Hello mjq,
It appears that this procedure, 'needle aponeurotomy', also called
'needle fasciotomy' is not well accepted by the medical community in
the US- yet. For this reason, there are few hand surgeons performing
this procedure. (It has been said that it is not readily performed in
the US because it is so much less expensive? cutting into profits).
Side effects are ruptured tendons, nerve damage, and infection.
Recurrence is common, 50% of the time, and occurs at 3-5 years,
depending on the patient. Page 4 of this document from the National
Institute for Clinical Excellence, UK, illustrates safety and
efficacy ratings of this procedure.
?Validity and generalisability of the studies (Of Needle Aponeurotomy)
? In general the studies are of poor methodological quality. Little
information was reported on factors such as patient characteristics,
selection and measurement of outcomes.
? In a number of papers the severity of the condition in study
participants was unclear, and one paper excluded from the analysis
those patients who initially did not have a successful outcome.
? While recurrence rates after the procedure ranged from 11% to 65%.
These rates should be interpreted with some caution, given the
different populations and time points in which they were measured.
? Considerable loss to follow up was reported in the Badois and
co-workers (1993) paper. It is unclear whether there was similar loss
to follow up in the results of the 1995 study. It is also unclear what
impact this loss to follow up might have on re-operation and/or
recurrence rates.
? The papers by Foucher and co-workers (2001a, b), although separate
reviews, do include a subset of the same patients. This is also the
case for the results reported by Badois and co-workers (1993).
? A considerable amount of literature on this procedure is published
in French. This literature does not include comparative information;
instead most of the studies seem to be case-series papers.
In general, papers reported on a limited number of outcomes and it was
often unclear at what time point outcomes were measured. The number of
hands was frequently used as a denominator to measure outcomes.
Specialist Advisors? opinions
? The procedure is established practice.
? Less than 10% of specialists are engaged in this area of work.
? This procedure has been used in Europe for many years. Many surgeons
in Britain perform it in the palm, but significantly fewer in the
fingers.
? Surgeons with appropriate training should undertake the procedure.
? Media coverage about this procedure has perhaps been misleading.?
http://www.nice.org.uk/pdf/ip/177overview.pdf
http://www.dupuytren.org/wwwboard/messages/825.html
?Collagenase percutaneous needle fasciotomy is currently undergoing
clinical trials.?
http://www.emedicine.com/orthoped/topic81.htm
Aponeurotomy is the same as ?Fasciotomy?. Fasciotomy is the ?cutting
but not removing the fascia. This refers to cutting across tight bands
of fascia, letting the edges gape apart and heal back at or closer to
their natural length to restore the area's original flexibility.?
http://www.handcenter.org/newfile25.htm#Fasciotomy
?A variation of surgery is a minimally invasive procedure referred to
as a Needle Aponeurotomy. In this procedure, the abnormal tissue is
weakened using a small needle in the palm. Needle Aponeurotomy is most
effective for disease in the palm of the hand, but can be used in
certain cases of finger contractures.?
http://www.eatonhand.com/hw/hw009.htm
http://www.eatonhand.com/thr/thr027.htm
From the Hand Center, in Jupiter, Florida:
?Needle Aponevrotomy (Needle Aponeurotomy or NA) is a minimally
invasive treatment for Dupuytren's contracture. In contrast to
surgical treatment, which requires several months of recovery, Needle
Aponeurotomy allows a more rapid recovery. In most cases, it is
possible to return to near normal activities without bandages within a
few days of treatment.?
http://www.handcenter.org/newfile16.htm
I have located two highly probable locations, the Cleveland Clinic,
and a surgeon in Stony Brook, NY who may be able to accomodate you.
The contact information is found below:
Department of Orthopaedics, Health Science Center, State University of
New York at Stony Brook, USA
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10050246&dopt=Citation
It appears that Dr. Lawrence Hurst may be performing needle
aponeurotomies, as he is one of the authors of the above article.
http://www.uhmc.sunysb.edu/ortho/
LAWRENCE HURST MD.
ORTHOPAEDICS,
14 TECHNOLOGY DRIVE,
EAST SETAUKET, NY 11733.
Ph.: 631-444-4230
Fax: 631-444-4217
http://www.upsb.org/html_patient/physician.asp?code=701
Cleveland Clinic
Cleveland Clinic Foundation Research Institute
9500 Euclid Avenue,
Cleveland, OH 44195
?If you want to learn more about Cleveland Clinic treatment options or
make an appointment, contact the appointment line at 216/444-HAND or
toll free at 800/223-2273 (CCF-CARE) ext. 42606, Monday through
Friday, 8:00 a.m. to 5:00 p.m. (Eastern Standard Time).? Try calling
the Cleveland Clinic and inquire about needle aponeurotomy surgery.
This hospital would be a good bet at this not often performed (In the
US) procedure.
?Cleveland Clinic orthopaedic surgeons and biomedical engineers have a
unique opportunity to participate in a broad array of research
projects through the Orthopaedic Research Center. This collaborative
effort by clinicians in the Department of Orthopaedic Surgery and
scientists in the Cleveland Clinic Lerner Research Institute involves
more than 30 principal investigators ? many of them international
leaders in their field.
Currently, 100 peer-reviewed basic research studies and clinical
trials are being conducted at The Cleveland Clinic to better
understand, prevent and treat musculoskeletal disorders. Clinic
orthopaedic clinician-scientists seek to improve the outcome of joint
replacement and other orthopaedic procedures to enhance the quality of
life for patients.?
http://cms.clevelandclinic.org/ortho/body.cfm?id=45
Additional Information
http://www.dupuytren.org/wwwboard/messages/825.html
You may find my colleague tehuti-ga's answer on contracture's useful
http://answers.google.com/answers/threadview?id=219040
I hope this information proved useful. If anything is unclear, please
request an Answer Clarification, before rating. this will enable me to
assist you further, if possible.
Regards,
crabcakes
Search Terms
needle fasciotomy + dupuytren's contractures
needle aponeurotomy |
