Needle Fasciotomy
Also known as: percutaneous needle fasciotomy (PNF) or percutaneous aponeurotomy
Surgical treatment, including needle fasciotomy, offers an effective treatment option for patients with Dupuytren’s contracture, especially when finger contracture significantly impacts hand function and quality of life.
What is Dupuytren’s Disease?
Dupuytren’s disease (also known as Dupuytren’s contracture) is a hand condition that affects the layer of tissue called the fascia, located just beneath the skin. The fascia helps support the structures of the hand, but in Dupuytren’s disease, it gradually thickens and tightens over time. This can lead to the formation of firm cords that pull one or more fingers toward the palm. As the condition progresses, it can become difficult to straighten the affected fingers, making everyday activities, like shaking hands or placing the hand flat on a surface, more challenging.
Dupuytren’s can affect one or both hands and tends to develop slowly over time. It’s more common in men, especially those over 50, and often runs in families. Although the exact cause isn’t fully understood, it’s believed to be linked to genetics.
What are the symptoms?
The first sign is often a small, firm lump in the palm, which may be painless. You might also notice dimpling or puckering of the skin or find that your hand no longer lies flat. As the condition progresses, a thick cord may develop, pulling your fingers, usually the ring and little fingers, downward. This can interfere with simple tasks like reaching into pockets or washing your face.
What causes it?
Dupuytren’s is largely inherited, so lifestyle factors don’t typically cause it. Your risk increases if you’re male, over 50, and of Northern European descent. In some cases, an injury or previous hand surgery may trigger the condition or make it worse, but the underlying cause is usually genetic.
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Initial consultation
One of our hand and wrist surgeons can diagnose you during an initial consultation, and you won’t need to have any tests or scans. If your condition is in its early stages, we’ll often suggest a watch-and-wait approach. For some people, the disease will progress very slowly, and for others it may get worse much more quickly.
If you’re unable to straighten your fingers and your quality of life is being impacted, then surgery is the gold standard of treatment.
Preparation for surgery
Preparing for a needle fasciotomy involves carefully following the instructions provided by your surgeon and our team. You may be asked to arrange transport, as you won’t be able to drive yourself home after the procedure. Be sure to follow any preoperative guidelines, which could include fasting (if anaesthesia is involved), stopping certain medications, and practising good hand hygiene. It’s also important to plan for your recovery – depending on the extent of the procedure, you may need to take time off work or limit the use of your hand. Discuss these preparations with your doctor so you know exactly what to expect.
During surgery
Needle fasciotomy is typically performed as a day surgery, meaning you’ll come to the hospital and return home the same day. The procedure is usually done under local anaesthetic in your hand, so you’ll remain awake throughout.
During the surgery, the surgeon uses a needle to carefully release the thickened bands of tissue beneath the skin, allowing the affected fingers and joints to straighten. Once the release is complete, the wound is closed, and normal hand function can begin to return. The entire procedure usually takes about an half an hour.
While most patients are discharged the same day, it’s essential to follow the recommended recovery process to ensure proper healing.
After surgery
After your needle fasciotomy, you should keep your hand clean and dry for the first 24 to 48 hours. A light dressing will usually be applied, and you can often remove it the next day unless your doctor advises otherwise.
It’s normal to have some mild pain or bruising at the needle insertion sites, which you can manage with over-the-counter pain medication. You should gently move your fingers soon after the procedure to keep them flexible but avoid any strenuous use of your hand for the first few days. Your doctor may recommend wearing a night splint to help keep your fingers straight while you sleep.
You’ll likely have a follow-up appointment within 1-2 weeks, and in some cases, hand therapy may be suggested to improve your range of motion and overall hand function. Your healthcare team will give you tools and exercises to ensure you have a smooth and successful recovery and to help manage any wounds that may occur, which typically heal without complications within two weeks.
