Tophaceous Gout of the Rotator Cuff

Abstract

Gout is a common metabolic disorder characterized by recurrent episodes of arthritis associated with the presence of monosodium urate monohydrate crystals in synovial fluid leukocytes or periarticular soft tissues1. Tophaceous gout, representing the chronic phase of the disease process, usually occurs at least ten years before these lesions become visible radiographically or on physical examination2,3. Although gout frequently affects the feet, hands, wrists, elbows, and knees, involvement of the shoulder joint by gouty tophi is unusual4, and tophaceous gout of the rotator cuff is rare5. The magnetic resonance imaging characteristics of tophaceous gout of the rotator cuff have not been previously described in the literature, to our knowledge. We report the case of a man with tophaceous gout of the rotator cuff who had plain radiography and magnetic resonance imaging as well as intraoperative and histopathologic correlation. The patient was informed that data concerning the case would be submitted for publication and consented. A twenty-six-year-old man presented with a one-month history of intermittent pain and a limited range of motion of the right shoulder following a stretching injury at work when he tried to grasp the handrail of a ladder before falling off of it. An anti-inflammatory agent (tiaprofenic acid) was given on the third day after the injury, and this treatment was discontinued two weeks later because pain relief had been achieved. However, the pain returned soon thereafter. The patient stated that he had no systemic symptoms, medical history of hyperuricemia, or prior episodes of acute gouty arthritis. Except for the problems with the right, involved shoulder, the findings of the general clinical examination were unremarkable. Physical examination of the right shoulder revealed substantially decreased active ranges of motion in forward flexion (30°), extension (10°), and abduction (30°) in …