Diagnosis and treatment of gout in the hand or wrist

Abstract

Objective To explore the diagnosis and treatment of gout in the hand and wrist. Methods Of the 5 cases of gout in the hand and wrist, 2 patients had tophus and underwent extirpating of the tophus, tenolysis and neurolysis. Another 3 patients without tophus underwent carpal tunnel release and localized debridement. All the resected tissues were subject to histological examination. Results Primary healing of the wound was achieved in all cases with no infection. The average postoperative follow-up period was 7 months.Histology confirmed the diagnosis of gouty arthritis. For the 2 patients with tophus, symptoms of finger numbness were alleviated and wrist function was significantly improved. There was, however, recurrence that demanded further treatment. For the 3 patients without tophus, their wrists were pain-free and the grip strength of their hands returned to near normal. Conclusion It is difficult to diagnose non-classic gout of the hand or wrist without tophus. Surgical exploration not only confirms the diagnosis of gout but more importantly is a definitive treatment. Diagnosis of gout with tophus is relatively easy, however surgical treatment leads to less ideal results. Key words: Hand; Carpal joints; Gout; Arthritis