Potential complications and risks
As with any surgical procedure, there are potential complications and risks associated with needle fasciotomy. These can include infection, nerve damage, and recurrence of the contracture. Skin tears commonly occur, especially in cases where the affected tissue is tightly adhered to the overlying skin- the tears are usually small and will be left to heal by itself usually. Additionally, there is a risk of damage to the digital nerves and tendons, although this is rare. It’s essential to discuss these risks with a surgeon and follow post-operative instructions carefully to minimise the risk of complications. In some cases, more extensive surgery, such as a partial fasciectomy or dermofasciectomy, may be necessary to treat severe cases of Dupuytren’s contracture.
Appointment and Treatment Plan
Initial Consultation
Your hand and wrist surgeon will assess symptoms like finger bending or lumps in the palm. Diagnosis is usually based on physical exam, with no scans needed. Early-stage cases may be monitored; more advanced ones may need surgery.
Pre-Surgery Preparations
Before the procedure, arrange for someone to take you home. You may need to fast, stop certain medications, or follow other instructions from your surgeon. Prepare your home for recovery by setting up a rest area and limiting hand use for the first few days.
Day of Surgery
This is a day procedure, typically under local anaesthesia. A needle is used to divide tight cords in the palm, allowing the fingers to straighten. It takes about 30-60 minutes, and you’ll go home the same day.
Immediately After Surgery
Your hand will be bandaged. Expect mild pain or swelling. Keep it elevated and dry for 1-2 days. Start gentle finger movements right away and follow care instructions closely.
Early Recovery at Home
Rest your hand and avoid heavy use. You might wear a night splint and should keep the area clean. Continue light movement to prevent stiffness. Most people resume their daily tasks within a few days.
Hand Therapy
Some people benefit from therapy to improve motion and prevent recurrence. This may involve finger stretches, strengthening, and splinting. Your doctor will guide you based on your progress.
Full Recovery
Recovery takes 6-12 weeks. Most regain good function, though some tightness may persist. There’s a small chance of recurrence, but following rehab instructions lowers the risk.
Experts
We are proud to provide patients with access to a wide range of clinicians, chosen specifically for their knowledge and reputation in their area of expertise. Our experts align with our values: putting you at the centre of your care and educating you on your options at each step of the journey. We encourage you to learn more about our clinicians and how they can help you below. As always, please contact our patient services team if you require any additional information.
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FAQs
Recovery time after a needle fasciotomy generally takes up to from 2 weeks to a couple of months. Most patients can return to normal daily activities relatively quickly, often within a few days, but full healing and regaining optimal hand function may take longer. During this period, it’s important to follow your surgeon’s advice and to attend hand therapy sessions to support recovery. Therapist-guided hand exercises help improve mobility, reduce stiffness, and strengthen the affected finger and surrounding tissues.
Injection needle aponeurotomy is usually well tolerated because it is performed under local anaesthetic, which numbs the treatment area. Patients may experience some mild discomfort or pressure during the procedure, but significant pain is uncommon. After the procedure, mild soreness or tenderness around the treated area can occur, which typically subsides within a few days. Pain relief medication and proper wound care can help manage any post-procedure discomfort.
Surgical treatment, including needle fasciotomy, offers an effective treatment option for patients with Dupuytren’s contracture, especially when finger contracture significantly impacts hand function and quality of life. While there is currently no definitive cure for this benign condition, the procedure is minimally invasive and has a relatively quick recovery, helping to straighten the affected finger and improve hand function. However, like with all treatments for this condition, there is a risk of recurrence over time. Patients should discuss surgical options, including partial fasciectomy or segmental fasciectomy, with their surgeon to determine the best approach for their specific case. Overall, many patients find that needle fasciotomy improves hand function and reduces symptoms, making it a worthwhile option.
Medically reviewed by Mr Nawfal Al-Hadithy - Consultant Trauma & Orthopaedic Shoulder, Elbow & Hand Surgeon on 28/05/2025