What is needle aponeurotomy or palmar fasciotomy and what are the risks?

Alternative Medicine: Safer alternative than needle aponeurotomy  

Before discussing the Dupuytren contracture surgery known as needle aponeurotomy (NA) and its inherent risks, it is important for the reader to know there is a conservative alternative therapy that avoids the possible side effects and adverse reactions of needle aponeurotomy, also called palmar fasciotomy.  Any Dupuytren’s surgery, even when done well, can have bad unintended consequences as well as stimulate the recurrence of additional nodule and cord formation within a year or two.

Needle aponeurotomy, and other kinds of Dupuytren surgery, is not the only treatment option available.   Alternative Medicine is a conservative and essentially risk free alternative that could make surgery unnecessary.   Most people agree that it makes more sense to use conservative options first, followed by more aggressive and risky options if they are still needed.  However, in the case of Dupuytren contracture most patients are unaware they have other options outside of surgery.

Since 2002 this website has suggested that anyone with Dupuytren contracture should first consider the conservative non-surgical and non-drug treatment options before attempting irreversible surgery.  To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

While all medical websites approach the subject of Dupuytren treatment as though hand surgery and Xiaflex injections are the only options to consider, they intentionally avoid the many diverse Alternative Medicine options that are easy to incorporate and can be used with practically no risk at all. Please read Conservative Philosophy for Dupuytren Therapy

Medical doctors discuss Dupuytren surgery risks

For verification of the risks associated with Dupuytren surgery simply read what hand surgeons have to say.  If the reader goes to the website of a surgeon who specializes in needle aponeurotomy you can read about the dangers of open hand surgery like fasciectomy or even Xiaflex injections.   And, if the reader goes to the website of a surgeon who specializes in open hand surgery you can read about the dangers of needle aponeurotomy.

Each surgical procedure obviously has pros and cons about it, and it us up to the informed patient to know the best option to use.  The intention of this article to simply say that all surgery has a certain level of built-in risk that is best avoided if at all possible.

Risks of needle aponeurotomy

The surgeon cannot see the tip of the needle or the actual tissue being sliced and torn during a needle aponeurotomy, since there is no surgical incision made when performing a needle aponeurotomy.  The surgeon inserts the needle that is used to do the cutting and slicing, and must rely on a high level of skill to only contact and destroy the Dupuytren cord – and nothing else.

There are two risks involved. The first risk is that normal and healthy tendon, ligament, blood vessel and nerve tissue can be accidentally cut instead of the intended targets of palmar fascia contracture and Dupuytren cords.

However, the second risk is greatest.  After a palmar fasciotomy or needle aponeurotomy is done, the cutting and tearing of the Dupuytren contracture tissue accelerates the time for recurrence of another episode of Dupuytren’s contracture when compared to conventional open hand surgery.   The reality of this hand problem is that the contracture will come back at some point after any Dupuytren intervention, and recurrence is statistically faster after needle aponeurotomy than after other types of hand surgery.

Difference between needle aponevrotomy and needle aponeurotomy

There is a simple reason for the difference in terminology encountered while learning about Dupuytren treatment.  Many people find it confusing to occasionally see aponeurotomy spelled a little differently, as in the phrase “needle aponevrotomy.”

Needle aponevrotomy is not an accidental misspelling of needle aponeurotomy. It is simply a matter of a French word being used because the earliest and most innovative development of needle aponeurotomy was done in France, hence the occasional use of the French terminology needle aponevrotomy; both words refer to the same procedure.

Needle aponeurotomy is Dupuytren surgery  

In medical terminology an “-otomy” is a surgical procedure in which the body is cut into, but nothing is removed.  Familiar examples are: tracheotomy, laparotomy, phlebotomy.

The reader will occasionally come upon another –otomy, the term palmar fasciotomy to describe needle aponeurotomy.  In a fasciotomy a type of tissue called fascia is cut but not removed.   Fascia is a kind of thin but tough layer of connective tissue that surrounds, covers and lines all major organs, tissues and cavities of the body.  There is fascia – a lot of it – under the skin on the palm of hand.  During a needle aponeurotomy fascia is cut but not removed, qualifying for this surgery to be called a palmar fasciotomy.

Further, in medical terminology an “-ectomy” is a surgical procedure in which the body is cut into, and something is removed.  Familiar examples are:  Tonsillectomy, appendectomy, and vasectomy.

The reader will also occasionally come upon another –ectomy, as in palmar fasciectomy which is an open hand surgery during which an incision is made to allow for removal of part or all contracted fascia of Dupuytren contracture.   During a palmar fasciectomy sometimes so much fascia and skin is removed that sometimes a skin and fascia graft must be done.

