New Dupuytren Procedure Comes to the United States, Proves Promising to Dupuytren Patients - European procedure providing hope to Dupuytren Contracture patients reluctant to undergo surgery

In our last blog of the Dupuytren Series we discussed the effects of Dupuytren’s Disease and who is most often impacted. This blog is dedicated to the discussion of the promising new treatment for those who suffer from severe Dupuytren contractures that either continue to reoccur following conservative treatment or exceed acceptable degrees of contraction and severely limit hand function.

Traditionally, open surgery to remove Dupuytren nodules and release the contracted palmar fascia, generally at the base of the small and ring fingers, was the last resort measure taken by patients afflicted by severe Dupuytren Contractures. This type of surgery came with the same risks and lengthy recovery time associated with open surgery.

Today, an innovative new procedure first established in Europe is addressing these severe contractures less invasively. Known as the Percutaneous Needle Fasciotomy (PNF), or Needle Aponeurotomy (NA), this new procedure can address the contracture without cutting into the skin and disturbing surrounding soft tissue and nerves. This new minimally invasive surgical approach is an outpatient procedure and entails a local anesthetic and tiny needles.

Needles are applied to the affected areas, which are first identified with small marks. The needles are maneuvered in such a way that “punctures” the contracting tissue. The puncturing process weakens this contracting cord and initiates a breakdown. Fingers are freed from the contraction, allowing the hand to function normally.

Patients are then instructed on rehabilitative exercises in order to ensure full resumption of hand function.

The minimally invasive nature of the needle aponeurotomy procedure allows a faster recovery and more rapid return to activity. The risks associated with traditional open surgery are eliminated and patients report minimal pain following the procedure.

While this procedure is not available in every US city, Dr. Evan Collins is one of the few hand specialist who performs PNF.

Dupuytren’s Disease - A Little Known Condition that Can Dramatically Impact Quality of Life

One of a Two-Part Series

A little known, though common orthopedic condition affecting the hands and fingers, is called Dupuytren’s Disease. While conditions such as carpal tunnel syndrome, cubital tunnel syndrome, tennis elbow and other types of tendinopathic injuries and conditions are readily discussed, little is written on Dupuytren’s disease and the associated nodules and finger contractures that have the potential to dramatically impact hand function if left untreated.

This blog series will take a closer look at this particular condition and the exciting things that are changing treatment options available to chronic sufferers.

About Dupuytren’s DiseaseA progressive condition, Dupuytren’s disease causes the fibrous tissue of the Palmar Fascia in the hand to shorten and thicken, forming scar tissue or nodules. These nodules can grow together and form tight, restricting “cords,” which limits finger extension and results in contractures. Generally located in the palm at the base of the ring and little fingers, a Dupuytren’s Contracture can dramatically impact hand function.



While little is known about what prompts Dupuytren’s disease, it is believed to be a hereditary condition. It is also more frequently seen in men over the age of 40, those of Northern European descent and those who smoke, use alcohol or have diabetes.

While a small percentage of cases can be resolved conservatively, utilizing cortisone injections, heat ultrasound therapy and stretching exercises, those suffering from chronic contractures now have a less invasive option to traditional surgery - Percutaneous Needle Fasciotomy (PNF), or Needle Aponeurtomy (NA).

PNF is considered when Dupuytren contractures cause problems with hand function, either as a result of tightening or contracture of the cords affecting nearby digits, or if there is a fixed flexion contracture of the middle finger joint, known as the proximal interphalangeal (PIP) joint. The procedure is also considered when contracture of the metacarpophalangeal (MCP) joint reaches 30 degrees to 40 degrees.

Until recently, open surgery was the only option for patients suffering from severe Dupuytren contractures. Today, the needle aponeurotomy, first practiced with great success in Europe, is a minimally invasive surgical approach to addressing the contractures and restoring hand and finger function.

More on this procedure will be discussed in Part Two of our Dupuytren Series. Read more now onDupuytren’s Disease and PNF.

Effective and Innovative New Treatment Options for Tennis Elbow Sufferers

Several years ago a new high-energy shockwave treatment received FDA approval for the treatment of chronic tennis elbow nonresponsive to conservative treatment. This came after a period of clinical trials we performed. This outpatient shockwave therapy is an outpatient procedure known as OssaTron Treatment. Unfortunately, few insurance companies include the treatment in their plan and limited OssaTron facilities make it more difficult to arrange than other treatments proving just as effective.

Most recently, autologous blood injections for the treatment of refractory lateral epicondylitis was introduced and is proving a very effective, less invasive treatment option for chronic tennis elbow. The injection provides the necessary cellular and humoral mediators to promote healing.

The autologous blood is drawn from the dorsal vein of the hand and injected along the supracondylar ridge, into the undersurface of the extensor carpi radialis.

Chronic tennis elbow sufferers remaining symptomatic despite less invasive treatment programs may require a Lateral Epicondyle Release, an outpatient procedure designed to relieve the tension from the extensor tendon at the elbow joint.

Tennis Elbow, A Condition Affecting More than Those on the Court

Tennis elbow, or lateral epicondylitis, is one of the most common upper extremity conditions seen in orthopedics today. It is a common tendinopathy classified as an overuse or overstress condition and can be the result of a repetitive activity fatiguing the hand, wrist, forearm or elbow.

The fatigue and stress creates an inflammation that grows increasingly worse over time.

There are over nine million reported cases of tennis elbow in the United States alone every year, though most of those diagnosed with Tennis Elbow have never played tennis. While tennis is the sport for which the condition is named, affecting approximately five in 10 recreational and professional tennis players, the most prominent profile of a tennis elbow patient is the average man and woman between the ages of 40 and 60 – performing everyday activities. A smaller percentage of those diagnosed with tennis elbow, approximately 10 to 20 percent, are those sustaining severe injury resulting from a fall or direct hit to the area.

Tennis elbow actually causes the tendons around the elbow to become inflamed and results in pain at the outside, or lateral side, of the elbow – as opposed to the inside, or medial side, of the elbow associated with a condition known as Golfer’s Elbow, or medial epicondylitis.

Tennis elbow often occurs in the dominant arm. If left untreated, the affected tendon can tear and cause scar tissue to develop. Those suffering from the condition may experience moderate to debilitating pain as the tendon becomes increasingly weaker over time.

Some of the common symptoms of tennis elbow include:
•  Pain along the outside of the elbow of the dominant arm – radiating or traveling into the forearm and possibly the hand.
•  Pain and subsequent weakness with reaching or grabbing activities.