# Case Report: Sliding gouty tophi: a case of dynamic ultrasound diagnosis of carpal tunnel syndrome

## TL;DR

This case report describes a rare instance of carpal tunnel syndrome caused by gouty tophi, diagnosed using ultrasound.

## Contribution

The paper presents a novel dynamic ultrasound diagnosis of gout-related carpal tunnel syndrome.

## Key findings

- Ultrasound identified gouty tophi in the superficial flexor tendon of the middle finger.
- Thickened tendon movement under the transverse carpal ligament caused CTS symptoms.
- Dynamic ultrasound provided direct evidence of the condition's etiology.

## Abstract

Carpal tunnel syndrome (CTS) caused by gouty tophi is a rare clinical condition. In this case, ultrasonography clearly identified gouty tophi deposited within the superficial flexor tendon of the right middle finger, resulting in tendon thickening. The thickened tendon was constrained by the transverse carpal ligament, leading to restricted finger movement. Additionally, when the finger was extended, the thickened tendon slid beneath the transverse carpal ligament, triggering severe symptomatic episodes of CTS. This observation provided direct evidence of the underlying etiology of CTS in this patient.