We encountered only three patients of carpal tunnel syndrome (CTS) due to tophaceous gout during 25 years of practice in a ‘hand clinic’ situated in a large metropolis in West India. In two patients, the CTS was bilateral, a rare occurrence in gout. There was an unwarranted delay (up to 9 years) in the diagnosis of both the ailments. In each case, the site of offending tophus was uniquely different.