/8 2025/3/27 2025/7/1 2025/8/1 2025/8/8 2026/1/7 851.1 709 591 808.8 442 469 508 391 419 202–416 Imaging examinations : The patient underwent MRI examination of the right wrist joint before surgery, which showed: a slightly fluid signal shadow was seen around the flexor digitorum profundus tendon and in the joint capsule, the synovium showed thickening, and strips of mixed T1WI slightly low-signal shadow were seen in the flexor digitorum superficialis tendon area. The fat-suppressed image showed uneven and high signal. The length of the scan range was about 7 cm, and the thickest part was about 1 cm. A follow-up MRI of the right wrist joint 6 months after the operation showed that the above abnormal signals had basically disappeared. See Fig. 2 . Electromyography The latency of the right wrist median nerve was 4.4 ms, the amplitude was 7.2 mV, and the conduction velocity was 54.7 m/s, indicating that the right wrist median nerve latency was prolonged and the sensory conduction velocity was slowed down. The electromyography reexamination 6 months after the operation showed that the latency of the median nerve of the right wrist was 4.1 ms, the amplitude was 7.0 mV, and the conduction velocity was 50.5 m/s, indicating that the latency of the median nerve of the right wrist was prolonged and the sensory conduction velocity slowed down, which was not much different from before. Considering that the current winter temperature affects the results and the nerve recovery period is longer. Pathological examination Foreign body granuloma with urate crystal deposition, consistent with gout nodules. ( Fig. 2 .) FINAL DIAGNOSIS Tophi in the left wrist; left median nerve injury; flexion contracture deformity of the right ring finger TREATMENT The patient underwent right wrist exploration under general anesthesia. First, loosen the tendon sheath of the fourth flexor tendon of the right hand, and uric acid crystals can be seen attached to the tendon sheath. In the carpal tunnel, the flexor digitorum profundus tendon is seen to be fusiform and enlarged, covered with tophi, and widely adherent. The carpal tunnel is compressed, causing finger flexion deformity. Tophi were removed, tendon adhesions were loosened, part of the transverse carpal ligament was incised and decompressed, and flushed with sodium bicarbonate solution. Median nerve entrapment was released, and finally, the tendon was repaired, and the incision was sutured. The finger deformity disappeared immediately after surgery, and the activity improved. OUTCOME AND FOLLOW-UP The patient was given continuous uric acid-lowering treatment (Febuxostat 20 mg qd po), and functional exercises of the finger and wrist joints were instructed. One month after the operation, the uric acid level was lower than before (see Table 1 , Fig. 3 ), and the patient's clinical symptoms were significantly improved. In terms of subjective feelings, the pain VAS score dropped from 8 points before surgery to 3 points, and the hand function QuickDASH score improved from 75 points to 40 points. Objective examination showed that the total active range of motion of the wrist joint and fingers was significantly increased compared with that before surgery. It is particularly worth mentioning that the main clinical manifestation before surgery − 45° flexion contracture of the proximal interphalangeal joint of the ring finger - was reduced to 15° after surgery (see Table 2 ). After that, because the patient was not in the local area, the patient's function recovered well through monthly telephone follow-up visits. Six months after the operation, the uric acid level continued to remain at a low level (see Table 1 and Fig. 3 ), and the patient's clinical symptoms improved significantly. In terms of subjective feelings, the pain VAS score dropped to 1 point, and the hand function QuickDASH score increased to 15 points. The total active range of motion of the wrist joint and fingers has been significantly increased and further improved compared with the preoperative level, and is close to the normal level. The flexion contracture of the proximal interphalangeal joint of the ring finger was reduced to 5°, which was basically normal (see Table 2 ). Table 2. Comparison of clinical outcomes before surgery and at one-month follow-up Note: TAM = (metacarpophalangeal joint flexion + proximal interphalangeal joint flexion + distal interphalangeal joint flexion) - (sum of extension loss at any joint) DISCUSSION This case is unique in that it reports an extremely rare severe hand deformity caused by direct invasion of tophi into the carpi flexor tendon. Its distinctive feature is not only that tophi cause the typical carpal tunnel syndrome, but also that its aggressive growth leads to tendon adhesion and fixed flexion contracture of the fingers, which is a serious complication of end-stage gout that is rarely documented in detail in the existing literature. This case provides direct evidence of this pathological process through surgical imaging and intraoperative findings, and confirms the short-term effectiveness of surgical debridement combined with postoperative urate-lowering therapy. The