Hello all,

It was very nice meeting Paula in the office and discussing her situation. She has done a wonderful job relaying some important information about Dupuytren's treatment to you and I appreciate her kind comments about me. I wanted to add one important item to the discussion.

In my opinion, the most important factor in deciding to proceed with Dupuytren treatment by any technique is loss of function. I always ask my patients "What tasks can you not perform today that you would like to be able to perform after a procedure?" Answers to this vary according to the individual but common responses that mean surgery or needle aponeurotomy should be helpful include:

1) "I cannot lay my hand flat on a table."
2) "It is difficult to get my hand in my pocket."
3) "I have trouble putting on makeup."
4) "It is difficult to get my hand around or to grip certain objects."

While measurements of range of motion have their role, I have found it much better to focus on function. That way, when one considers the risks and benefits of a procedure, it is much easier to talk about the potential upside. Additionally, patients are always able to point to some function that they would like to gain long before their contractures reach a point that prevents effective treatment.

Thank you all for the interesting discussion and to Wolfgang for maintaining this website with all of its useful patient information.

Regards,

Harris Rose, MD
Austin, Texas
www.harrisrosemd.com

Thanks for your comments, Dr. Rose. The more information and discussion we can have about this crazy condition, the better.
Wolfgang, would you mind telling me, the pinkie you referred to earlier, how many degrees has it bent approximately? And is it bent from the actual PIP joint like mine is? And also, if you dont mind, why do the docs say that NA is not feasible? Is it because there is no actual cord? Because at this point I am not sure whether there is a cord or just the nodule causing the contraction in my pinkie. Dr. Eaton said it "appeared" there was a cord from my pics, but I have never seen him in person. Anyway, thanks for any help.

Paula

@Mike S:

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Paula,

I am no expert but I do have DD. I had a 90-95 degree pinkie contracture successfully released to about 15-20 degrees by Dr. Keith Denkler in Larkspur, CA, using NA. Having a PIP contracture does not NECESSARILY limit the NA correction to 50%.

Edited 09/24/10 03:20

Luba/Pat and Paula,

In my case my PIP contracture had been slowly but steadily progressing for about 8 years when I had NA in Nov. 2006. To this day, I'm not certain if I had a chord or nodules (though I definitely have new nodules/dimples now; maybe chords as well), but I did have a severe (90-95 degrees) contracture. Although the doctor did not accept insurance and asked to be paid up front, my insurance company (Blue Cross POS) surprisingly covered the NA procedure 100% without any inquisitions.

Paula; my pinkie bends in the middle = PIP joint qnd the contrqcture is cuased by nodule sitting close to the joint; no recognizable cord there.

Wolfgang

patandpaula:

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Thanks for your comments, Dr. Rose. The more information and discussion we can have about this crazy condition, the better.
Wolfgang, would you mind telling me, the pinkie you referred to earlier, how many degrees has it bent approximately? And is it bent from the actual PIP joint like mine is? And also, if you dont mind, why do the docs say that NA is not feasible? Is it because there is no actual cord? Because at this point I am not sure whether there is a cord or just the nodule causing the contraction in my pinkie. Dr. Eaton said it "appeared" there was a cord from my pics, but I have never seen him in person. Anyway, thanks for any help.

Paula