To our knowledge, this is the first report of carpal tunnel syndrome following Xiaflex injection. It is unlikely that the collagenase mix itself led to carpal tunnel syndrome, as the injection was very distal to the carpal tunnel. We suspect the primary causative factor was the swelling, which is very common following Xiaflex injection.1,4 The patient may have had subclinical carpal tunnel syndrome and the swelling from the Xiaflex treatment pushed him to develop symptoms. Given the scenario, we have since raised the question of whether Dupuytren patients would benefit from carpal tunnel syndrome screening before Xiaflex injection. Electromyography/nerve conduction velocity studies may not be necessary, but a thorough history and physical examination are likely warranted. Even if asymptomatic, provocative maneuvers such as Phalen and Durkan tests may help identify patients at risk and appropriately direct treatment.
The authors have no financial interest to declare in relation to the content of this article.
Valeriy Shubinets, M.D.
Ines C. Lin, M.D.
Benjamin Chang, M.D.
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2. Warwick D, Arandes-Renú JM, Pajardi G, Witthaut J, Hurst LCCollagenase Clostridium histolyticum
: Emerging practice patterns and treatment advances. J Plast Surg Hand Surg. 2016;50:251–261.
3. Eaton CEvidence-based medicine: Dupuytren contracture. Plast Reconstr Surg. 2014;133:1241–1251.
4. Peimer CA, Wilbrand S, Gerber RA, Chapman D, Szczypa PPSafety and tolerability of collagenase Clostridium histolyticum
and fasciectomy for Dupuytren’s contracture. J Hand Surg Eur Vol. 2015;40:141–149.
5. Gaston RG, Larsen SE, Pess GM, et alThe efficacy and safety of concurrent collagenase Clostridium histolyticum
injections for 2 Dupuytren contractures in the same hand: A prospective, multicenter study. J Hand Surg Am. 2015;40:1963–1971.
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