NA is a great first step. And then can be the second or third steps depending on the choice of the patient.
Limited fasciectomy had a 5% major complication rate in this study. NA did not.
I have advocated starting with NA, then the patient can decide later if they want it "cut out", further needled, or wait for the enzyme dissolution (Xiaflex technique).
The power of NA is it puts the secondary decisions in the patients hands.
With open surgery, the only second choice is an even bigger open surgery with an even higher complication rate than for "virgin" Dupuytren's.

Thank you Dr Denkler. Where does radiation fit in? Or steroids? Would you recommend ithem for someone who already has nodule and cord with contraction? What if someone starts to develop a new nodule?

1 year ago this week i had NA on both hands by Dr. Kline. contactions between 90 degrees(left hand, little finger) and 5-20 degrees on four other fingers, cupping of palms, approx 15 degrees, with nodules and cords in palms. 13 years ago i had open hand surgery on the left little finger as it was the only area effected at that time(contaction was approx 45 degrees). althought i would never probably get open surgery again, i was really disappointed that my DC has returned to almost pre-NA levels of contraction on all treated areas and new areas are appearing. as my insurance denied NA, it was $3200 out of pocket for a year of relief. now im at the point i need something done again, little finger is getting in the way to often. i think i will try some Dr, in calif this time as the air fare/hotel for Kline is hard to justify, althought Dr. Kline was a great guy and a pleasure to have do the NA proceedure and i did have full release of all contrations. by the way, i sure dont look forward to having my hand poked with those damn needles again. the cords and nodules of my DC are very painful and shoving a good sized needle in them was an experience i dont look forward to repeating. i hate this disease!

p.s. 48 y.o. male, first noticed DC at age 30

Regarding NA success rate:

I had NA done by Dr. Denkler, July 2006 on small finger, PIP joint that had a 45% contracture. The finger was perfectly straight right after NA (I have nothing but possitive comments on Dr. Denkler and his staff, and the procedure itself). Unfortunately, only 6 months after NA the finger started to contract again. Less than one year after NA it was back to the original contracture of 45% and now I have an added boutonierre contracture of +5% last joint of the same finger.

I have been seeing one of the top orthopedic surgeons in the L.A. area and was considering surgery because of the rapid recurrence...however, he was very honest with me and said that the recurrence after surgery on a PIP joint on a small finger is over 90%. Having seen the wounds on people post OS at the therapist's office and considering the high recurrence rate I'm not rushing into it...I'm waiting for the collagenese to be FDA approved and also considering a second NA, hoping that next time it will last longer (maybe I wasn't aggresive enough with therapy and wearing a night brace long enough).

I'm considering going back to Dr. Denkler for consultation and possible NA. We are also planning a trip to France in September and there would be a possibility for me to have it done by Dr.Lermusiaux.

I would appreciate comments/suggestions.

Thank you Wolfgang for your quick reply.

I think you are right about trying another NA, especially since my orthopedic surgeon said there is a 90% chance of re-ocurrence after a small finger PIP open surgery. I should try a second NA before even thinking of surgery, even though the first NA only held six months.

I have read on this forum about collagenese and am not so sure I should wait (I understand that it won't be available, after approval of FDA, until 2009/2010), and truly we don't know what the re-ocurrence rate will be since its only now in final trials.

My next question to you is: given the choice, would you have it done by Dr. L. in France versus a Dr. in the States? (I have confidence in Dr. Denkler who did my first NA), but I am planning a trip to France in September anyway, so I have that choice. Thanks.