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Experience with Needle Aponeurotomy?
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04/12/22 01:23
rockinroller 
04/12/22 01:23
rockinroller 
Experience with Needle Aponeurotomy?

I've suffered with DD for approximately 8 years and have had 4 Xiaflex injections at various times, involving both hands' ring and little fingers. I currently have a 30 degree contracture of my LH ring finger and after visiting my ortho surgeon today hoping to arrange yet another Xiaflex injection, he confirmed that the contracting was caused by a cord IN my finger and not originating in my palm below that finger. Consequently the Xiaflex would not be an effective option and is apparently restricted from use directly into the finger area. He proposed NA (which he had tried, unsuccessfully, last year in an attempt to provide some relief to a horribly mutilated RH little finger resulting from having been infected with DD so horribly that even Xiaflex couldn't save it and it officially evolved into a Boutonniere Deformity.

QUESTION FOR THE FORUM: Have any of you had experience with NA, especially when treating a cord within the finger area (not in the palm)? If so, was it effective in releasing the finger back into semi-normal position? And even as critical: Did the procedure result in removing/reducing the contracture for any length of time? I understand that NA is probably the least impactive of all the procedures to treat DD but I also heard that DD has a high recurrence rate afterward. Thanks in advance.

04/12/22 09:24
spanishbuddha 

Administrator

04/12/22 09:24
spanishbuddha 

Administrator

Re: Experience with Needle Aponeurotomy?

I've not had NA so cannot comment from personal experience. But the success or otherwise of NA, does depend on how isolated and accessible the cord is from other finger structures, nerves, tendons, nodules, etc, and the skill/experience of the surgeon. So any personal experience answers here may not be applicable or helpful in your specific case anyway. Dr Pess in NJ would be the 'best' doc in your case to advise on the possibility of NA helping your case. Maybe you can do a video consultation?

04/12/22 10:02
wach 

Administrator

04/12/22 10:02
wach 

Administrator

Re: Experience with Needle Aponeurotomy?

Did you see the pictures by Keith Denkler at the bottom of https://www.dupuytren-online.info/needle_aponeurotomy.html ? The PIP cord is, at least in part, in the finger but probably extends into the palm.

I myself had NA on a contracted little finger, also in the PIP joint. It reduced the contracture from probably 40 deg to about 15 deg, which was good enough. The finger was stable as long as I kept wearing a night splint. After a year or so I stopped wearing it and the contracture returned within a year to its original state.

Wolfgang

04/12/22 18:28
mikes 
04/12/22 18:28
mikes 
Re: Experience with Needle Aponeurotomy?

I suppose I've been extremely lucky. In 2006, I had NA performed by DR. Denkler on a 90+ degree PIP pinkie contracture. His effort initially resulted in a reduction to about 25 degrees. Over time, with hand therapy for 3 months and nightly splinting tapering off gradually after about 3 years, the contracture further reduced to virtually nothing. And it has held steady ever since! Unfortunately, I now have 2 fingers on the opposite hand that are somewhat contracted, which I have been "watching" carefully for some time. The NA itself, and its aftermath, were certainly not pleasant and I'd like to avoid a repeat if possible. That said, it was wildly successful and Dr. Denkler and his staff were superb throughout.

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