122015Sep

How Needle Aponeurotomy Treats Dupuytren’s Contracture

Dupuytren’s contracture might be painless, but this hand disorder can be very troublesome to patients since it has no cure and is progressive.  One promising treatment for this condition is aponeurotomy (NA), which is usually performed on an outpatient basis.

The Disorder

This condition causes a noticeable thickening and contracting of tissue under the skin of a patient’s palm and fingers, according to MedlinePlus.  Both its specific cause and cure remain unknown, though family history probably plays a role in its progression.  There is no proven link between its development and trauma.

The disorder most often affects males older than 40.  Among the risk factors are diabetes, alcoholism, and being a smoker.

The University of Chicago Medicine reports that the illness can strike one or more fingers, with the ring and little fingers those most commonly afflicted.  People of Northern European or Scandinavian descent are particularly at risk.

The most common symptom progression is:

  • Nodules that appear as lumps form in the palm
  • When nodules thicken, then contract, thick tissue develops
  • The process pulls fingers forward
  • The patient notices less hand function

Why a Hand Specialist Performs a Needle Aponeurotomy

In past generations, when exercises, splints, or warm-water baths failed to help, a hand doctor usually recommended open hand surgery.  Unfortunately, the disorder often returns after surgery.  Many patients today undergo a minimally invasive needle aponeurotomy instead.

NAs became popular in France two decades ago, according to the International Depuytren Society.  A hand surgeon might also refer to one as a percutaneous needle fasciotomy.

This procedure gained popularity in the United States, Germany, and the United Kingdom because it:

  • Straightens bent fingers and restores hand function
  • Is quick to apply
  • Requires only a local anesthetic
  • Results in minimal or no scarring
  • Usually has a fast recovery
  • Costs less than open hand surgery
  • Involves little pain
  • Can be repeated if necessary

What Patients Should Expect

An NA takes around half an hour, the Dartmouth-Hitchcock Norris Cotton Cancer Center reports.  After cleaning the hand, the hand specialist injects a numbing agent, then inserts a needle to make holes in the affected tissue.  The objective is severing the pull of abnormal tissue so that fingers will become straighter.  Some physicians inject steroid medication to reduce swelling in the hand.

Patients typically return home with a few adhesive bandages and sometimes report tingling in the hand for a few days.  Hand doctors provide instructions to reduce swelling during that period and advise when to remove any bandages.

Healing typically takes one to two weeks.  Physicians advise against using the treated hand for activities that require a strong grip or considerable hand strength.  However, light-exertion activities like getting dressed or eating are permissible.  How long a patient is off work depends on how he or she needs to use the treated hand on the job.



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