Name:
How to Perform a Needle Aponeurotomy for Dupuytren's Contracture
Description:
How to Perform a Needle Aponeurotomy for Dupuytren's Contracture
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Duration:
T00H03M37S
Embed URL:
https://stream.cadmore.media/player/6ba5d2f7-6355-4f94-9152-e49aebd7cd12
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/6ba5d2f7-6355-4f94-9152-e49aebd7cd12/v-005475.mp4?sv=2019-02-02&sr=c&sig=9eEypPsn1aklbLjgpKw8wAvJObbJzfWzhJke5APKMG4%3D&st=2024-11-21T16%3A26%3A15Z&se=2024-11-21T18%3A31%3A15Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
YIBO TERESA LI: Today we will be demonstrating how to perform a needle aponeurotomy for Dupuytren's contracture. This may be performed in an office or clinic setting. You will require towels, gauze, a chlorhexidine stick and alcohol wipes, 1% lidocaine with epinephrine and methylprednisolone, a 25 gauge needle on a 10 mil syringe, an 18 gauge needle and dressings.
YIBO TERESA LI: Use the 10 mil syringe to draw up nine Mils of lidocaine and one mil of methylprednisolone, equivalent to 20mg. Before starting the procedure, examine the affected digits visually to assess the degree of contracture and by palpation to localize the cords to be treated. Our patient today has a 45 degree flexion contracture of the MP joint. We will not be focusing on the PIP joint today, which is contracted secondary to osteoarthritis.
YIBO TERESA LI: After obtaining informed consent and re verifying any allergies, begin by cleaning the affected area with alcohol swabs. Next infiltrate aliquots of 0.1 to 0.5 mils of the lidocaine and methylprednisolone mixture superficially along the length of the cords in the palm to be treated from proximal to distal. Place a rolled up green towel underneath the hand to accentuate the cords.
YIBO TERESA LI: Prep the hand and wrist. Uncap your 18 gauge needle and hold it in your dominant hand with the bevel facing upwards. Hold the needle between your thumb and index finger. Use your long finger to support the needle just proximal to its bevel. This will limit the depth you can insert the needle.
YIBO TERESA LI: It should go no deeper than the bevel to prevent injuring the flexor tendon. This is especially important while learning the technique. Tension the cord by applying pressure onto the palm and finger with each hand. Palpate the cord with your non-dominant hand. Carefully insert the needle, then progress using a windshield wiper motion to release the cord.
YIBO TERESA LI: Listen to the scraping sound that indicates the release of the cord. Again, we emphasize ensuring the bevel is facing upwards and that the needle is inserted no deeper than the bevel when starting. Aim to release 90% of the cord with the needle. Continue performing releases every 1 to 2cm from proximal to distal.
YIBO TERESA LI: We will perform the rest of the release using manipulation. Distally release the spiral cord, again be, be careful not to insert the needle deeper than the bevel to avoid injuring the flexor tendon and the digital nerves which usually displace to the midline in this location. Manipulate the affected joint using constant, controlled pressure.
YIBO TERESA LI: Assess the integrity of the flexor tendon by asking the patient to make a fist. We have released the 45 degree MP joint contracture and the patient is now able to hyperextend to 15 degrees. Apply a dry dressing. Instruct the patient to keep the dressing dry and intact for 48 hours. Encourage active and passive range of motion of the wrist and fingers every 30 to 60 minutes during the day until follow up.
YIBO TERESA LI: Follow up with the patient at two weeks for a wound check, digital nerve check and to assess the range of motion. Patients are encouraged to continue range of motion afterward and return for follow up as needed.
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