Table 2_Tophaceous gout-related carpal tunnel syndrome and flexor tendon involvement: a systematic review.xlsx

Primary reports were additionally classified post hoc by causal certainty.</p>Results<p>Of 478 database records, 302 unique records were screened, and 69 canonical reports were included. The 57-report primary synthesis comprised 44 case reports or clinical-image reports, 12 case series, and one nonrandomized comparative study, representing at least 120 patients, 152 CTS wrists, and 146 gout-attributable wrists. Sex was reportable for 117 patients, of whom 111 (94.9%) were male.

Causal certainty was Tier 1 (direct local confirmation) in 41 reports, Tier 2 (anatomically supported) in 5, and Tier 3 (explicit report-level attribution) in 11. Post hoc sensitivity analyses retaining Tier 1 + 2 (n = 46) and then Tier 1 only (n = 41) did not change the principal qualitative interpretations. Open decompression with lesion treatment was the most frequently reported operative pattern, but evidence remained insufficient to determine a preferred tendon procedure.

JBI findings are reported by design; 481 item-level judgments are retained only as an audit total.</p>Conclusion<p>Gout should be considered in atypical, acute, severe, recurrent, bilateral, or mass-associated CTS. In surgically treated reports, decompression was commonly combined with individualized management of tophaceous and tendon disease. The evidence is predominantly case-based and hypothesis-generating and is insufficient to define a validated treatment pathway or preferred tendon procedure.</p>