Images in Clinical Rheumatology
Carpal Tunnel Syndrome Due to a Tophus: Low-field Magnetic Resonance Image
Síndrome del túnel del carpo por tofo: imagen de resonancia magnética de bajo campo
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Arrows: T1 hypointense material with increased signal in STIR, within the sheath of the carpal flexor tendon level.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Carpal tunnel syndrome (CTS) is a common condition in rheumatology due to inflammatory diseases, microtraumas, and metabolic, or more frequently idiopathic, processes.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Nuclear magnetic resonance is a supplementary technique in inflammatory diseases of the locomotor system, which detects subclinical inflammatory changes.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Gouty arthritis may lead to CTS due to: synovial hypertrophy, tenosynovitis, tophaceous nodules and crystal deposits in nerves, muscles or tendons. Their appearance in the flexor sheath for the tendons is extremely rare, and may compress the median nerve leading to CTS.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Suspected CTS by tophaceous compression may be diagnosed in those patients with poorly controlled gout and atypical symptoms of CTS.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The rate of CTS by tophus is .6%.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> We present a case where NMR identified a tophus in the carpal tunnel as the cause of CTS.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 62 year-old male, by profession a butcher. He had a history of gout which was poorly controlled by sporadic treatment. He presented at the rheumatology department with “tingling” in the fingers of both hands which was more acute in the left hand (right-handed patient) and a loss of fine motor skills. An electroneurogram was performed with showed severe compression of the sensitive fibers of the bilateral median nerve, more acute in the left. Due to suspicion of a tophus being the cause of the CTS, NMR was performed. Findings (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) were as follows: tophus inside the sheath of the flexor tendons at carpal level. The patient underwent surgery and the surgeon confirmed the existence of the tophus. The patient is currently receiving hypouricaemic therapy and there are no clinical signs of left CTS.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conclusion</span><p id="par0020" class="elsevierStylePara elsevierViewall">CTS caused by gouty tophus is extremely rare. Its determination by NMR is diagnostic. In selected cases where there is high clinical suspicion, atypical CTS symptomatology, in patients with poorly controlled gout, it may be a supplementary test requested as diagnostic support and for the planning of treatment.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Ethical Disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experimentation has been carried out on human beings or animals.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to their center of work on the publication of patient data.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have obtained the informed consent of the patients and/or subjects referred to in this article. This document is held by the corresponding author.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of Interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conclusion" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of Interests" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-06-16" "fechaAceptado" => "2017-07-24" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ruiz Montesino MD, Mendoza Mendoza D. Síndrome del túnel del carpo por tofo: imagen de resonancia magnética de bajo campo. Reumatol Clin. 2019;15:e149–e150.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 431 "Ancho" => 1500 "Tamanyo" => 85243 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Axial T1; (B) Axial STIR; (C) Sagittal STIR. Arrows: T1 hypointense material with increased signal in STIR, within the sheath of the carpal flexor tendon level.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.C. Leite" 1 => "C. Jerosch-Herold" 2 => "F. 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Uchida" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/14397595.2013.874753" "Revista" => array:6 [ "tituloSerie" => "Mod Rheumatol" "fecha" => "2015" "volumen" => "25" "paginaInicial" => "298" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24533543" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A repeated carpal tunnel syndrome due to tophaceous gout in flexor tendon: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Lu H." 1 => "Q. Chen" 2 => "H. Shen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Medicine (Baltimore)" "fecha" => "2017" "volumen" => "96" "paginaInicial" => "e6245" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001500000006/v1_201911250632/S2173574318301576/v1_201911250632/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000006/v1_201911250632/S2173574318301576/v1_201911250632/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301576?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 2 | 5 |
| 2024 October | 42 | 20 | 62 |
| 2024 September | 36 | 14 | 50 |
| 2024 August | 47 | 25 | 72 |
| 2024 July | 42 | 28 | 70 |
| 2024 June | 41 | 33 | 74 |
| 2024 May | 52 | 27 | 79 |
| 2024 April | 37 | 28 | 65 |
| 2024 March | 41 | 32 | 73 |
| 2024 February | 37 | 31 | 68 |
| 2024 January | 24 | 20 | 44 |
| 2023 December | 30 | 22 | 52 |
| 2023 November | 46 | 25 | 71 |
| 2023 October | 26 | 18 | 44 |
| 2023 September | 63 | 36 | 99 |
| 2023 August | 65 | 14 | 79 |
| 2023 July | 26 | 29 | 55 |
| 2023 June | 38 | 19 | 57 |
| 2023 May | 31 | 21 | 52 |
| 2023 April | 19 | 4 | 23 |
| 2023 March | 55 | 25 | 80 |
| 2023 February | 32 | 19 | 51 |
| 2023 January | 29 | 7 | 36 |
| 2022 December | 37 | 22 | 59 |
| 2022 November | 39 | 32 | 71 |
| 2022 October | 56 | 27 | 83 |
| 2022 September | 20 | 20 | 40 |
| 2022 August | 30 | 47 | 77 |
| 2022 July | 33 | 32 | 65 |
| 2022 June | 25 | 27 | 52 |
| 2022 May | 28 | 34 | 62 |
| 2022 April | 28 | 31 | 59 |
| 2022 March | 34 | 40 | 74 |
| 2022 February | 33 | 24 | 57 |
| 2022 January | 30 | 36 | 66 |
| 2021 December | 29 | 36 | 65 |
| 2021 November | 34 | 46 | 80 |
| 2021 October | 29 | 38 | 67 |
| 2021 September | 33 | 43 | 76 |
| 2021 August | 21 | 36 | 57 |
| 2021 July | 16 | 28 | 44 |
| 2021 June | 17 | 29 | 46 |
| 2021 May | 27 | 37 | 64 |
| 2021 April | 50 | 71 | 121 |
| 2021 March | 49 | 33 | 82 |
| 2021 February | 32 | 12 | 44 |
| 2021 January | 49 | 18 | 67 |
| 2020 December | 51 | 11 | 62 |
| 2020 November | 30 | 24 | 54 |
| 2020 October | 25 | 12 | 37 |
| 2020 September | 49 | 23 | 72 |
| 2020 August | 28 | 17 | 45 |
| 2020 July | 36 | 18 | 54 |
| 2020 June | 34 | 10 | 44 |
| 2020 May | 47 | 14 | 61 |
| 2020 January | 1 | 0 | 1 |
| 2019 September | 1 | 0 | 1 |
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