Needle Aponeurotomy for Dupuytren's Disease

Treatment Overview

Needle aponeurotomy (say "ap-uh-noo-RAH-tuh-mee") is a procedure used to straighten bent fingers (contracture) caused by Dupuytren's disease. This procedure may also be called percutaneous needle fasciotomy.

The procedure can be done in your doctor's office. It usually takes about 30 minutes.

The affected hand will be cleaned and injected with medicine to numb the area. When it is numb, the doctor will insert a needle into the tissue that is pulling your fingers toward your palm. The needle is used to make holes in the tissue. The doctor will then straighten your fingers. This will separate the tissue and release the pull on your fingers.

After the procedure, your doctor may inject steroid medicine into your hand to reduce swelling.

What To Expect After Treatment

Your fingers may be numb for a few hours after the procedure. You may have tingling in the treated area for 1 or 2 days.

Your hand and fingers may be swollen and sore for the first few days. To reduce swelling:

  • Apply ice or a cold pack for 10 to 20 minutes, 3 or more times a day. Place a towel over the ice or cold pack before you put it on the skin.
  • Prop your hand above the level of your heart while you apply ice and anytime you sit or lie down.
  • Gently bend and straighten your fingers throughout the day.

You may have a few adhesive bandages on your hand at the site of the needle sticks. Your doctor will tell you when these can come off.

You may shower and get your hand wet after the procedure. But don't put your hand underwater for 2 days.

It will probably take about 1 to 2 weeks for your hand to heal. You can use your hand right away for light activities such as eating or dressing. But until your hand heals, don't use it for any activity that requires a lot of hand strength or a strong grip.

How soon you can return to work depends on your job.

  • You may be able to go back to work in 1 to 2 days if you can do your job without using your hand or with light use, such as working at a computer.
  • You may need to take about 1 to 3 weeks off work if your job requires you to use a lot of hand strength, to grip things tightly, or to get your hands dirty.

Most people don't need any special hand therapy after the procedure. You may need to wear a splint or brace at night for a few months.

Why It Is Done

Dupuytren's disease causes tissue under the skin of the palm of your hand, called the palmar fascia, to get thicker and shorter. This can pull and bend the fingers in toward the palm. Needle aponeurotomy is done to release the tight tissue in the hands and improve the use of the hands.

Needle aponeurotomy is an alternative to hand surgery, which is called fasciectomy. For this surgery, the palm is cut open and the tight tissue is removed. Compared to surgery, needle aponeurotomy:

  • Is less invasive.
  • Has a shorter recovery time.
  • Has fewer risks.
  • Costs less.

But the chance that a contracture will come back is higher and occurs sooner after needle aponeurotomy than after surgery. In one study, after 5 years, the problem had come back in:1

  • More than 8 out of 10 people who had needle aponeurotomy.
  • About 2 out of 10 people who had hand surgery.

This procedure may be a good option if you:

  • Have a mild to moderate contracture. It doesn't work as well for severe contractures.
  • Are an older adult or can't have open surgery because of other health problems.
  • Need a quick recovery and can accept that the problem may come back.

How Well It Works

Your fingers may not be completely straight after this procedure. But most people are able to use their hand better and are happy with the results.

You can have the procedure again if the contracture comes back.

Risks

The risk of problems after this procedure is very low. When problems do occur, the most common ones are:

  • A deep crack in the skin (fissure).
  • Minor nerve or tendon injury.
  • Infection.

What To Think About

Treatments for Dupuytren's disease only deal with the symptoms. They don't deal with what causes the disease. So no matter what treatment you choose, there is always a chance that a contracture could come back.

Complete the special treatment information form (PDF)special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.

Related Information

References

Citations

  1. van Rijssen AL, et al. (2012). Five-year results of a randomized clinical trial on treatment in Dupuytren's disease: Percutaneous needle fasciotomy versus limited fasciectomy. Plastic and Reconstructive Surgery, 129(2): 469–479.

Credits

By Healthwise Staff
Adam Husney, MD - Family Medicine
Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery
Last Revised May 21, 2013

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