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Percutaneous Needle Fasciotomy for Dupuytren’s disease

Dupuytren’s disease, also known as Dupuytren’s contracture, is a benign condition that affects the fibrous sheet of tissue called the fascia. Dupuytren’s disease causes the fascia in the hand to thicken and become less flexible. Over many months or years, this can cause one or more of the fingers to bend in towards the palm.

Also known as: percutaneous aponeurotomy or needle aponeurotomy

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What is Dupuytren’s disease?

Dupuytren’s disease, also known as Dupuytren’s contracture, is a benign condition that affects the fibrous sheet of tissue called the fascia. The fascia is a flexible connective tissue that surrounds and supports every part of your body. Dupuytren’s disease causes the fascia in the hand to thicken and become less flexible. Over many months or years, this can cause one or more of the fingers to bend toward the palm. Dupuytren’s can affect one or both hands.

The cause of Dupuytren’s contracture is not fully understood, but it is more common in men than in women and often runs in families. It is more common in people of Northern European descent.

Everything you need to know

What are the symptoms of Dupuytren’s contracture?

The first sign is usually a firm lump in the palm of your hand. You may also notice pits of skin/dimples in the palm. Over time, you may no longer be able to place your hand down flat and find it difficult to put your hands into pockets, wear gloves, wash your face and shake hands. Eventually, (usually the ring and little) fingers will bend it towards the palm and you will not be able to straighten them.

Dupuytren’s is not usually painful, but the nodules in the hand can be uncomfortable. The disease normally progresses very slowly over many years, and whilst not dangerous, can make the tasks of everyday life difficult.

Before

Our Hand & Wrist doctors can diagnose you at an initial appointment. You will not need to have any tests or scans. Dupuytren’s disease cannot be cured, but there are options for improving your condition. If your disease is in the early stages, we’ll often suggest a watch-and-wait approach. This means we do nothing for the time being. For some people, the disease will progress very slowly and for others, it may get worse much more quickly.

There is a small amount of evidence that radiotherapy may be helpful in the very early stages of Dupuytren’s contracture, although this remains a fairly uncommon treatment.  Xiapex (collagenase) injections used to be performed as a minimally invasive option. This is no longer available in Europe and Asia.

If you are unable to straighten your fingers and your quality of life is being impacted, your doctor will discuss surgical options with you. These generally include a minimally invasive percutaneous needle fasciotomy (PNF) or partial fasciectomy surgery.

The main advantages of a minimally invasive PNF are faster recovery and lower risk of complications, compared to more invasive surgical options. However, the likelihood of the contracture returning is higher. Which option is most appropriate for you will depend on your personal circumstances, including how advanced your disease is and whether you have had previous treatment in your hand.

During

PNF can be performed in our hospital’s outpatient clinic or in one of our operating theatres. It is a day-case procedure, meaning you can be treated and go home the same day. PNF is usually performed using local anaesthetic, so you will be awake but have no sensation in your hand. Your doctor will discuss this with you ahead of surgery so you know what to expect and feel comfortable.

To start the procedure, local anaesthetic will be injected into your hand. This can sting a little at first, but after this your hand should be completely numb. A fine needle will then be placed under the skin of your hand and stroked repeatedly against the thickened bands of tissue that are pulling down the finger. The bands are eventually cut, releasing the finger.

Your surgeon will then straighten the affected finger(s) and place a simple dressing on the hand. From start to finish, the procedure should take no more than 30 minutes.

The recovery after the procedure is fast and straightforward.

After

Your hand and fingers may be a little swollen for a few days and you can help reduce this by elevating your hand above your head a few times a day, keeping your fingers moving, and using ice packs. Your hand may also feel slightly numb or tingly for a day or two. There is very little pain after PNF, so you may not need painkillers, but it’s best to have some over-the-counter pain relief handy just in case.

You should be able to go back to work and your usual routine within 48 hours. However, specific instructions on your recovery and return to work and driving will be given to you by your specialist doctor.

In the weeks following your procedure, your doctor may advise you to wear a splint intermittently during the day and at night, as well as perform gentle finger bending and straightening exercises at home.

Our hospital has an excellent hand therapy service which can provide you with a hand physiotherapy programme and support you throughout your recovery if needed.

A PNF is a good option for people with mild or moderate Dupuytren’s disease. Unfortunately, contractures can return in up to half of those who receive this treatment. However, if this is the case, the procedure can be repeated.

How to pay for your treatment

If you’re… paying for yourself

Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.

For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.

If you’re… insured

St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.