WESTERN
MASSACHUSETTS VERMONT CONNECTICUT
NEEDLE
APONEUROTOMY for DUPUYTREN'S
DISEASE
PATIENT HANDOUT
Before The
Procedure:
· Food?
It is safe to eat before the
procedure. In fact, you
should eat something.
For this type of procedure, you don't want or need an empty stomach.
Just don't overdo it. Avoid eating foods that you think might not sit right
with you or make you feel uncomfortable.
· Medication?
If
your regular doctor has recommended that you take prophylactic antibiotics
before surgery because of joint replacement, heart disease, or
other medical problems, it is appropriate to take that type of medicine
before this procedure.
You'll need to make arrangements with your primary care physician to obtain
prescriptions for these types of medicines prior to your procedure. If you
take aspirin, vitamin E, or blood thinners such as coumadin, or have any
questions about your medications; please
check with the Hand Center before your scheduled appointment.
· Problem Skin?
If you have recent injuries,
wounds, insect bites, or healing areas involving
the palm of the hand or the fingers; it might not
be safe to proceed with needle aponeurotomy
because of the risk of possible infection.
Please check with the Hand Center if you have
any other similar issues which could jeopardize your procedure.
The Procedure:
· How long does the procedure take?
The procedure typically takes about an hour. At first you will be seated in an exam room so that your history and physical exam can be reviewed. The physician will go over the details of the procedure as well as the risks, benefits, likely outcomes, and treatment options. The information contained in this hand out will also be discussed. Following completion of this and certain documentation forms, you will be able to undergo the procedure. The proposed needle aponeurotomy sites will be marked out on the skin by the physician, and you will be asked to wash your hands.
If there are medical issues or concerns that arise on the day of your procedure, it might be necessary, in rare instances, to reschedule the procedure to a later date. At the Hand Center or Western Massachusetts, our physicians do not do the initial evaluation and the procedure on the same day. The procedure must be scheduled at a later date.
· What actually is done during the procedure?
The procedure is performed
while you lie down
on your back with your arm stretched out. The
doctor may use a marking pen to make further dot
marks on the skin where he plans to use the
needle. He will then numb up the skin at these
sites with a tiny needle and local anesthetic.
The doctor will then work with a needle in the
areas that were numbed to cut the fascial cords under
the skin. At the end of the procedure, the
doctor will give anesthetic and cortisone shots
into these areas to prevent pain and swelling.
If you know that you have a shoulder, neck, or other problem that precludes you from lying face up and flat with your arm outstretched;please let the doctor know before the procedure begins.
· What will I need to do?
Relax, listen to music,
and talk as much as you like (if you like). The actual procedure
is only typically uncomfortable for a few moments when small tiny
needles are used for injections.
You should tell the doctor
if you feel anything painful, and in particular if you feel any tingling
or numbness in your fingertips – that will help minimize the chance of nerve
irritation after the procedure.
· Is it very painful?
Usually not. The little
shots into the skin of the palm sting for only a few seconds, and take
effect instantly. The fascial cords
themselves have no feeling and don't hurt when they are cut. Joints which
have been stiff or flexed down for some time, may be painful to stretch
out.
It often helps to give a small anesthetic shot into a joint before
straightening it, especially if arthritis of the finger joints is present.
· What will my
hand be like at the end of the
procedure?
If all goes well, your
fingers should be straighter. The needle entry sites will be
covered with small round bandaids or larger rectangular ones.
You may have some numbness
in your fingers from the last set of shots at the end of the procedure,
and this may last through into the next day.
After The
Procedure:
· That
Day: Bandaids can usually be removed and
left off later on the same day.
You should be able to use
your
hand for light activities (eating, getting
dressed, going to the bathroom) and
get your hand wet in the shower on
the day of the procedure.
· First 48 hours: Ice and Elevation are the
keys
to a painless recovery. On the day of and the
day after the procedure, keep your hand
pointing up as much as you can, and hold
something cold in your hand every hour for 10 minutes at a time.
After that take a 50 minute break.
Put the ice pack back in the
freezer right away so it will be cold. This is important for the first and
second day.
If the ice pack feels too cold for your skin or it hurts, you can wrap it
in a towel or facecloth.
You do not need to apply ice when you go to sleep at night. However, you
should begin this same icing regimen the next morning.
Remember: For the first
48 hours, Ice and Elevation are the keys
to a painless recovery.
At the Hand Center or
Western Massachusetts we will give you a comfort gel cold pack 
which you may use with an ace wrap if you desire.
If you do use an ace wrap with the ice pack, be sure not to
overtighten the bandage. The printed instructions on the ice pack may
differ.
Do not use this pack for heat. Do not apply heat to your hand.
You should try to keep your
hands
dry for a few hours after the procedure. If you
get the band-aids wet, take them off and leave
them off. If you are still gettng a little bloody fluid
from the puncture holes you can replace the bandaids
with clean new ones, but most people won't need to do that.
· Washing:
Avoid swimming,
submerging, or prolonged soaking of your hand in the bath during this first
2 day (48 hour)
period. You may wash and shower. Use gentle soap and water without vigorous
scrubbing.
· The
First Week: You should avoid strenuous
activities with the hands for one week after the
procedure. During this time, avoid activities
which would make your hands sweaty, grimy,
or exposed to harsh chemicals. This is very
important to prevent infection.
·
Splinting: Splinting
your hand with a custom brace at night,
in some instances, may be helpful if you have several
fingers involved, contractures of the PIP joints,
severe contractures, or tendon imbalance.
Splinting after needle aponeurotomy is seldom needed.
Your doctor will advise you if he feels splinting is necessary following
your procedure.
· Medications: Usually,
there is no need for
prescription pain medicine after the procedure.
You should continue to take all of your regularly
prescribed medication on schedule.
Follow up: Before you leave the office on the day of your procedure, you will be given a follow-up appointment..
Questions? As with any procedure or office visit, if any questions, issues or problems arise, please contact the office.
Needle Aponeurotomy for Dupuytren's Contracture FAQ
Further Needle Aponeurotomy Standout Examples
THE HAND CENTER OF WESTERN MASSACHUSETTS