Houston Methodist. Leading Medicine

Wrist FAQ

Question:

I've had gout for about 10 years now. Usually, it's pretty well controlled with diet and drugs. Last week, I started getting some wrist pain. My regular doctor was out of town, so I went to the local walk-in clinic. They didn't think the wrist pain was coming from the gout. But they didn't know what was causing it. (I haven't hurt myself that I know of). Is it possible they are wrong?

Answer:

Treatment for gout has improved steadily over the years. As new information and understanding of the disease process is revealed, better drugs and treatment have been developed. As a result, gout affecting the wrist or hand is fairly rare. And if your main symptoms of gout have been under control, the physicians will naturally look elsewhere for a cause of your new wrist symptoms. However, it is possible that your wrist pain is a direct result of urate crystals from the gout in the wrist. Studies have confirmed that these crystals not only attach to the wrist cartilage but also form on ligaments stabilizing the wrist joint. There are ways to evaluate this. Tenderness over the scapholunate ligament of the wrist is a red flag. Your regular doctor can test the integrity of that particular ligament. There's also a test called the scapholunate ligament shift test. A positive test indicates wrist instability because the ligament isn't holding the bones steady. The two bones shift or move more than they should. X-rays and MRIs can be ordered. Your doctor will look at the X-rays for signs of scapholunate advanced collapse (SLAC). In this condition, the cartilage of the two wrist bones (the scaphoid and the lunate) is worn away from the cartilage wear. The bones started to deteriorate and collapse. Arthroscopic surgery may be needed to find out what is really happening. The surgeon inserts a long, thin probe with a tiny TV camera on the end into the wrist. The scope gives the surgeon a clear view of what is going on. They can see if there are urate crystals deposited on and around the scapholunate ligament. The scope will show if the ligament is disrupted (torn). The size of the tear can be assessed. The next step is to make a follow-up appointment with the physician who normally treats your gout. It may be better to rule out (or confirm) gout as the underlying cause of your wrist pain before further damage is done to the joint or ligaments supporting the wrist. Early diagnosis and treatment can prevent an acute condition from becoming a chronic one. Mark C. Wilczynski, MD, et al. Arthroscopic Findings in Gout of the Wrist. In The Journal of Hand Surgery. February 2009. Vol. 34A. No. 2. Pp. 244-250.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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