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Needle fasciotomy
Needle fasciotomy, also called needle aponeurotomy, is a minimally invasive procedure for Dupuytren’s contracture.
Dr Jill Tomlinson is one of a handful of surgeons in Australia who regularly perform it.
It is usually done in our consulting rooms under local anaesthetic, without the need for hospital admission or sedation.
At a glance
Anaesthetic
Local anaesthetic, wide awake. Rarely performed in hospital with sedation.
Where
Melbourne Hand Surgery - our Consulting Rooms in Richmond
Admission type
This is an outpatient procedure. Plan to be at our Richmond rooms for approximately 90 minutes for your visit.
First post operative review
Approximately two weeks after surgery
Driving
Once the local anaesthetic wears off and you feel comfortable to grip the steering wheel. You cannot personally drive home from your procedure appointment, so please arrange for someone to collect you.
Post Operative Hand Therapy
Required
Splinting
Yes - worn at night for three months. Worn during the day time as possible during the first two weeks.
Pain relief
Paracetamol and/or ibuprofen as required, generally minimal needed.
Return to repetitive & heavy loading
As tolerated
What is needle fasciotomy?
Needle fasciotomy or needle aponeurotomy is a procedure where the contracted Dupuytren’s tissue (called the “aponeurosis” or the “fascia”) is divided at multiple points so that your finger can stretch out straight again. The procedure is performed with a needle through the skin, and the sharp, small bevel of the needle is used to cut the Dupuytren’s tissue beneath the skin.
To read about the condition itself, see our Dupuytren’s disease page.
Who is needle fasciotomy suitable for?
- individuals whose Dupuytren's contracture is affecting their hand function
- individuals with mild, moderate and severe contractures
- individuals who have had previous aponeurotomy
- sometimes but not always: individuals who have had previous open surgery for their Dupuytren's contracture
Needle fasciotomy is not a “lesser” treatment for Dupuytren’s contracture than open surgery. When understanding where the two treatment options sit it is important to understand that there is a spectrum of severity of Dupuytren’s contracture. Severity is not measured by the degree of the contracture, although that plays a role. Severity relates to how extensive the fascial thickenings are, and how aggressive the contractures are. Typically, someone who has severe Dupuytren’s contracture will have
- more than three fingers involved, likely both hands and perhaps the thumb involved in addition to other fingers
- earlier onset of disease (eg in their 30s or 40s)
- more aggressive biology with faster recurrence
- a greater number of fascial cords per finger, which means the cords often feel like one big lump rather than a single defined, narrow line.
Individuals who have severe Dupuytren’s contracture are in the minority. Needle fasciotomy can be performed on individuals who have severe Dupuytren’s contracture, but their extensive disease is likely to warrant open surgery with skin grafting at some point. Individuals who have Dupuytren’s contracture but whose disease pattern is not extensive or aggressive can avoid open surgery by having needle fasciotomy, and may never require open surgery.
Needle fasciotomy can be performed on the same area multiple times over a lifetime. Because the procedure produces minimal scar tissue, there is a lower cumulative risk of injury to nerves and arteries with repeat procedures than with open surgery.
Dr Tomlinson most commonly performs needle fasciotomy in the consulting room under local anaesthetic. A nurse is present for all consulting room procedures. If you are anxious about medical procedures or needles, you can choose to have the procedure performed under sedation in a hospital.
Dr Tomlinson has performed needle fasciotomy in the setting of previous axillary lymph node dissection for breast cancer without encountering the problem of lymphoedema.
How does it work?
Have you ever seen a sewing tool for unpicking a hem? The needle is used a little bit like that tool. The Dupuytren’s contracture is sequentially “unpicked” at multiple points. Then your joints are stretched out, both by Dr Tomlinson during the procedure and by you afterwards, through a series of exercises and by wearing a splint at night that holds the joints out straight. Stretching, exercises and extension splinting during the recovery phase are important to gain maximum benefit from the procedure.
We also administer a corticosteroid injection to the treatment area at the time of the procedure, as research shows that this improves results. It also helps to soften tough nodules of fibrous tissue.
What we discuss at your initial consultation
At your consultation Dr Tomlinson will assess you and your hands, determine your suitability for needle fasciotomy, discuss the procedure and answer any questions you have.
Handouts given to you at the consultation are the post procedure care instructions, a flow chart outlining the stages of the treatment process, the procedure consent form, and a fee estimate. Dr Tomlinson will discuss the procedure, consent, post procedure care and flow chart with you. Our administrative staff will discuss the fee estimate and scheduling options with you.