pathological mechanism of tophi deposition mainly stems from the chronic deposition of urate crystals in tendons and surrounding tissues, which triggers inflammatory reactions, fibrous tissue hyperplasia, and soft tissue adhesions [ 8 – 10 ] . In the narrow anatomical space of the carpal tunnel, tophi can not only cause nerve compression, manifesting as typical carpal tunnel syndrome, but may also directly invade the flexor tendons and their synovial membrane, restrict the normal sliding of the tendons, and ultimately cause fixed flexion deformity of the fingers [ 11 – 12 ] . Although gout is a common metabolic disease, it is rare for tophi to involve the carpal tunnel and cause tendon function impairment and contracture deformity, and diagnosis and treatment are easily delayed. This patient's disease course lasted for 8 months. The initial misdiagnosis may be related to the atypical clinical manifestations and insufficient understanding of the complications. In this case, the scope of tophi was clarified through ultrasound and MRI, which laid the foundation for formulating a treatment plan. Postoperative pathology confirmed the diagnosis of tophi. This case reminds clinicians that patients with unexplained wrist masses accompanied by progressive loss of hand function, especially those with a history of gout, should pay close attention to the possibility of tophi invasion. The key to successful treatment is complete resection of the lesion and removal of mechanical obstruction. In this case, through thorough removal of tophi, release of soft tissue adhesions, and decompression of the carpal tunnel, the postoperative deformity and function were rapidly improved. Combined with standardized perioperative urate-lowering treatment, disease activity can be effectively controlled, and recurrence prevented [ 13 – 15 ] . Early postoperative individualized rehabilitation training is crucial to restore tendon sliding and joint mobility, helping to maximize hand function recovery and reduce complications. In this case, the preoperative and postoperative comparison showed that the VAS and QuickDASH scores improved significantly, indicating pain relief and functional recovery. The range of motion of the wrist joint and fingers was greatly improved in the early postoperative period due to the removal of mechanical obstruction and adhesion lysis, but it has not yet reached the normal range, which is consistent with the characteristics of edema and stiffness in the early postoperative period. The range of motion of the joint is significantly increased, but may not completely return to normal, possibly due to loss of elasticity caused by long-term tendon invasion. The treatment experience of this case demonstrates the importance of a comprehensive management strategy with multidisciplinary collaboration in the management of such complex cases. A longer follow-up is still needed in the future to evaluate its long-term efficacy and risk of recurrence. In summary, patients with unexplained hand masses accompanied by deformities, especially those with hyperuricemia, should be alert to the possibility of tophi. Multidisciplinary collaboration and long-term regular follow-up play a key role in improving prognosis. CONCLUSION Tophi's invasion of the flexor tendons within the carpal tunnel can cause severe hand deformity, and clinical vigilance needs to be increased. There are a few reports of tophi invading the carpal tunnel and causing tendinopathy, and its treatment requires both uric acid control and local surgical intervention. The comprehensive treatment plan in this case highlights the importance of multidisciplinary collaboration, and the short-term results support the value of early surgery in preventing permanent disability. Declarations Author contributions: Weifeng Li was responsible for the surgical treatment of the patient; Jingyu Guo was a member of the surgical team; Weifeng Li drafted the manuscript; all authors read and approved the final manuscript, assisted in data collection, and wrote and revised the manuscript. Informed Consent Statement: Informed consent was obtained from the patient for participation in this study. Verbal informed consent was obtained from the patient for the publication of this report and any accompanying imaging data. Conflict of Interest Statement: The authors declare that they have no conflicts of interest. Funding: Anhui Provincial Health Research Project (2024Aa30355); Bengbu Medical College Department Key Scientific Research Platform Open Project (AHTT2024B002); Anhui Provincial Clinical Medical Research Transformation Special Project (202427b10020098) Data availability: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. ACKNOWLEDGEMENTS The authors would like to thank Junjie Li from the Department of Orthopedics, Fuyang People's Hospital, Anhui Province, for his support and help with this case report. References FitzGerald JD, Gout. Ann Intern Med. 2025;178(3):ITC33–48. Qi H, Chen H, Dalbeth N et al. Two-decade trajectories of gout: a multi-center cohort study of 10,658 Chinese patients with gout. Rheumatology (Oxford). Published online October 25, 2025. Tabi-Amponsah AD, Stewart S, Stamp LK, Taylor WJ, Terkeltaub R, Dalbeth N. The Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN) definition of clinical remission in gout. Ann Rheum Dis Published online June 18, 2025. Punzi L, Scanu A, Galozzi P, et al. One year in review 2020: gout. Clin Exp Rheumatol. 