Needle Aponeurotomy vs. Fasciectomy

Navigating Treatment for Dupuytren’s Contracture: NA vs. Fasciectomy

Dupuytren’s disease is a fibroproliferative disorder that causes the palmar fascia to thicken and shorten, eventually pulling fingers into a permanent bend. When the "tabletop test" fails—meaning you can no longer lay your hand flat—it’s time to discuss surgical or procedural intervention.

The two primary mechanical treatments are Needle Aponeurotomy (NA) and Fasciectomy. While both aim to restore extension, they offer very different experiences regarding recovery and long-term durability.

1. Needle Aponeurotomy (NA)

Often referred to as a "percutaneous" procedure, NA is a minimally invasive technique usually performed in an office setting under local anesthesia.

• The Procedure: A surgeon uses the sharp tip of a needle as a tiny scalpel, sweeping it through the diseased cords to weaken them until they can be manually snapped or "released."

  
  

• Recovery: Extremely rapid. Most patients return to light activities within 48 hours and do not require extensive physical therapy.

• The Trade-off: Because the diseased tissue remains in the hand (it is only severed, not removed), the recurrence rate is significantly higher—often cited around 50% within 3 to 5 years.

2. Limited Fasciectomy

This is the traditional "gold standard" surgical approach, typically performed in an operating room.

• The Procedure: An incision is made over the affected area, and the surgeon physically removes the diseased cords and nodules while carefully dissecting them away from nerves and tendons.

  
  

• Recovery: More intensive. Expect bandages, stitches for 10–14 days, and several weeks of hand therapy and night splinting to maintain the gains.

  
  

• The Benefit: Because the pathological tissue is excised, the recurrence rate is much lower than NA, offering a more "permanent" fix for many patients.

Comparison at a Glance

Feature	Needle Aponeurotomy (NA)	Limited Fasciectomy
Setting	Office / Outpatient	Operating Room
Anesthesia	Local	General or Regional Block
Incision	None (Punctures only)	Traditional Surgical Incision
Recovery Time	1–3 Days	4–8 Weeks
Recurrence Risk	High (Short-term relief)	Low (Long-term relief)
Complications	Skin tears, nerve irritation	Infection, hematoma, stiffness

Which is Right for You?

The choice often depends on your stage of life and medical profile:

• Choose NA if: You are older, have comorbidities that make surgery risky, or simply cannot afford weeks of downtime. It is also excellent for simple, well-defined cords.

• Choose Fasciectomy if: You are younger (where recurrence is more aggressive), have complex "mats" of tissue, or have involvement in the PIP (middle) joint, which is notoriously harder to treat with needles alone.