How we do the procedure
After Dr Tomlinson’s nurse takes pre-procedure photographs, Dr Tomlinson will measure your joint contractures and you will be asked to recline on the procedure couch in our consulting room. Your hand will be cleaned with an antiseptic wash and local anaesthetic injections will be administered to the treatment area over your palm or fingers. During the procedure most individuals talk with Dr Tomlinson and her nurse.
After the initial local anaesthetic injections have been administered, the remainder of the procedure is generally comfortable. Once Dr Tomlinson has sequentially divided the tight cords, she will stretch out your hand and fingers in a controlled manner. If you have a moderate or severe contracture this can be uncomfortable. If the stretching discomfort is significant, Dr Tomlinson will offer a short acting injection to numb the deeper parts of the hand and fingers for the stretching. This is routine for severe contractures and when the contracture involves the PIP joint in the finger.
In our experience, strong painkillers are not required before or after the procedure. If you do not wish to be awake for the procedure, you can choose to have it performed in a hospital operating theatre with an anaesthetist.
Alternatives to surgery
Needle fasciotomy is itself a minimally invasive alternative to open surgery for Dupuytren’s contracture. Depending on your situation, other options may include:
- Observation: a contracture that is mild or not progressing can safely be left alone and monitored over time.
- Open surgery (fasciectomy): for more severe, recurrent, or complex contractures where needle fasciotomy is not suitable, open surgical removal of the diseased tissue may be recommended instead.
Dr Tomlinson will discuss which options suit your specific situation at your consultation, and advise you of her recommendation for your hand.
Aftercare
While many of our patients report returning to work or household tasks on the day of the procedure, we suggest you plan to take it easy for 2 days. During that time you are strongly advised not to clean your toilet or perform other “dirty” tasks. Wear a plastic glove for any activity where your treated hand is likely to be exposed to problematic bacteria. Typical activities to avoid during this time include gardening, changing nappies and toilet cleaning. Applying a cold pack, or a bag of frozen peas, regularly while you are awake during the first 2 days can further reduce swelling and discomfort. Do not plan to perform activities that require strong gripping for at least 7 days, including golf and tennis, because doing so is likely to be uncomfortable. However, while it is likely to be uncomfortable it is not dangerous for you to do so. If you can, wear the extension splint on your hand during the day and night for the first two weeks for optimal results, although you can remove the splint for necessary activities. The splint is not for protection or to restrict you, it is to keep the fascial fibres held out at length to optimise the outcome of the procedure.
The input of a hand therapist is very important after the procedure. The techniques we recommend include extension splinting, extension exercises, stretches and massage. You will see a hand therapist immediately after your needle fasciotomy. At that appointment you will be given exercises and have a custom-made extension splint fitted to hold your hand in the new extended position. You must wear the splint at night for 3 months after the needle fasciotomy.
If you have a contracture of your finger joints, Dr Tomlinson recommends you also obtain a splint to wear during the day for the first 3 months at times when it is convenient, as this increases the amount of sustained stretching and optimises the result. When it is not convenient to wear the finger splint you can keep it in your pocket and put it on when your activities permit. The finger joints (the proximal interphalangeal joints) are configured in a way that means they do not stretch out as quickly or easily as the knuckle joints (the metacarpophalangeal joints). Stretching and splinting is vital to obtain maximal improvement of these contractures.
You will also be advised to perform extension exercises, steadying your treatment hand with your other hand and repetitively straightening each treated joint. It is good to get into the habit of placing your hand flat on a solid surface when you sit down, or pressing your treated fingers on the edge of a table to stretch them backwards.
Massaging the treatment area helps to soften Dupuytren’s tissue and improve healing. Massage can begin 2 days after treatment and should be as firm as possible without causing discomfort. It is usually done with the thumb of the opposite hand and is easier and more effective with a moisturising cream or oil to reduce friction.
We arrange your initial hand therapy appointment for you so that you will be fitted with a splint immediately after your procedure. If you have private health insurance extras cover, check with your insurer about your hand therapy rebate. If you do not have extras cover, ask your GP about a Chronic Disease Management Plan, which may allow Medicare rebates on up to five allied health (including physiotherapy and occupational therapy) visits.
Recovery and post-procedure reviews
Following the procedure Dr Tomlinson will usually see you at 2 weeks, 6 weeks and 12 weeks to assess your progress and provide advice. However, these reviews are not mandatory and there are individual factors that assist Dr Tomlinson in determining prior to the procedure whether you are likely to have a straightforward post procedural course where the review appointments are of lesser importance, or a post procedural course where the likelihood of joint swelling, joint stiffness and secondary contractures are likely to benefit from active management to optimise your outcome.
Your needle fasciotomy patient appointment and aftercare pack
At your needle fasciotomy consultation, we give you our full patient information pack covering the treatment pathway, the procedure consent form, and detailed instructions for the weeks after your procedure. You’re welcome to read it in advance.