2020;38(5):807–21. Ma C, Chen H, Deng Y, Lei Y. A novel surgical approach for carpal tunnel syndrome caused by tophi. Asian J Surg Published online September 16, 2024. Liu F, Chen S, Qian J, Zheng J, Yu H. A case of carpal tunnel syndrome caused by gouty tophi confirmed by dual-source CT. Rheumatology (Oxford). 2024;63(3):e104–6. Kubo Y, Sonoda K, Ushijima T, Hara T. Gouty finger flexor tenosynovitis with urate milk remarkably similar to infection: a case-based review. Rheumatol Int. 2025;45(4):86. Published 2025 Apr 3. Qi P, Li L, Zhang J, Ren L, Xie X. The dual regulatory effects of intestinal microorganisms and their metabolites in gouty arthritis pathogenesis: a balance between promotion and inhibition. Front Immunol. 2025;16:1591369. Published 2025 Jun 18. Kilpatrick SE. Non-Neoplastic Orthopedic Pathology Updates: Common Problems and Pitfalls and How to Avoid Them. Mod Pathol. Published online Oct 13, 2025. Guo W, Wei M, Li Y, et al. Mechanisms of urate transport and uricosuric drugs inhibition in human URAT1. Nat Commun. 2025;16(1):1512. Published 2025 Feb 10. Khoo SS, Chai YC, Ling XW, et al. Intratendinous Gout Causing Carpal Tunnel Syndrome: Clinical Characteristics and Proposed Surgical Algorithm. Indian J Orthop. 2025;59(10):1732–43. Published 2025 Jul 15. Liu J, Gu F, Liu Q, et al. Comparative study of trimming and resection of diseased finger superficial flexor tendons in gouty carpal tunnel syndrome. BMC Musculoskelet Disord. 2023;24(1):935. Published 2023 Dec 2. Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020;16(7):380–90. Peng X, Li X, Xie B, et al. Gout therapeutics and drug delivery. J Control Release. 2023;362:728–54. Zhang Z, Shi X, Wu T, et al. Discovery of multi-target anti-gout agents from Eurycoma longifolia Jack through phenotypic screening and structural optimization. Nat Commun. 2025;16(1):7430. Published 2025 Aug 12. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 16 Apr, 2026 Reviews received at journal 15 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers invited by journal 31 Mar, 2026 Editor invited by journal 02 Mar, 2026 Editor assigned by journal 18 Feb, 2026 Submission checks completed at journal 18 Feb, 2026 First submitted to journal 18 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8766537","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":615285507,"identity":"6d37abd2-ed74-42ed-aa96-8d3920c5c6f7","order_by":0,"name":"Weifeng Li","email":"","orcid":"","institution":"People’s Hospital of Lixin County","correspondingAuthor":false,"prefix":"","firstName":"Weifeng","middleName":"","lastName":"Li","suffix":""},{"id":615285508,"identity":"a0d5b221-187a-430a-b32c-8838d0ffbdb6","order_by":1,"name":"Man Wang","email":"","orcid":"","institution":"People’s Hospital of Lixin County","correspondingAuthor":false,"prefix":"","firstName":"Man","middleName":"","lastName":"Wang","suffix":""},{"id":615285509,"identity":"270240cb-b703-4546-b4e6-58d6d0f29721","order_by":2,"name":"Lihua Wang","email":"","orcid":"","institution":"People’s Hospital of Lixin County","correspondingAuthor":false,"prefix":"","firstName":"Lihua","middleName":"","lastName":"Wang","suffix":""},{"id":615285510,"identity":"636a0125-ee4f-4968-ab9c-43158353ac32","order_by":3,"name":"Dong Zhao","email":"","orcid":"","institution":"People’s Hospital of Lixin County","correspondingAuthor":false,"prefix":"","firstName":"Dong","middleName":"","lastName":"Zhao","suffix":""},{"id":615285511,"identity":"862d6818-fe98-4804-be42-eb58d4dd061e","order_by":4,"name":"Jianzhong Guan","email":"","orcid":"","institution":"Bengbu Medical College","correspondingAuthor":false,"prefix":"","firstName":"Jianzhong","middleName":"","lastName":"Guan","suffix":""},{"id":615285512,"identity":"d1e1b2bf-3973-426c-805b-a6d5621a7cc0","order_by":5,"name":"Jingbiao Zhang","email":"data:image/png;base64,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","orcid":"","institution":"People’s Hospital of Lixin County","correspondingAuthor":true,"prefix":"","firstName":"Jingbiao","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-02-02 15:10:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8766537/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8766537/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106189665,"identity":"8abf4f62-1c7d-4157-8490-b733c0a8f889","added_by":"auto","created_at":"2026-04-05 17:10:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37179829,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative situation A: Release of the tendon sheath of the fourth flexor tendon of the right hand; B-C: The flexor tendon in the carpal tunnel is covered with tophi; D-G: Intraoperative removal of tophi and release of tendon adhesions; H, I: Tendon repair and postoperative incision conditions. White*: Superficial flexor tendon, filled with tophi; Blue#: Median nerve.