Therefore, a needle aponeurotomy is a surgical procedure that is performed by inserting a needle into a site of deep palmar fascia contracture and nothing is removed.  Instead, once under the skin of the palm, the needle tip is moved blindly around in a variety of directions to intentionally slash, weaken and otherwise disrupt the contracted palmar tissue that causes the reduced finger movement and flexion contracture of Dupuytren’s disease.

What is the difference between needle aponeurotomy and palmar fasciectomy and what are the risks?

Needle aponeurotomy and palmar fasciectomy greatly different

Needle aponeurotomy and palmar fasciectomy are two completely different kinds of Dupuytren contracture surgery.  As with any kind of hand surgery done to release the contractures of Dupuytren disease, each has its own value, risks and limitations.  The risk and limitation of Dupuytren surgery should be considered not only because of the potential permanent consequences (numbness, reduced finger movement, reduced hand strength, reduced sensations and pain) that can occur, but also because hand surgery is not your only Dupuytren therapy option.

Alternative Medicine is a conservative and essentially risk free alternative that could make surgery unnecessary.

Dupuytren’s surgery, even when done well, can have bad unintended consequences as well as stimulate the recurrence of additional nodule and cord formation in the palm.  Since 2002 this website has suggested that anyone with Dupuytren contracture should first consider the conservative non-surgical and non-drug treatment options before attempting irreversible surgery.  To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

What is a needle aponeurotomy?

Needle aponeurotomy, also called palmar fasciotomy, is considered minimally invasive Dupuytren hand surgery since a scalpel is not used to open the skin of the palm.

Needle aponeurotomy is performed by inserting a hypodermic needle into the palm of the hand with the intention to move the needle tip in a variety of directions to cut, tear and weaken the offending cords and contractures in the palm.  Without being able to see the collagen structures he is slashing with the needle tip, the surgeon blindly attempts to destabilize and release those same cords and fascial contractures that prevent full straightening of the involved fingers.

Because these structures cannot be seen as the needle moves, the risk is that nearby nerves, blood vessels and tendons might be accidentally injured or destroyed

What is a palmar fasciectomy?

There are several types or palmar fasciectomy, depending on how much tissue is removed during this type of hand surgery.  Let us begin with the words, palmar fasciectomy.

Palmar refers to the palm of the hand. Fasciectomy refers to a kind of surgery performed on fascia.  Fascia is the thin, white, tough layer of soft tissue that covers, surrounds and lines all organs, structures, tissues and cavities of the body. You can think of fascia like the clear plastic Saran wrap used to cover and protect food.  When you look in the meat case at the butcher shop you can see all kinds of fascia in the cheaper grades of roasts and steaks.   Because hands need extra support and protection from the heavy work they do, there is normally much fascia in the palm.

The ending “-ectomy” means that the surgery is done through an opening in the skin and something is removed – in this case fascia.   So, a palmar fasciectomy is a surgery on the palm during which fascia is removed.

As an interesting aside the reader will note, above, that needle aponeurotomy was noted to also be called a palmar fasciotomy.  The ending, “-otomy” means that the surgery is done to cut into the body but nothing is removed, not even the fascia. A common “-otomy” surgery is a tracheotomy in which a hole is placed in the trachea, so that breathing can take place through the opening, and noting is removed.  So, a palmar fasciotomy is a surgery on the palm during which no fascia is removed.

Not all palmar fasciectomy is performed the same. The type and extent of a palmar fasciectomy is determined by the patient’s history of previous hand injury and surgical treatment, occupation, age, family genetics and family history of the Dupuytren’s contracture, severity and location of contracture, degree of disability, and general health status.

Different types of this Dupuytren surgery include a complete palmar fasciectomy (rarely done because of typically bad results after such large tissue removal), partial or selective palmar fasciectomy, fasciectomy with skin grafting, and amputation.


Cost of Treatment for Dupuytren Contracture

Cost of Dupuytren treatment dependent on many variables   

It is not possible to provide clear and meaningful Dupuytren treatment cost information for any one type of procedure.  Costs differ so greatly in various parts of the U.S, and the world for that matter, although this is less true outside the U.S. where regulated socialized medicine is practiced.

Any reported cost of medical or surgical Dupuytren treatment would have to be speculative based on insurance plan deductibles, rate discounts negotiated between insurance company and doctor providing care, discounts for rapid cash payments of outstanding balances, etc.  In addition, there is not much published information about costs for various Dupuytren contracture treatments because doctors are very hesitant to advertise their fees for service since it is there professional standard that this would make them appear less professional, or at least cast suspicion about their financial motivation for offering this type of care.

Dupuytren treatment cost for hand surgery is also variable based on the specific technique used, the type of anesthesia required, the severity of the contracture, the number of hands and fingers involved and the need for physical therapy after surgery.  Lastly, even the response to treatment provided influences the cost of Dupuytren treatment since sometimes multiple needle aponeurotomy procedures must be done to a single finger to reduce strength and integrity of the cords involved.

