Expert: Dupuytrens Contracture

Dupuytrens Center of Idaho

Dr. David Kline

I am a board certified Emergency Room physician practicing medicine near Boise, Idaho. I do many invasive procedures in the ER, including hand procedures. When I first started developing symptoms of Dupuytren's contracture in my little fingers, I went to see two different local hand surgeons. I was given the standard advice that nothing could be done until the disease progressed and my contractures were more severe. The treatment would be surgery involving 3-4 months of intense rehab afterwards and not being able to use my hands during that time.

In the meantime, as I watched my little fingers gradually draw down, every day use - such as putting my hands in my pockets, putting them flat on a table, swimming laps, playing my guitar or shaking hands - become more and more difficult. I began reading all that I could about Dupuytren's condition and stumbled across a website on needle aponevrotomy (NA). I read about this technique with great interest; needle aponevrotomy had not even been mentioned by the two hand surgeons who had examined my hands.

After much research of the current medical literature and after contacting other Dupuytren's patients who all had excellent results after having NA on their hands - including a Pediatric Neurosurgeon - I decided not to wait for my hands to deteriorate further. I made the trip over to Paris in 2002 to be treated by Dr. Lermusiaux.

I was, of course, somewhat nervous. I had the same questions you probably have now: if this procedure is as great as every one says, why aren't US physicians offering this to their patients? Was it going to hurt? How would my hands be afterwards? Would I have complications? But as anyone who has this condition will understand, I was also very anxious to get back full use of my hands so I went through with my appointment. In a short 15 minute procedure, Dr. Lermusiaux released my contractures and erased the previous 10 years of discomfort and worry that I had suffered. I was absolutely astounded! Immediately my fingers were straight and functional again. I knew this was something I had to help bring back to patients in the United States.

I returned to Paris in the fall of 2005 to train with Dr. Lermusiaux, Dr. Lellouche, and all the other doctors who offer NA to their patients at Lariboisiere Hospital. There are now a handful of physicians in the US who are treating Dupuytren's contractures with NA.

Needle Aponevrotomy (NA)

NA is a non-surgical procedure for the treatment of contracted Dupuytren's cords in the hand. It is sometimes also called needle aponeurotomy or needle fasciotomy. It is minimally invasive - under local anesthetic, the physician uses a small hypodermic needle to divide and sever the contracting bands in the diseased areas of the palm and fingers. This technique was developed in Paris by Dr. Lermusiaux in the early 1950's and has been in use in France for the past 30 years. This procedure is now available to you in the US.

The effectiveness of this method is outstanding.

NA vs. Surgery

NA is an office procedure which takes approximately a half-hour to an hour to perform; no need for hospitalization or general anesthesia.

Rapid healing - aside from heavy lifting, normal activity is easily resumed after 48 hours. Physical therapy is not required. After standard surgical methods months of physical therapy and rehab are required.

- Little or no pain medication is needed afterwards.
- Virtually no complications or scarring. Complications that may occur from traditional surgical methods used to correct Dupuytren's contracture - such as nerve injury, infection, hematoma formation, stiffness, flare reaction or RSD (Reflex sympathetic dystrophy) - are extremely minimal, if not unheard of, with NA. There is no scarring.
- In the event that the disease returns, which happens in about 50 percent of patients, this procedure can be repeated many times if necessary. This cannot be said for other surgical methods used to treat Dupuytren's contracture, which can eventually lead to amputation of the finger if repeated.
- Much less expensive than standard surgical methods (fascitomy, fasciectomy, dermofasciectomy). Depending upon the severity of the disease, it can be as little as 1/20 the cost of surgery.