2004, Number 2
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ABSTRACTObjective:Describe the MRI findings in patients with tophaceous gout and carpal tunnel, and it’s usefulness in the pre-operatory evaluation and establishment of a surgical plan.
Material and Method: Seven patients with tophaceous gout and clinical signs of carpal tunnel syndrome were prospectively included for neurologic evaluation and evaluation of nervous conduction velocities (NCV). The MRI with T1 and T2-weighted sequences, were interpreted by two radiologists. The surgical plan was evaluated by orthopedics.
Results: bilateral median nerve peripheral neuropathy in five patients and unilateral in one patient with NCV. Distal compressive neuropathy in four and carpal atrophy in two patients, 100% deficit in muscular force in one patient; 50% in one; 33% in two; 5% in one, and normal in two patients as evaluated by orthopedics. The MRI with extrinsic compression by tophi in the carpal tunnel in seven, thickening of the flexor retinaculum due to nodular tophaceous infiltration in five (unilateral in three and bilateral in two). Two patients with flexor retinaculum thickening and diffuse infiltration by probable tophaceous material, without calcifications. Presurgical evaluation: three patients did not have sufficient criteria for surgery and two had severe morphologic and functional affection, being non-candidates. The other two patients were programmed for median nerve release and resection of tophi.
Conclusions. MRI is useful for establishing a surgical plan in patients with tophaceous gout and associated carpal tunnel syndrome.
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