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8766537/v1/d704c557dc3fc198d359d513.png"},{"id":106189667,"identity":"a5510175-dba5-4289-9f5a-94fcff32641b","added_by":"auto","created_at":"2026-04-05 17:10:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23203638,"visible":true,"origin":"","legend":"\u003cp\u003eA-D: Preoperative magnetic resonance imaging shows a mixed-signal mass within the superficial flexor tendon; E-H: Magnetic resonance imaging 6 months after surgery showed a mixed-signal mass in the superficial flexor tendon that had essentially disappeared；I: Peripheral skin biopsy shows amorphous material deposition in the dermis, accompanied by surrounding granulomatous inflammation; J: shows amorphous material deposition in the dermis, surrounded by mononuclear histiocytes, giant cells, and fibrosis.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8766537/v1/d91401697eb02b6834306c9a.png"},{"id":106189669,"identity":"e83df3ec-ad1a-4ba6-b90a-84bf26e7c5e9","added_by":"auto","created_at":"2026-04-05 17:10:37","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":120271,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in uric acid levels\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-8766537/v1/493754e812d3f1371dc4d1e9.png"},{"id":106189666,"identity":"d7054ae6-73a0-43f1-8eab-3d2bd039a7c3","added_by":"auto","created_at":"2026-04-05 17:10:36","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":33946809,"visible":true,"origin":"","legend":"\u003cp\u003eA: Preoperative manifestation is flexion deformity of the proximal interphalangeal joint of the right ring finger; B, C: Good flexion and extension activities of the right wrist joint one month after operation; D-F: Good flexion and extension activities of the right fingers and good grip function one month after operation；G-I: The flexion and extension activities of the right wrist joint were further improved 6 months after the operation；J-L: The flexion and extension activities of the right fingers were further restored 6 months after the operation, and the grip function was basically normal.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-8766537/v1/9ac3ed4d616c063f4d21a6b6.png"},{"id":108490590,"identity":"9668f5af-68f4-4aad-b6f9-2ce206ad2222","added_by":"auto","created_at":"2026-05-05 09:44:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":88972559,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8766537/v1/759d8aca-1600-4a11-ba98-1aece480a46e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gouty Tophi within the Carpal Tunnel Leading to Severe Finger Flexion Contracture A Case Report and Short-Term Follow-Up","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAlthough gout is common, it is rare to cause carpal tunnel syndrome and fixed flexion contracture. Gout is a metabolic disease caused by disordered uric acid metabolism, leading to the deposition of urate crystals. In the late stage, tophi can form, which is common in joints, soft tissues, and kidneys \u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Typical clinical manifestations of gout include acute arthritis attacks and subcutaneous tophi formation [4], but cases involving the carpal tunnel and compressing the flexor tendons are rare, and treatment and short-term outcomes are even less well described \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. The carpal tunnel serves as a fibrous tube, and its contents include the median nerve and multiple flexor tendons. When tophi invade the flexor tendon and can lead to tendon adhesion, entrapment, and secondary deformity, it is easily misdiagnosed as stenosing tenosynovitis or tumor, resulting in delayed treatment \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. This article reports a case of finger flexion contracture deformity caused by tophi involving the flexor tendons in the carpal tunnel. Through comprehensive intervention, including preoperative imaging evaluation, surgical removal of tophi, tendon release, and postoperative rehabilitation, recent follow-up showed significant improvement in deformity correction and hand function. This report aims to explore the clinical characteristics, diagnostic points, and individualized treatment strategies of this special case, combined with a review of the literature, to provide a reference for the management of similar cases.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical Approval\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e \u003cb\u003eand accordance\u003c/b\u003e: The Ethics Committee of Lixin County People's Hospital approved this study, which was conducted in accordance with the guidelines of the Ethics Committee of Lixin County People's Hospital.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eChief complaints\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe patient, a 47-year-old male, a farmer, visited our department because of \"a mass on the palmar side of the right wrist accompanied by flexion deformity of the right ring finger for 8 months.