Needle aponeurotomy (NA) and Collagenase Injections (Xiaflex) are two nonsurgical treatments for Dupuytrens Contractures when the fingers can no longer full straighten. Steroid injections (cortisone shots) are available for symptomatic Dupuytrens nodules before development of cords and flexion contractures. Steroid injections can also soften and flatten the Dupuytrens nodules and reduce tenderness of the nodules.
Needle Aponeurotomy (NA) is a minimally-invasive procedure performed under local anesthesia in the office. Using the tip of a syringe needle, the cords in the palm are perforated multiple times. Then the fingers are manipulated to rupture the cords, allowing the fingers to straighten. This is shown in the photos above. Light wound care and range of motion exercises are then performed, and often a night splint is applied by therapy.
NA is the least expensive treatment intervention for Dupuytrens contractures. The procedure has minimal recovery time needed. Most patients are advised to avoid heavy use with the hand for one week, but otherwise patients can use the hand for most light activities immediately.
NA is a procedure performed in the office and it has some risks. Skin irritation, pain, bruising, and swelling at the needle sites are common. These symptoms typically resolve in a few days. Skin tears can occur as well, and these heal with daily wound care within about 2 weeks. More severe complications such as infections, injuries to the nerves and flexor tendons are very rare.
Not everyone is a candidate for the NA procedure. The best candidates have isolated metacarpophalangeal (MP) joint contractures and a palpable cord. Proximal interphalangeal (PIP) joint contractures are more difficult to treat with this technique. Recurrence rates are high for this technique as well as collagenase injections, but the procedure can be repeated in the future for recurrent contractures. Many patients choose this as an alternative to Dupuytrens surgery in the operating room.
Collagenase injections (Xiaflex is the brand name) are also used to treat Dupuytrens contractures. This medication is injected into the cord which breaks up the collagen fibers chemically. This allows the surgeon to manually stretch the finger and rupture the cord at a follow-up appointment. Numbing medication is used to reduce the pain during the hand manipulation. Results are similar to the needle aponeurotomy procedure and recurrences of the contractures are common. Complications include bruising, pain, swelling, skin tears, allergic reactions and flexor tendon rupture. This medication was FDA approved in the United States in 2010.
Dr. Erickson will discuss the treatment options with you in the office and make his recommendations based on your individual case and functional needs. He treats patients at the Raleigh Hand to Shoulder Center in Raleigh, NC.