Cost of treatment for Dupuytren contracture; surgical release, needle aponeurotomy, Xiaflex enzyme injections

As a cost reference point, here are price ranges to compare total cost of treatment for Dupuytren contracture for the basic medical procedures currently available, per hand involvement:

Open hand (release) surgery  $10,000-$16,000

Radiotherapy                            $6,000-$10,000 – one report on the internet of a $20,000 RT

Needle aponeurotomy             $700-1,000 per finger –one report of $3,000 cost at Mayo Clinic

Xiaflex injection                        $7,000-9,000 per finger

Because of the high costs for many forms of Dupuytren care in the U.S., a new industry has emerged which has been called medical tourism or vacation medical care.  In this scenario a patient from a high-cost country will travel to a lower-cost country to receive medical care.  While in that country the patient will often arrive days or weeks before the surgery to have a vacation there.  After the surgery is done and no complications or adverse reactions are evident the patient will return home.

Some host countries have a large and thriving medical tourism industry based on low cost lodging, food and recreation opportunities, and subsequently can also offer lower prices for what is reported to be the same or better surgical repair of Dupuytren contracture at lower fees, such as
In U.S. dollars

France                                   $   770
Poland                                   $1500
Romania                               $   455
Singapore                             $1600
Tunisia                                   $ 980

Cost of treatment for Dupuytren contracture using Alternative Medicine

While the ultimate Alternative Medicine cost to treat Dupuytren contracture is also dependent on the same variables as medical care, the cost for four months of non-drug and non-surgical care with a DCI based medium treatment plan would be $520.  Bear in mind that this form of treatment does not have any side effects, will not result in more contracted tissue, nerve damage or ruptured tendons, presents no possibility for infections, and does not require physical therapy rehabilitation.

Cost is not the only factor, but satisfaction after treatment based on safety and reduced complications.  These last issues are very important to also consider when assessing the cost of treatment for Dupuytren treatment.

Getting Started with Dupuytren’s Contracture Treatment

>> Dupuytren Contracture Treatment – FAQs

>> Testimonials from Dupuytren Contracture Institute


Why not have needle aponeurotomy and avoid all those vitamins?

Dr. Herazy,

Why should I fool around with all these vitamins and DMSO on my hand if I can just have needle aponeurotomy and get quick results and be done with my problem?  Your ideas seem like a lot of work.



Greetings Victoria,

Thank you for your very direct question.

Using the DCI treatment protocol can be work, but you should follow it anyway for a few good reasons.

1.  After having a needle aponeurotomy you are not necessarily “done” with your problem.  Needle aponeurotomy is not a cure for Dupuytren contracture, and after having your first one you could easily need another one – and perhaps another – in a just a short time; sometimes in as little as a year.  Dupuytren contracture is well known as a hand problem that recurs after correctional surgery, and the Dupuytren recurrence rate is the highest and fastest after needle aponeurotomy.

2.  Needle aponeurotomy is surgery, although it is a less complicated type of hand surgery.  Doctors who perform NA like to say it is a non-surgical treatment for Dupuytrens, but when you consider what is involved you will see it is indeed hand surgery.   A doctor must perform this procedure (your barber or butcher cannot do it), sterile technique must be used, cutting and laceration of internal tissue is done, bleeding takes place, bandages and post-surgical drugs are prescribed infection is possible – it is surgery.  The only thing missing is the scalpel, but the same kind of work is done with the tip of a hypodermic needle.   The selling of the idea of doing this kind of surgery is to make it seem like it is not surgery because all surgeries have complications and risks. Most thinking people will go out of their way to avoid the risks and complications of surgery.

3.  Many people have found that once they have their first hand surgery, their Dupuytren contracture is worse the second time it recurs (as they all eventually do) simply because of the scar tissue that develops after having any surgery.  It is my opinion it is a good idea to avoid getting on that surgical merry-go-round if it can be at all avoided.

4.  If you attempt to use natural Alternative Medicine as a Dupuytren treatment for a brief therapeutic trial to see how well your hand  responds, and you are not satisfied, you will still be able to have any kind of hand surgery that is appropriate for you. The opposite cannot be said:  Once you have any kind of surgery, there is no way to undo it.  Once you have been cut on, once scar tissue has developed, once your body has been surgically altered, there is no way to get back to normal.  Because surgery that is done to remove the scar tissue of past surgery often results in more scar tissue and even less normal tissue – it is much more difficult and less effective to later try to use natural Alternative Medicine methods to reduce your Dupuytren contracture.

Let me know if I can help you in any way to avoid hand surgery and to return your hand to full use.   TRH