This page about wrist gout, page 1, was last reviewed, or updated, on 3 November 2015.
Think of your wrist as the railway junction between your hand and your forearm.
The wrist explained
Most non medical people will be surprised to read the wrist has eight bones, called the carpals, in two rows, all of which have joints and cartilage between them. It’s all these bones that make the wrist so flexible. One of these rows connects the two bones of the forearm – the radius and ulna – to the bones of the hand – the metacarpals.
wrist bones are held together by ligaments, and are surrounded by capsules in
which the precious synovial fluid for prescribing gout accurately is located.
Plus the wrist holds tendons, muscles, nerves, blood vessels and two bursae,
the small sacs into which gout crystals can also deposit. They can suffer
inflammation for reasons other than gout
However, despite all these gout-juicy locations, wrist gout is not as common as gout in most other gouty areas.
Gout in the wrist
gout normally begins down in the toes or ankles, a wrist gout flare is probably
a sign of chronic gout, the stage of gout where you had your first attack a
number of years ago and have suffered more flares in other joints. So wrist
gout could be a sign you have suffered gout for a few years.
At this gout stage, it might be that attacks "fly" from one joint to another, and up to an ear, in a single painful session.
A first attack in the wrist is rare, and this fact helps to rule out gout from all the other afflictions that affect the wrist. Note these because some can be confused with gout – carpal tunnel syndrome, rheumatoid arthritis, osteoarthritis, tendinitis, pseudo gout, ganglion cysts, bursitis, repetitive stress injury and others. More about the difference between gout and pseudo gout here.
Ganglion cysts are swellings but they are not painful, merely uncomfortable, and they certainly do not cause the severe pain of gout. Unlike gout’s crystals, pseudo gout’s crystals, a different kind, can usually be seen by X ray.
Tendinitis is inflammation of the wrist’s tendons. A variant, tensosynovitis, is inflammation of the tendons plus their protecting sheath, if they have one. If either is caused by gout, tendons will be encrusted or inflamed by tophi. Bursitis is inflammation of the bursa sacs where gout is suspected if they are very inflamed. Gout is not the only, or main cause of bursitis, but it is if the inflammation is caused by gout crystals or tophi.
Tophi gout - also a sign of advanced gout
A tophus is the chalky-like white matter that grows from gout’s accumulated MSU crystals which get deposited out of the serum (blood) every time you have a gout attack. It usually forms a shape like a knobbly lump under the skin, but in smaller amounts it can be deposited on cartilage, tendons, (and their sheaths), ligaments, in and on bones, in the ears, and even on the floor of the wrist's carpal tunnel (see below). All these deposit places apply to the wrist too. Tophi don’t usually form in gout patients until they have suffered gout, without successful treatment, for about 10 years, although two years has been known.
A tophus or tophi (plural) in the wrist, can lead to carpal tunnel syndrome, although it’s rare
Carpal tunnel syndrome (CTS) is the squeezing of the median nerve which runs through the wrist and into the hand. It is normally caused by swelling fibres (fibers) – ligaments and tendons – on the palm (inside) side of the wrist, which squeeze the nerve. So you can easily imagine that deposited tophi on adjacent tendons or ligaments can squeeze this nerve and cause CTS.
CTS causes tingles, numbness and finger pain. It can be treated with NSAID’s, or if they don’t work, by an anti-inflammatory corticosteroid such as cortisone, injected into the affected area. Failing that, by surgery to remove the pressure on the nerve. In gout’s case, by surgery to remove the tophus or tophi. Or you solve it because you get uric acid down to levels at which tophi shrink, eventually away
is a wrist gout attack like?
If you have gout of the wrist, you’ve probably had a gout flare somewhere else before. Gout can attack both sides of the wrist. Its crystals can infest into or onto the fluid sacs, cartilage, tendon and the bursae. Over time, without successful treatment, tophi will grow on and into the bones. You could end up with a tophi lump on your wrist. The wrist will be inflamed, sore, very painful and the skin, reddish. No prizes for guessing that you’ll have lost the ability to move the hand. Or you’ll have very limited hand movement. Normal service from the wrist will resume after the attack is over.
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