When should I consider NA?

The easiest way to follow progression of contracture is the "table test" (see below). With your palm against a table or other flat surface, if you can't lift the fingertip up off of the table surface, and this is only because of Dupuytren's contracture, it's reasonable to consider needle aponeurotomy.

This is a little different than the table test used to evaluate the time for an open procedure - because surgery is so involved, most surgeons wait until the contracture is bad enough that the palm can no longer fully contact a flat surface.

Because it's less invasive and less of an ordeal than an open procedure, Needle Aponevrotomy can be recommended at an earlier stage than surgery.