Results of Needle Aponeurotomy for Dupuytren Contracture in Over 1,000 Fingers

Dupuytren’s Contracture is a condition of the hand which causes the connective tissue in the palm of the hand to become thickened and shortened. Men are more commonly affected than women. The disease is found most frequently in people 50 years or older who are of northern European ancestry. Scientific research suggests that the primary cause is a genetic abnormality, but the exact gene (or genes) is not known.

This figure shows a patient's ring finger with a 90 degree contracture of the PIP joint. This is the type of contracture that is more difficult to treat, and it has a higher recurrence rate with treatment.

Traditional treatment has meant removing the diseased fascia in the palm by an open surgical technique. Less invasive techniques have been created over the last twenty years which allow the release of the contracture without the need for invasive surgery. The big trade-off, however, is that these less invasive techniques tend to have a higher recurrence rate compared to surgery. The exact rate of recurrence has been unknown until now. Gary Pess is a hand surgeon from New Jersey. He has been practicing needle aponeurotomy (also called needle fasciotomy or NA) for Dupuytren’s disease for more than 5 years. He has just report the follow up results form more than 1000 fingers that he has treated between 2005-2008. These results were published in the Journal of Hand Surgery.

The figure above shows a patient's hand with Dupuytren's contracture primarily of the MCP joint. The two photos marked "before" are prior to treatment. The two marked "after" are immediately after treatment by needle aponeurotomy, showing a complete correction of the contracture.

He reports that his patients had a good initial correction, but there was recurrence over time. The best results were obtained when the initial contracture was between the palm and the finger (at the MCP joint). In those patients the recurrence rate was approximately 20%. When the contracture was in the finger itself, the results were not as good, with a recurrence rate in those patients of approximately 65% (at the  PIP joint). It should be noted that the rate of recurrence is useful when talking about a group of patients. For a particular patient, the disease will either come back or it will not. And if it does come back, recurrence may be rapid or occur gradually over time. Anything can happen. Some patients will do better than average, some worse than average. It is difficult to predict

Overall, the results that Dr. Pess present are not surprising. The recurrence rates are approximately what I have been telling my patients. I still perform needle aponeurotomy for Dupuytren’s contracture, and I believe that it is a useful tool in the treatment of Duputyren’s disease. Needle aponeurotomy does not cure the condition, but allows the patient a rapid return to relatively normal hand use, with the understanding that the treatment (or some other treatment) will probably be needed again in the future.

Read more from the Journal of Hand Surgery: Results of Needle Aponeurotomy for Dupuytren Contracture in Over 1,000 Fingers.

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