Protocol

Firstly I would recommend that you go and see your GP.  We cannot see you in this country without a referral from your GP.

However it is a bit unfair to expect them to have heard of Needle Aponeurotomy so please do take a copy of some of the pages of this website or a note of the web address.  They should then send me a referral letter at one of the two addresses here depending on whether you want to be seen privately or on the NHS.

 

The next thing to do is to send me some photographs of your hand and to fill in the form regarding your general health (if you are unsure, your GP may fill it in for you). Please be aware when sending photographs that most digital cameras produce files which are far too big, please therefore see here before sending the pictures. If I think that you are suitable for NA I will then either email you or write to you with some more details of the procedure and the list of complications, etc.  We will also organise a price for you.  If you are insured then this will be covered by your insurer (however please see here).

 

Information you need

This page will link you to further information regarding Needle Aponeurotomy, the consent form, etc.  You must read this as it tells you what you must bring with you.

 

Organising a date

The next step is to arrange the date.  At the moment all private NA procedures are performed on a Tuesday evening.  We recommend that you plan to stay in the Derby area for the night so that if there is a complication we can see you the following morning and deal with any problems.  We also feel that driving any distance after the treatment is likely to raise your blood pressure and lead to an increased risk of complications.

At the appointment we will examine your hand to chart the extent of the disease, the presence of any scars and the range of motion of your hand.  We will then ask you to sign a consent form and answer any questions you may have.

The procedure is undertaken in a relaxed office environment and typically takes 15-20 minutes (the assessment often takes longer!).

After maximal extension has been achieved some small elastoplasts will be applied and you will be taken through to see the occupational therapist.

The occupational therapist will advise you on some range of motion and stretching exercises we like you to do and then make a splint for you.

Whilst you are awake you can remember to stretch your fingers but when asleep they will tend to return to the "remembered" position which will be with the fingers bent.  The aim of the splint is to prevent this happening and to stretch any early recurrence to prevent a new contracture.

The initial preoperative picture with contractures of the ring finger and mild contractures of the index and middle

 

Injecting the local anaesthetic, we use approximately 0.1ml of Lignocaine.

Using the needle to section the band in the ring finger

After the first sectioning.  There will be another two or three punctures in the ring finger to complete the process but none of the wounds will be larger than this.

The final picture.  There was some joint contracture in the ring finger which will improve with the splint.  No physiotherapy was required and the patient could return to all activities the following day.