An Alternative to Surgery for Dupuytren's Contracture

Needle Aponevrotomy (NA)
Also Known as Needle Aponeurotomy (NA)
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We want to share an experience that deals with Americans' taking charge of their healthcare and also the awesome capability of search engines.

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Our head Webmaster has Dupuytren's Contracture. This is an inherited condition that causes the fingers to contract into the palm on one or both hands. It most commonly affects adult males of northern European heritage particularly those of Scottish descent.

The condition can start around age 50 to 60 and sometimes earlier. Dupuytren's Contracture shows first as what looks like a callus in the palm of the hand. This is actually a nodule that is developing. The nodule increases in size and then stops growing but then a series of cords develop in the palm in an area called the palmar fascia. The cords thicken and most commonly contracts the pinkie and/or ring finger into the palm of the hand. The contracture is often only pulling the pinkie in at the joints but in the process also causes the ring finger and other fingers to contract into the palm of the hand. Left untreated Dupuytren's Contracture can cripple the use of the hand and fingers.

The condition can occur in both hands but at different rates of progression. For our Webmaster who is right handed, he had the first nodule in the palm of his left hand and was diagnosed in 1995. The contracture developed very slowly in his left hand up. However, his right hand developed a nodule in the palm in 2001 and progressed rapidly to a contracted position that left his pinkie and ring finger almost totally pulled into the palm of his right hand.

To complicate matters, the Dupuytren's Contracture had become a preexisting health condition as his family changed health policies over an 11 year period. They literally could not afford to keep health insurance that covered Dupuytren's Contracture so they gave it up as a pre-existing condition so they could afford health insurance.

As time passed it eventually became critical to have the Webmaster's hands corrected and the family was in the process of arranging for paying "Cash" for the traditional surgical procedure that most hand surgeons recommend for Dupuytren's Contracture. The family negotiated cash discounts with the surgeon, anesthesiologist and the hospital. With all the discounts in place they were still facing a $6,000 to $8,000 bill to repair one hand. The Webmaster was also concerned about healing and rehabilitation, which was estimated to be 6 to 8 weeks with this surgical solution.

They were ready to pick a date for the surgical procedure for December 2006 and at the last minute and in utter frustration at the costs they were facing, the Webmaster's wife decided to "google" "Dupuytren's Contracture". She could not believe her eyes when she ran across a term called "Needle Aponevrotomy (NA)" that was supposed to be a much less invasive solution for "Dupuytren's Contracture". As an aside, the only listings for "Needle Aponevrotomy (NA)" under "Dupuytren's Contracture" were paid sponsored listings as the doctors offering the procedures did not have websites that were being picked up in the free search engines of

When she finished her research she found five offices across the United States offering Needle Aponevrotomy (NA). She proceeded to call each office and interview the doctors for her husband. The Webmaster settled on Dr. Kline and his Dupuytren's Center in Ontario, Oregon. Part of the decision to choose Dr. Kline was because he also has Dupuytren's Contracture.

Dr. Kline at that time was located in Ontario, Oregon and his office was a 45 minute drive from Boise, Idaho. It was quite simple to fly to Boise, rent a car and drive to Ontario, Oregon. Also Dr. Kline had arranged for special hotel rates at the new Holiday Inn in Ontario, Oregon for patients wanting to stay overnight.

The Webmaster had his procedure on Thursday, December 7, 2006 and compared to the traditional surgical treatment it was amazing. First of all, only local anesthetic was needed. Avoiding general anesthesia was a cost savings and also contributes to a quicker recovery. In layman's terms, a Needle Aponevrotomy (NA) involves a series of needles inserted into the hand with local anesthetic and the tips of the needles are used to cut the cords that are contracting the fingers. The doctor worked slowly up the affected finger cutting the cords and manipulating the finger to a non-contracted position.

For our Webmaster the procedure was 2 hours for both hands. Normally Dr. Kline does not like to do both hands at once but because the family came from such a distance and both hands were in such need, he made an exception.

During the procedure the Webmaster was fully awake and talking to the doctor. They found they shared a common interest in geology. When the procedure was finished the doctor applied antibiotic ointment and a minimal bandage dressing over both hands. Basic instructions were to keep the hands elevated for the first 12 hours and limit lifting for 14 days. The Webmaster was given a prescription for antibiotics as a precaution for the small punctures and skin tears from straightening the fingers.

View the before and after photos below to see the differences:

The Webmaster's Left Hand

Before the Procedure
Note how the hand cannot lay flat
photo before surgery
21 days after procedure
Note how the palm can now be flattened
photo after surgery

The Webmaster's Right Hand

Note that this hand had very advanced Dupuytren's Contracture on the pinkie

Before the Procedure
Note the extreme contraction
photo before surgery
21 days after procedure
Note how the palm can almost be flattened*
photo after surgery

*Note that our webmaster's Right Hand was very advanced in contraction. The Needle Aponevrotomy (NA) released the contracture but he will need to splint the finger at night for three months and do simple hand exercises to help the finger straighten. This hand should have had the Needle Aponevrotomy (NA) at least a year ago.

Here is a photograph of our Webmaster 1 hour after the procedure. He reported that the pain was really just discomfort which was managed with over the counter pain medicine. The most difficult task was to remember to keep his hands elevated above his heart for the first 12 hours.
photo of both hands

Note 21 days later both hands are entirely healed and there are no large surgical scars on the palms.

photo of left hand after 21 days photo of right hand after 21 days

Learn more about Dupuytren's Contracture by visiting Dr. Kline's website:

Dr. Kline is located at:

Dupuytren's Center Idaho
750 Warm Springs Avenue, Suite A *
Boise, Idaho 83712

Dupuytren's Center Oregon
9370 SW Greenburg Rd Suite A
Portland, Oregon 97223

*IMPORTANT NOTE: Although our address is officially Warm Springs Avenue, our 750 building and parking lot are actually located around the block off of Bannock Street. We are directly behind the big old orphanage building on Warm Springs Avenue that has 'Children's Home' engraved on the front. Drive around the block to the parking lot for building 750, enter the door into a small lobby, and 'Suite A' is right across the hallway.

If you contact Dr. Kline, tell him you found him on

If you know someone with Dupuytren's Contracture send them a link to this web page:

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Other websites about Dupuytren's Contracture:

Important note:
The information and material on this web site does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.