\"\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHistory of present illness\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe patient accidentally discovered a mass on the palmar side of his right wrist 8 months ago. The mass gradually increased in size and was accompanied by excessive flexion of the ring finger and difficulty in extending the finger. The diagnosis was not confirmed after multiple visits to other hospitals, and the symptoms gradually worsened.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHistory of past illness\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe patient had a history of hyperuricemia. He visited Lixin County People's Hospital many times in the past year and was diagnosed with hyperuricemia without standardized treatment.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePersonal and family history\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe patient has been engaged in agricultural work and construction site labor all year round. The history of hyperuricemia in his parents is unknown in the family history.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePhysical examination\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eA mass of about 7 cm × 2 cm was palpable under the skin on the volar side of the right wrist, with a tough texture, clear boundaries, no tenderness, and normal skin temperature; the right ring finger showed extreme flexion deformity, and tenderness on the volar side of the fourth metacarpophalangeal joint; the flexion and extension of the wrist joint was slightly limited, and the extension activities of the fingers were limited. Blood supply and sensation were normal.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLaboratory examinations\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eA uric acid test was performed at Lixin County People's Hospital from 2024-07-11 to 2025-3-27, and the uric acid level reached (680.38 ± 166.79) umol/L. After surgery and anti-uric acid treatment, the uric acid level gradually decreased from 2025-07. See Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChanges in uric acid levels.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eDate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eUric acid value (umol/L)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eReference range (umol/L)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003c/colgroup\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2024/7/11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2024/7/17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2024/8/30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2025/1/8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2025/3/27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2025/7/1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2025/8/1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2025/8/8\u003c/p\u003e \u003cp\u003e2026/1/7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003c/colgroup\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e851.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e709\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e591\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e808.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e469\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e508\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e391\u003c/p\u003e \u003cp\u003e419\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e202–416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eImaging examinations\u003c/b\u003e: The patient underwent MRI examination of the right wrist joint before surgery, which showed: a slightly fluid signal shadow was seen around the flexor digitorum profundus tendon and in the joint capsule, the synovium showed thickening, and strips of mixed T1WI slightly low-signal shadow were seen in the flexor digitorum superficialis tendon area. The fat-suppressed image showed uneven and high signal. The length of the scan range was about 7 cm, and the thickest part was about 1 cm. A follow-up MRI of the right wrist joint 6 months after the operation showed that the above abnormal signals had basically disappeared. See Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eElectromyography\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe latency of the right wrist median nerve was 4.4 ms, the amplitude was 7.2 mV, and the conduction velocity was 54.7 m/s, indicating that the right wrist median nerve latency was prolonged and the sensory conduction velocity was slowed down. The electromyography reexamination 6 months after the operation showed that the latency of the median nerve of the right wrist was 4.1 ms, the amplitude was 7.0 mV, and the conduction velocity was 50.5 m/s, indicating that the latency of the median nerve of the right wrist was prolonged and the sensory conduction velocity slowed down, which was not much different from before. Considering that the current winter temperature affects the results and the nerve recovery period is longer.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePathological examination\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eForeign body granuloma with urate crystal deposition, consistent with gout nodules. ( Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.)