- The treatment pathway, including what happens on the day and your follow-up visits at 2, 6 and 12 weeks
- The procedure consent form, including the risks of needle fasciotomy
- Instructions for the first two weeks after your procedure, including dressings, pain relief and keeping your hand clean
- The recommended splinting schedule for your hand and fingers, from the first two weeks through to three months
- Information on having your procedure in hospital using private health insurance, including current Medicare rebate figures
Watch: Dupuytren's information video
A realistic guide to your result
This page explains the procedure. The download goes into
- what shapes your outcome
- why results differ by joint
- what a Boutonnière deformity changes
- the splinting routine that optimises the result
Frequently Asked Questions
Why would someone have needle fasciotomy rather than open surgery?
Needle fasciotomy does not involve incisions to the skin of the hand, so there is less tissue damage, less swelling, less pain, less down time and quicker healing. It does not require a hospital admission or sedation.
Doesn't the contracture recur faster after needle fasciotomy than open surgery?
Studies show that open surgery gives a longer lasting result than needle fasciotomy. However, neither treatment cures Dupuytren’s disease. We commonly treat patients whose contracture has recurred after open surgery, or who say that open surgery did not work on their hand. The feedback from these patients is that, having had both procedures performed, they much prefer needle fasciotomy.
How come my GP doesn't know about needle fasciotomy?
It has traditionally not been widely offered in Australia and many surgeons do not perform it, so many general practitioners have not come across it. This is in no way a reflection on the knowledge of your general practitioner.
Why isn't needle fasciotomy widely offered in Australia?
We don’t know, but we do know that patients travel from across (and beyond) Australia for the treatment, and that patients were previously travelling to France or the US to access it. We are pleased to offer it and pleased with the results and patient satisfaction we obtain.
I live interstate, do I have to return to Melbourne for follow up?
If you are travelling from country Victoria or interstate, we can make alternative arrangements for your follow up. We ask that you provide contact details for a local hand therapist and/or your GP so that we can communicate with them about your treatment and follow up.
Experience demonstrates that if you are linked in with a hand therapist prior to your procedure that you are more likely to receive appropriate hand therapy care post operatively. Planning ahead is important: we do not recommend starting to try to find a local hand therapist after your procedure has been performed.
Where will my procedure be done?
At Melbourne Hand Surgery, procedures are performed either in our consulting rooms under local anaesthetic, or at The Avenue Hospital. The vast majority of individuals choose to have their needle fasciotomy performed under local anaesthetic at our Richmond rooms. For some procedures you can choose between the two: in the rooms under local anaesthetic, or at The Avenue Hospital with sedation or a general anaesthetic. You can also choose to have your procedure at the hospital under local anaesthetic alone if you’d prefer the hospital setting. Please note that sedation and general anaesthetic are only available in hospital – they cannot be provided in the consulting rooms.
How much time will I need to have away from work?
This depends on what your job involves. If your work is desk-based or administrative, you may be able to return within days, often with some temporary modifications, but it is desirable that you wear the hand based splint during the day for two weeks which does create some limitations. If your work is physical – heavy lifting, manual labour or “on tools” – you’ll usually need longer, but while it may be uncomfortable to load or apply a twisting force to the skin of the hand there are no specific loading restrictions or dangers associated with hand use. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: you must not drive home from the appointment.
When can I do a full day of administrative or desk work?
When it is comfortable for you to do so. This may be within days of your procedure, although we do recommend that you wear a hand based splint on the treated hand during the day for two weeks after the procedure.
How long will I need to wear a splint?
Splinting recommendations are individualised to the pattern and severity of contracture, and various hand and patient related factors. Generally, a hand based night splint (ie a splint that covers a portion of the hand and fingers and is worn in the evening and overnight) is worn for 3 months. We recommend that the hand based splint be worn during the day during the first two weeks. If the PIP joint is involved in the contracture then a finger based splint for day time use is made at around the two week stage and worn intermittently during the day time for up to twelve months.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
Yes — hand therapy is an important part of optimising your outcomes from this procedure.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Most individuals do not need to take regular pain relief medication in the days after the procedure.
Where can I learn more about needle fasciotomy?
For more detailed information, US hand surgeon Dr Charles Eaton has written a document, “Needle Aponeurotomy Terminology and Methodology”.
What will my procedure cost if I choose to have it done in hospital using my private health insurance?
Needle fasciotomy procedures are routinely performed in our consulting rooms. Some patients choose to have the procedure done in hospital instead, either because they want sedation, because it is combined with another in-hospital procedure, or to claim a private health insurance rebate.
