I am French, 46 years now and have a quite aggressive and recurrent dup on my pinkie finger. It all started 5 years ago with a nodule evolving within two years with a finger bending up to 40 degrees. I had first NA in Hopital Lariboisière in Paris with no real good result (about 10 degrees relax), a second NA was performed 6 months later by Dr Lermusiaux at his private place in Gagny. Remember that Dr Lermusiaux invented NA some 30 years ago. He did a very good job and got my finger back to 0 degree which seemed at that moment quite unbelievable! During the four following months I had the first and very severe recurrence, my finger bent back much more than previous to NA, about 100 degrees. I showed it to Dr Lermusiaux who dismissed any further NA treatment and sent me right away to Dr Roulot, the famous surgeon in Paris (Institut de la main) who performed open surgery (PIP and MTP). Once again, I admit he did a very good job but then (today, some 9 months after) I have a reccurence at 90 degrees. It also triggered the disease in the palm with many nodules growing. I went to Essen to have Radiotherapy on the palm (with PROF. Seegenschmiedt), I hope it will stop the process …
I followed the exchange on the forum in the last months and found some information on these surgeons practising both NA and surgery which is completely different from what’s being done in France where an option is practised in opposition to the other one. Traditionnaly NA is done by rheumatologists and not by surgeons who ignore it. I hear that Dr Schenkel and Eaton are both from this new generation of doctors combining both NA and surgery for the benefit of hard cases like mine. I would add that what I understand so far about Dupuytren, at least for my case, is that getting a bending finger straight is quite easy now but preventing recurrence is the real challenge…
Can we say that these surgeons practising NA are on this way and a bit more in advance for treatment of reccurence?
If so, are there some doctors of this kind in France or elsewhere in Europe or should I make the trip to California ?
Thanks for help.
Luc

Luc,

Je peux vous dire que Dr. Denkler qui a son bureau pres de San Francisco en Californie est un medecin excellent. J'ai recu NA avec Dr. Denkler, il y a trois ans - 95 degres PIP. J'utilize encore "splint" dans la nuit. Bien sur, il ya des autres bons medecins des mains qui sont plus proche. Peut-etre en france ou en allemagne.

Bonne chance!

luc,

The problem with Dups is that regardless of the correcting procedure recurrence is always a threat. While NA does not remove tissue that can continue to grow, Open surgery so traumatizes the hand that completely *new* growth can be activated. Once active disease gets started it's really a no win situation because as of now there is no cure.

There continues to be this "Either Or" dichotomy disconnect between NA and OS. I think the main reason for this is that so few CHS offer both. NA is still controversial so two camps have formed. Clearly, I'm a rabid part of there NA camp. Still, that does not force someone with my convictions to be "anti" OS however. That's like saying that being in favor of frequent tune ups and oil changes makes one against rebuilding an engine if it needs it. Look at NA as preventive maintenance that can forestall more drastic, and not always better, measures.

The goal is to keep fingers as straight as possible for as long as possible. For the majority NA is sufficient, thus preventing the need for opening up on hand. When it is not, OS is simply the next step up the ladder of invasiveness. A huge step, but there is not much in between.

The acception is Denkler's "combo" approach which makes sense when previous scar tissues stands in the way.

TrevB,
How does one determine whether radiation is working? My hand (other than the one I had surgery) has not progressed in 10 years. If I would have chosen radiation 10 years ago, my reaction would be how great the radiation worked in slowing/stopping the progress of Dupuytren's. But, I did not chose radiation and the Dupuytren's has not progressed at all. I know many friends with Dupuytren's who have slight contraction, or nodules, and the Dupuytren's doesn't progress their entire life.

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TrevB,
How does one determine whether radiation is working? My hand (other than the one I had surgery) has not progressed in 10 years. If I would have chosen radiation 10 years ago, my reaction would be how great the radiation worked in slowing/stopping the progress of Dupuytren's. But, I did not chose radiation and the Dupuytren's has not progressed at all. I know many friends with Dupuytren's who have slight contraction, or nodules, and the Dupuytren's doesn't progress their entire life.

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Edited 07/28/09 13:39