\u003c/p\u003e"},{"header":"FINAL DIAGNOSIS","content":"\u003cp\u003eTophi in the left wrist; left median nerve injury; flexion contracture deformity of the right ring finger\u003c/p\u003e"},{"header":"TREATMENT","content":"\u003cp\u003eThe patient underwent right wrist exploration under general anesthesia. First, loosen the tendon sheath of the fourth flexor tendon of the right hand, and uric acid crystals can be seen attached to the tendon sheath. In the carpal tunnel, the flexor digitorum profundus tendon is seen to be fusiform and enlarged, covered with tophi, and widely adherent. The carpal tunnel is compressed, causing finger flexion deformity. Tophi were removed, tendon adhesions were loosened, part of the transverse carpal ligament was incised and decompressed, and flushed with sodium bicarbonate solution. Median nerve entrapment was released, and finally, the tendon was repaired, and the incision was sutured. The finger deformity disappeared immediately after surgery, and the activity improved.\u003c/p\u003e"},{"header":"OUTCOME AND FOLLOW-UP","content":"\u003cp\u003eThe patient was given continuous uric acid-lowering treatment (Febuxostat 20 mg qd po), and functional exercises of the finger and wrist joints were instructed. One month after the operation, the uric acid level was lower than before (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e), and the patient's clinical symptoms were significantly improved. In terms of subjective feelings, the pain VAS score dropped from 8 points before surgery to 3 points, and the hand function QuickDASH score improved from 75 points to 40 points. Objective examination showed that the total active range of motion of the wrist joint and fingers was significantly increased compared with that before surgery. It is particularly worth mentioning that the main clinical manifestation before surgery\u0026thinsp;\u0026minus;\u0026thinsp;45\u0026deg; flexion contracture of the proximal interphalangeal joint of the ring finger - was reduced to 15\u0026deg; after surgery (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After that, because the patient was not in the local area, the patient's function recovered well through monthly telephone follow-up visits. Six months after the operation, the uric acid level continued to remain at a low level (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e), and the patient's clinical symptoms improved significantly. In terms of subjective feelings, the pain VAS score dropped to 1 point, and the hand function QuickDASH score increased to 15 points. The total active range of motion of the wrist joint and fingers has been significantly increased and further improved compared with the preoperative level, and is close to the normal level. The flexion contracture of the proximal interphalangeal joint of the ring finger was reduced to 5\u0026deg;, which was basically normal (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eComparison of clinical outcomes before surgery and at one-month follow-up\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003eNote: TAM = (metacarpophalangeal joint flexion + proximal interphalangeal joint flexion + distal interphalangeal joint flexion) - (sum of extension loss at any joint)\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis case is unique in that it reports an extremely rare severe hand deformity caused by direct invasion of tophi into the carpi flexor tendon. Its distinctive feature is not only that tophi cause the typical carpal tunnel syndrome, but also that its aggressive growth leads to tendon adhesion and fixed flexion contracture of the fingers, which is a serious complication of end-stage gout that is rarely documented in detail in the existing literature. This case provides direct evidence of this pathological process through surgical imaging and intraoperative findings, and confirms the short-term effectiveness of surgical debridement combined with postoperative urate-lowering therapy.\u003c/p\u003e \u003cp\u003eThe pathological mechanism of tophi deposition mainly stems from the chronic deposition of urate crystals in tendons and surrounding tissues, which triggers inflammatory reactions, fibrous tissue hyperplasia, and soft tissue adhesions \u003csup\u003e[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. In the narrow anatomical space of the carpal tunnel, tophi can not only cause nerve compression, manifesting as typical carpal tunnel syndrome, but may also directly invade the flexor tendons and their synovial membrane, restrict the normal sliding of the tendons, and ultimately cause fixed flexion deformity of the fingers \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough gout is a common metabolic disease, it is rare for tophi to involve the carpal tunnel and cause tendon function impairment and contracture deformity, and diagnosis and treatment are easily delayed. This patient's disease course lasted for 8 months. The initial misdiagnosis may be related to the atypical clinical manifestations and insufficient understanding of the complications. In this case, the scope of tophi was clarified through ultrasound and MRI, which laid the foundation for formulating a treatment plan. Postoperative pathology confirmed the diagnosis of tophi. This case reminds clinicians that patients with unexplained wrist masses accompanied by progressive loss of hand function, especially those with a history of gout, should pay close attention to the possibility of tophi invasion.