PMC5750497_01
A photograph of the patient's right hand. There were several subcutaneous nodules in the hand and digits. The index finger was not able to extend actively at the metacarpophalangeal joints.
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Physical examination revealed multiple tophi on both hands (Figure 1) and similar tophi bilaterally on the elbows, knees, toes, and ankle joints.
Preoperative radiograph of the right hand showing gouty arthritis and inflammatory osteolysis with numerous calcified soft tissue swellings, especially in the proximal interphalangeal joints of the index, middle, and little fingers.
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PIP joints of the four fingers, and the MP joint of the index finger (Figure 2). Palmar dislocation of the MP joint of the index finger was observed as well.
(a) Intraoperative findings. Hypertrophic white crystal deposits consistent with gouty tophi are seen surrounding the extensor digitorum communis of the index finger and extensor indicis proprius tendon. (b) After debridement of the tophi, the extensor indicis proprius was found to be intact but slightly elongated.
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The extensor indicis muscle tendon was found on the ulnar side of the mass and was not ruptured (Figure 3).
Photomicrograph of a section from the resected tissue specimen showing an eosinophilic amorphous tophaceous deposit surrounded by chronic inflammatory cells and multinucleated giant cells (arrow heads) and surrounded by fibrillations around them (arrows) (H&E stain, x100).
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Pathologically, crystalline masses surrounded by palisades of multinucleate giant cells and lymphocytes, together with fibrosis, also were found (Figure 4).
Photograph of the right hand 6 weeks following surgery showing significant reduction of the tophi.
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Six months after surgery, there was no recurrence of the tophi, and while there was some limitation in the extension of the MP joint of the index finger, which had an arc of motion of 60  (range -20  to 80 ), the patient was satisfied with the cosmetic and finger motion improvements (Figure 5).