Frequently Asked Questions
- What is an aponeurosis?
- It is a sheet of tissue in the palm of the hand just beneath the skin.
- In Dupuytrens disease, why do fingers curl?
- The aponeurosis thickens, often forming cords. If and when the cords attached to fingers shrink, the fingers pull upward and then toward the palm.
- Are those bands or cords that I see and feel in my palm tendons?
- No. They are part of the thickened aponeurosis. The tendons are deep to these prominent structures.
- What is an aponeurotomy?
- It’s is a division of the aponeurosis. More particularly, the cord that has formed in the aponeurosis.
- How does the aponeurotomy work?
- By making multiple perforations in a line through the aponeurosis, the aponeurosis weakens along that line This is much like the perforations in a piece of paper that permit easy tearing. Following the multiple penetrations and when the physician straightens the curled finger, the perforated aponeurosis lengthens or divides and separates thus ending the contracting force. This permits the finger to straighten freely on its own.
- When should I have an aponeurotomy?
- When there is either 1) a definite contracture present, or 2) there is an early sign of loss of motion of a finger, or 3) the condition, without seeing a contracture, is uncomfortable or painful. Although the aponeurotomy can be done at any stage, in general, the sooner the better. The delay recommended by those practicing open procedures, is no longer appropriate.
- Does an aponeurotomy hurt?
- No. There are no nerve endings in the aponeurosis. We anesthetize the skin over the aponeurosis by a small amount of Lidocaine. This permits the painless entry of a small needle we use to make the perforations.
- Are the fingers always straight after an Aponeurotomy?
- Not always. Correction following the aponeurotomy is usually at least 85-95%. The fingers not infrequently spring back to a slightly bent position because of a “capsular contraction.”
- What is a “capsular contraction?”
- Each finger joint is encased in a fibrous envelope called a capsule. When the fingers have been kept in a bent position for a long period, the capsule on the concave side shrinks or contracts. This is called a “capsular contraction.” Although it tends to return the finger to a bent position, it is separate from a Dupuytrens contracture and responds to stretching.
- Does the condition ever come back following an aponeurotomy?
- Yes. The recurrence rate is between 30-50% in five years. This is essentially the same as with open surgery. The aponeurotomy, or needle release, unlike open surgery can be accomplished without difficulty should a recurrence take place.
- Are there any complications associated with an aponeurotomy?
- Yes. The most common is a slight separation of the skin occurring in about one out of four patients. These skin separations generally heal spontaneously in 2-7 days. Nerve and tendon injuries are rare occurring in less than 1 in 2,000. These numbers are far less than with open surgery.
- How far in advance must I schedule?
- I can normally schedule patients within a 1-3 week period.
- Can the initial consultation and the procedure be done on the same day?
- Yes. The total time is usually between 50-90 minutes. If both hands require treatment, however, the procedures are done on sequential days. If you arrive from a distance and need housing, we have a special rate arrangement with a nearby Holiday Inn Express.
- Can my wife/husband/son/daughter/grandchild/friend watch the procedure?
- Yes.
- Can I go home the day of the procedure?
- Yes. It makes no difference whether you live in or have to fly/drive out of Florida.
- Will I be able to drive following the procedure?
- Yes. We do request, however, that the treated hand be kept higher than the heart for the remainder of the day following the procedure.
- How soon can I play golf?
- Probably on the day following the procedure. Assuming you know how to play.
- Will I need physical therapy?
- Probably not.
- Do I have to return for follow-up care?
- No. The follow-up is usually done by telephone.
- How much does the procedure cost?
- The initial consultation is $200.
The procedural is $500 per finger.
- Does insurance pay for the procedure?
- Yes. Although we do not accept any insurance, we are happy to file insurance for our patients. We accept cash, checks and credit cards (MC, VISA, AMEX) and payment is expected at the time of the procedure.
- Will I be happy following the procedure?
- Yes. Even after paying the bill. And you should be able to shake hands, wash your face, smooth your hair, pet your animal, hold a bar of soap, etc. etc. pretty much normally for the first time in years.