\u003c/p\u003e \u003cp\u003eThe key to successful treatment is complete resection of the lesion and removal of mechanical obstruction. In this case, through thorough removal of tophi, release of soft tissue adhesions, and decompression of the carpal tunnel, the postoperative deformity and function were rapidly improved. Combined with standardized perioperative urate-lowering treatment, disease activity can be effectively controlled, and recurrence prevented \u003csup\u003e[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Early postoperative individualized rehabilitation training is crucial to restore tendon sliding and joint mobility, helping to maximize hand function recovery and reduce complications. In this case, the preoperative and postoperative comparison showed that the VAS and QuickDASH scores improved significantly, indicating pain relief and functional recovery. The range of motion of the wrist joint and fingers was greatly improved in the early postoperative period due to the removal of mechanical obstruction and adhesion lysis, but it has not yet reached the normal range, which is consistent with the characteristics of edema and stiffness in the early postoperative period. The range of motion of the joint is significantly increased, but may not completely return to normal, possibly due to loss of elasticity caused by long-term tendon invasion. The treatment experience of this case demonstrates the importance of a comprehensive management strategy with multidisciplinary collaboration in the management of such complex cases. A longer follow-up is still needed in the future to evaluate its long-term efficacy and risk of recurrence.\u003c/p\u003e \u003cp\u003eIn summary, patients with unexplained hand masses accompanied by deformities, especially those with hyperuricemia, should be alert to the possibility of tophi. Multidisciplinary collaboration and long-term regular follow-up play a key role in improving prognosis.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eTophi's invasion of the flexor tendons within the carpal tunnel can cause severe hand deformity, and clinical vigilance needs to be increased. There are a few reports of tophi invading the carpal tunnel and causing tendinopathy, and its treatment requires both uric acid control and local surgical intervention. The comprehensive treatment plan in this case highlights the importance of multidisciplinary collaboration, and the short-term results support the value of early surgery in preventing permanent disability.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor contributions: Weifeng Li was responsible for the surgical treatment of the patient; Jingyu Guo was a member of the surgical team; Weifeng Li drafted the manuscript; all authors read and approved the final manuscript, assisted in data collection, and wrote and revised the manuscript.\u003c/p\u003e\n\u003cp\u003eInformed Consent Statement: Informed consent was obtained from the patient for participation in this study. Verbal informed consent was obtained from the patient for the publication of this report and any accompanying imaging data.\u003c/p\u003e\n\u003cp\u003eConflict of Interest Statement: The authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003eFunding: Anhui Provincial Health Research Project (2024Aa30355); Bengbu Medical College Department Key Scientific Research Platform Open Project (AHTT2024B002); Anhui Provincial Clinical Medical Research Transformation Special Project (202427b10020098)\u003c/p\u003e\n\u003cp\u003eData availability: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Junjie Li from the Department of Orthopedics, Fuyang People\u0026apos;s Hospital, Anhui Province, for his support and help with this case report.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFitzGerald JD, Gout. Ann Intern Med. 2025;178(3):ITC33\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQi H, Chen H, Dalbeth N et al. Two-decade trajectories of gout: a multi-center cohort study of 10,658 Chinese patients with gout. Rheumatology (Oxford). Published online October 25, 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTabi-Amponsah AD, Stewart S, Stamp LK, Taylor WJ, Terkeltaub R, Dalbeth N. The Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN) definition of clinical remission in gout. Ann Rheum Dis Published online June 18, 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePunzi L, Scanu A, Galozzi P, et al. One year in review 2020: gout. Clin Exp Rheumatol. 2020;38(5):807\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa C, Chen H, Deng Y, Lei Y. A novel surgical approach for carpal tunnel syndrome caused by tophi. Asian J Surg Published online September 16, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu F, Chen S, Qian J, Zheng J, Yu H. A case of carpal tunnel syndrome caused by gouty tophi confirmed by dual-source CT. Rheumatology (Oxford). 