At California Pacific Orthopaedics in San Francisco, our hand specialists are dedicated to restoring the function of your hands with the least invasive treatments possible. If Dupuytren’s contracture is keeping your fingers from straightening, a procedure called needle aponeurotomy may help you get back to your daily life quickly.
Dupuytren’s Contracture Overview
Needle aponeurotomy (sometimes called percutaneous needle fasciotomy) is a minimally invasive procedure used to straighten fingers that have curled into the palm due to Dupuytren’s contracture.
Unlike traditional open surgery, which requires large incisions and a long recovery, this procedure uses a thin needle to release the tight bands of tissue causing your fingers to bend. It is often performed right in the office under local anesthesia, meaning you are awake but won’t feel pain in the hand during the treatment.
This technique is popular because it allows for a very fast recovery. Most patients can return to light daily activities within a few days, compared to the weeks or months of rehab often needed after open hand surgery.
Why the Procedure is Done
The main goal of needle aponeurotomy is to improve hand function by straightening fingers that have been pulled into a bent position.
Dupuytren’s contracture is a condition where the tissue under the skin of your palm (the fascia) thickens and tightens over time. This creates thick cords that pull one or more fingers down toward your palm. When this happens, you might find it hard to:
- Place your hand flat on a table.
- Put on gloves or put your hands in your pockets.
- Wash your face or shake hands.
- Grasp large objects.
Doctors typically recommend this procedure for patients who have a clear “cord” of tissue that can be felt under the skin. It is often an excellent option for:
- Mild to moderate contractures: When the finger is bent but not severely deformed.
- Older patients: Who may want to avoid the risks of general anesthesia associated with major surgery.
- Patients seeking quick recovery: Those who cannot take significant time off work or hobbies.
What to Expect
Before the Dupuytren’s Contracture Procedure
Your preparation for needle aponeurotomy is simple compared to major surgery.
- Consultation: Your doctor at California Pacific Orthopaedics will examine your hand to make sure the cord is accessible and safe to treat with a needle.
- Medications: You may be asked to stop taking blood thinners (like aspirin or ibuprofen) for a few days before the appointment to reduce bruising.
- Skin Prep: You won’t need to fast (stop eating) because you will remain awake. Just make sure your hands are clean.
During the Dupuytren’s Contracture Procedure
The entire appointment usually takes less than an hour. Here is what typically happens:
- Numbing: The doctor will inject a local anesthetic (numbing medicine) into the skin of your palm. This might sting briefly, like a bee sting, but the area will quickly go numb.
- Releasing the Cord: Once numb, the surgeon inserts a very fine needle through the skin and into the tight cord of tissue.
- Separating the Tissue: The doctor uses the sharp edge of the needle to cut and weaken the cord in several places. You will not feel pain, but you might feel some pressure or a “popping” sensation as the tight tissue releases.
- Straightening: After the cord is weakened, the doctor will gently stretch your finger to snap the remaining fibers and straighten the finger.
- No Stitches: Because the needle holes are so small, no stitches are needed. The puncture sites are simply covered with a bandage.
After the Dupuytren’s Contracture Procedure
Recovery is usually quick and straightforward.
- Immediate Recovery: You can go home immediately after the appointment. You will likely need someone to drive you, as your hand will be numb for a few hours.
- Pain Management: Most patients feel only minor soreness. Over-the-counter pain relievers and ice packs are usually enough to manage any discomfort.
- Hand Use: You can use your hand for light activities (like eating or typing) as soon as the numbness wears off, often within 24 hours.
- Wound Care: You should keep the bandage clean and dry for a few days. The small puncture wounds heal rapidly.
- Physical Therapy: Unlike open surgery, extensive physical therapy is rarely needed. Your doctor may suggest simple stretches to do at home to keep the finger straight.
Risks and Considerations of Dupuytren’s Contracture Treatment
While needle aponeurotomy is safe, it is important to understand the risks:
- Recurrence: The condition often comes back faster than it does with open surgery. Studies show the contracture may return within 3 to 5 years. However, the procedure can often be repeated.
- Skin Tears: Sometimes the skin may tear slightly when the finger is straightened, especially if the skin was very tight. This usually heals on its own.
- Nerve or Tendon Injury: There is a very small risk of the needle touching a nerve or tendon, which could cause temporary numbness or weakness. Our specialists are highly trained to avoid these structures.
Why Choose California Pacific Orthopaedics?
Located in the heart of San Francisco, California Pacific Orthopaedics is a top choice for hand and wrist care in the Bay Area. Our team includes board-certified hand surgeons who specialize in both surgical and non-surgical treatments for Dupuytren’s contracture. We focus on helping you regain the use of your hands so you can get back to work and the activities you love.
Is a bent finger affecting your daily life? Contact us today to schedule a consultation with one of our San Francisco hand specialists and find out if needle aponeurotomy is right for you.