There is no facility fee charged by Melbourne Hand Surgery when your procedure is performed in hospital, since we do not supply the procedure equipment and staffing there. However, you may need to pay a hospital excess, and other financial factors apply.
As an example, for item number 46370: the Medicare scheduled fee is $153.15 (correct as at 31 July 2026), Medicare covers 75% of this ($114.90), and your private health fund is required to contribute at least 25% above the Medicare fee ($38.29). Your actual out-of-pocket cost depends on your health fund’s rebate for this item, your policy excess, the number of fingers treated, the rooms facility fee you avoid by choosing hospital, and whether you have reached the Medicare Safety Net for the calendar year. You can check the current Medicare scheduled fee for item 46370 on MBS Online, and read about the Medicare Safety Net on the Services Australia website.
Ask your health fund: am I covered for hospital admission for item 46370? What is my excess? What rebate will I receive from you for this item? Our administrative staff can help you weigh this up against having your procedure done in our rooms.
Risks & complications
Risks of needle fasciotomy
The risks of needle fasciotomy are:
- allergy to the local anaesthetic, antiseptic preparation or tapes
- injury to nerves
- injury to arteries
- injury to tendons
- injury to bones (fracture)
- failure to improve the contracture to the degree desired
- early recurrence of joint or skin contracture
- infection of the soft tissues or joints
- injury to the skin (tearing) at the time of the procedure
- the development of complex regional pain syndrome
- the development of an epidermal (“sebaceous”) or pilar cyst at the site of treatment
- temporary joint swelling and discomfort
The most commonly seen problem is skin tears, which affect individuals who have moderate and severe contractures with skin shortage. These are relatively predictable and Dr Tomlinson will advise you at your first consultation if you are likely to experience this. If it occurs, we provide bandaids to apply daily to the site, and the skin steadily heals.
Anaesthetic
In the uncommon event that you are having sedation or a general anaesthetic for this procedure, your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bruising and swelling. Local anaesthetic usually lasts 1-2 hours.
First week
Take the dressings off the following day, wash your hand normally. Each time you remove your splint please flex and extend your fingers to keep them mobile. There are no specific hand restrictions, do what is comfortable for you. Try to wear the splint as much as possible during the day, but also remove it 10-15 times a day to do what you need to do. Wear it at night for three months.
Second week
Bruising and swelling will be settling. Use your hand wherever it is comfortable to do so. Finger joints that had a contracture treated may still be swollen and a little uncomfortable. If you had a finger joint (PIP joint) treated then when you see your hand therapist you will be fitted with a finger based splint for intermittent day time use.
6 weeks
You should be able to make a full fist and use your hand normally. Occasionally there will still be mild areas of discomfort with strong hand use and pressure. You will have noticed that your hand is stiff in the morning when you first remove your splint, and this will persist for another six weeks.
3 months
You may cease wearing your hand based splint at night. Any splint related stiffness will then resolve. There is no evidence for ongoing splint use as a means to prevent Dupuytren's contracture recurrence. The splint simply aims to optimise your outcome (achieve the greatest degree of extension) from the procedure.
Long term
Your Dupuytren's contracture is expected to recur.
Recommended splinting protocol
The splinting regimen depends on whether a proximal interphalangeal (PIP) finger joint was treated. Your hand therapist will confirm which schedule applies to you.
Splinting without PIP joint involvement
Period | Day | Night |
|---|---|---|
0-2 weeks | Hand-based splint at all times, except when removed for range-of-movement exercises, stretching and hygiene | Hand-based splint at all times |
2-12 weeks | No daytime splint required, except in special circumstances | Hand-based splint at all times |
After 3 months | No daytime splint indicated | Cease hand-based splint if preferred |
Splinting with PIP joint involvement
Period | Day | Night |
|---|---|---|
0-2 weeks | Hand-based splint at all times, except when removed for range-of-movement exercises, stretching and hygiene | Hand-based splint at all times |
2-12 weeks | Finger-based PIP joint splint, worn as much as practical during the day | Hand-based splint at all times |
After 3 months | Finger-based PIP joint splint can be weaned; if no additional flexion occurs it can be stopped. Some patients benefit from continuing intermittent use until 12 months if ligaments or tendons are particularly tight. | Cease hand-based splint if preferred and there is no significant loss of position on doing so |
Want to know more about needle fasciotomy?
Contact us to schedule an appointment with Dr Tomlinson.
Gallery
The following images are of patients treated at Melbourne Hand Surgery with needle fasciotomy who consented to have their images posted on this website. They include patients who have previously had open surgery for Dupuytren’s, patients who have previously had needle fasciotomy, and patients who have not had previous treatment for Dupuytren’s.