2024;63(3):e104\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKubo Y, Sonoda K, Ushijima T, Hara T. Gouty finger flexor tenosynovitis with urate milk remarkably similar to infection: a case-based review. Rheumatol Int. 2025;45(4):86. Published 2025 Apr 3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQi P, Li L, Zhang J, Ren L, Xie X. The dual regulatory effects of intestinal microorganisms and their metabolites in gouty arthritis pathogenesis: a balance between promotion and inhibition. Front Immunol. 2025;16:1591369. Published 2025 Jun 18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKilpatrick SE. Non-Neoplastic Orthopedic Pathology Updates: Common Problems and Pitfalls and How to Avoid Them. Mod Pathol. Published online Oct 13, 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo W, Wei M, Li Y, et al. Mechanisms of urate transport and uricosuric drugs inhibition in human URAT1. Nat Commun. 2025;16(1):1512. Published 2025 Feb 10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhoo SS, Chai YC, Ling XW, et al. Intratendinous Gout Causing Carpal Tunnel Syndrome: Clinical Characteristics and Proposed Surgical Algorithm. Indian J Orthop. 2025;59(10):1732\u0026ndash;43. Published 2025 Jul 15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu J, Gu F, Liu Q, et al. Comparative study of trimming and resection of diseased finger superficial flexor tendons in gouty carpal tunnel syndrome. BMC Musculoskelet Disord. 2023;24(1):935. Published 2023 Dec 2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020;16(7):380\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeng X, Li X, Xie B, et al. Gout therapeutics and drug delivery. J Control Release. 2023;362:728\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Z, Shi X, Wu T, et al. Discovery of multi-target anti-gout agents from Eurycoma longifolia Jack through phenotypic screening and structural optimization. Nat Commun. 2025;16(1):7430. Published 2025 Aug 12.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Medicine](https://link.springer.com/journal/44337)","snPcode":"44337","submissionUrl":"https://submission.springernature.com/new-submission/44337/3","title":"Discover Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"tophi, carpal tunnel syndrome, flexor tendon, flexion contracture, surgical treatment","lastPublishedDoi":"10.21203/rs.3.rs-8766537/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8766537/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBACKGROUND: It is rare for tophi to invade the carpal tunnel and cause finger flexion deformity. It is often misdiagnosed or delayed in treatment, seriously affecting hand function.\u003c/p\u003e\n\u003cp\u003eCASE SUMMARY: This article reports a 47-year-old male patient who presented with a mass on the palmar side of his right wrist and ring finger flexion deformity. Imaging and intraoperative findings revealed that tophi extensively involved the flexor tendon and caused tendon adhesion and carpal tunnel entrapment. Through surgical removal of tophi, loosening of adhesions, and decompression of the carpal tunnel, as well as continuous post-operative uric acid-lowering treatment, the patient's hand function recovered significantly.\u003c/p\u003e\n\u003cp\u003eCONCLUSION: Based on the literature review, it is suggested that for unexplained hand deformities, we need to be alert to the possibility of tophi. Early diagnosis and comprehensive treatment can improve the prognosis.\u003c/p\u003e","manuscriptTitle":"Gouty Tophi within the Carpal Tunnel Leading to Severe Finger Flexion Contracture A Case Report and Short-Term Follow-Up","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-05 17:10:30","doi":"10.21203/rs.3.rs-8766537/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"86301415020373942995765972890413534513","date":"2026-04-16T07:11:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-15T05:32:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153169097099709299357165995813147133831","date":"2026-04-15T05:27:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-31T10:05:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-02T08:49:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-18T15:26:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-18T15:14:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Medicine","date":"2026-02-18T15:10:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Medicine](https://link.springer.com/journal/44337)","snPcode":"44337","submissionUrl":"https://submission.springernature.com/new-submission/44337/3","title":"Discover Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2f0caec-3a2a-4a04-8f3e-a2fe82908b18","owner":[],"postedDate":"April 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-05T17:10:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-05 17:10:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8766537","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8766537","identity":"rs-8766537","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}