Endoscopic Decompression of a Gouty Tophus at the Hand Dorsum

Abstract

Medical treatment including lifestyle and dietary modifications and drug therapy remains the mainstay of treatment for gouty arthritis of the hand and wrist. Without proper and timely treatment, tophi develop approximately 10 years after the onset of the disease. Open surgery for tophaceous gout is associated with a relatively high rate of complications particularly related to the surgical wound and overlying skin necrosis. Intralesional shaving of the tophi through small incisions has been reported and has the advantage of fewer wound complications. However, this is a blind procedure, and the underlying tendons and neurovascular bundles are at risk. The purpose of this Technical Note is to report an endoscopic approach to debulking a gouty tophus at the hand dorsum. This allows the minimally invasive debulking procedure to be performed under endoscopic visualization and reduces the risk of injury to the tendon and neurovascular structures.

Management of ulcerated finger pad tophi

“…It includes debridement, debulking, irrigation, curettage, enucleation, shaving, endoscopic decompression, staged debridement, vacuum-assisted closure, etc. [8,17,20,[22][23][24][25][26][27].…”

“…It may be summarized as complex excision, tophectomy, tenosynovectomy, arthrodesis, arthroplasty, amputations, and reconstruction with skin grafts, flaps or bone grafts [8,17,18,25,26]. These procedures radically remove the deposits along with the infiltrated anatomical structures by sharp dissection and simultaneous reconstructions of exposed parts.…”

Endoscopic Decompression of Olecranon Tophus

“…4 Tophaceous material may present in a liquid, pasty, or chalky and/or granular state. 1 Treatment may be as simple as aspirating the liquid or squeezing out pasty tophaceous material. However, open debridement is needed for tophi in the chalky and/or granular state.…”

“…1 Techniques of endoscopic debridement of the tophus have been described. 1,4,5 These minimally invasive techniques allow resection of the gouty tophus through small incisions away from the lesion and minimize the risk of wound dehiscence and persistent tophaceous discharge. 5 The purpose of this Technical Note is to describe the details of endoscopic decompression of an olecranon tophus.…”

“…Gout is an inflammatory metabolic disorder that occurs in conjunction with hyperuricemia and is a result of the deposition of monosodium urate monohydrate crystals within the periarticular soft tissues. 1 , 2 Gout may cause bursitis, and the olecranon bursa is one of the most affected bursas. The olecranon bursa is very commonly involved in tophaceous gout because of the tendency of monosodium urate crystals to deposit in superficial structures with low temperatures.…”