Needle aponeurotomy (NA)
Needle Aponevrotomy, also called needle aponeurotomy or percutaneous needle fasciotomy (PNF) and in the U.S. usually abbreviated as NA, is a minimal invasive technique that originally became popular in France more than 20 years ago (fasciotomy was suggested already previously by Astley Cooper in 1822 and Guillaume Dupuytren in 1832). The aim of NA is to make bent fingers functional again by straightening them and achieve minimal side effects. The technique uses needles to puncture the contracting (blocking) Dupuytren cord and thus weaken it until it can be broken by mechanical force, typically with a characteristic snap. NA (needle aponeurotomy) is a non-surgical, ambulant, outpatient procedure.
"Before / after" examples of needle aponeurotomy/NA treatment are e.g. shown on the site of the Handcenter in Jupiter, FL, handcenter_NA, Dr. Denkler's NA site, or on the NA web site authored by Dr. Kline. On the latter select Needle Aponevrotomy from the menu there and then e.g. "Left Hand" from the left menu. Another impressive example, including a video, is shown on Dave's Dupuytren's contracture. Below examples include results after 6-8 months and links to several videos showing NA live.
Positive results of NA
NA (needle aponeurotomy or needle fasciotomy) has gained high popularity in France and in the mean time also in the US, the United Kingdom and Germany. The reason is that it usually succeeds in getting bent fingers straight and functional again, takes very little time to apply, requires only local anesthesia, creates no or minimal scarring, provides a fast recovery, is less expensive than surgery, can be repeated, and is typically fairly painless.
Example of needle aponeurotomy (NA), also called percutaneous needle fasciotomy (PNF)
Below pictures were provided by A. Meinel, Dupuytren Ambulanz, Germany. The good results documented here should not hide the possibility of recurrence of Dupuytren's contracture after NA. The probability of recurrence after NA (PNF) is suspected to be higher than after thorough surgery but reliable statistics have not been published yet.
Finger with Dupuytren's contracture before needle aponeurotomy (NA)
Immediately after NA, extension deficit nearly gone
Palm of above hand immediately after NA, showing the still folded skin
due to Dupuytren's contracture and where needle was applied
Above hand 6 months after NA. The finger is now nearly straight, the originally
strong cord became flatter. The patient had worn a night splint for 3 months.
Palm after six months. Skin folds have flattened considerably.
Watching treatment of Dupuytren's contracture with NA on video
If you want to watch a NA session you might have a look at below YouTube clips
NA by Dr. Kline (20 min film, complete procedure)
NA by Dr. Belcher (3.5 min film showing the essentials in a close up)
Application of needle aponeurotomy (NA) to advanced stages of Dupuytren's contracture
While NA (PNF) is typically applied in stage 1 of Dupuytren's contracture it can also be a valuable therapy for progressed stages of Dupuytren's contracture. Even stage 4 patients have been treated successfully. In the example below (provided by K. Denkler) the MCP joint (base joint) has been fully released, the more difficult PIP joint (middle joint) remained at 35 deg extension deficit, yet overall a significant improvement for the patient.
Treatment of Dupuytren's contracture in stage 4 with NA. Upper row: prior to NA. 70 degrees of extension deficit at the base joint and 65 degrees at the middle joint (total = 135 deg = stage 4). Bottom row: 8 months after NA.
For personal experience with NA see also link_to_personal_story_NA .
Page last modified:
08/29/2008