THE SYMPTOMS OF a 62-year-old man with carpal tunnel syndrome resulting from poorly controlled gout subsided after the transverse carpal ligament was released surgically. At the time of the operation, the tophi were found to deposit on the median nerve rather than the transverse ligament, a situation reported only once before. The absence of gouty tenosynovitis in this patient was supported by the wound healing well without the chalky discharge that patients have had in previous reports.