Hi Folks,

I have had Dupuytrens on my right hand for the past eight years. Four years ago, I had a needle procedure that corrected a minor contracture (20 degrees) on my little finger. Now, the little finger contracture has returned and is about 30 degrees. Despite this contracture, I have complete movement of my right hand and absolutely no pain.

I spoke with the doctor that performed the original NA and he suggested surgery versus another NA because I have developed what he calls retrovascular disease in my little finger. He claims that the cord now travels along the finger and wraps itself around my nerve and artery.

I then got a second opinion and this other doctor suggested another NA and stated that he could use Doppler ultrasound to ensure that neither nerves or blood vessels in my little finger would be at risk.

When I contracted the original doctor to mention the second opinion comments, his response was that his skills using Doppler ultrasound were not sufficient to safely and reliably treat the disease I have.

I have postponed the surgery that was scheduled for October 15 and want to make a decision on the next steps. Should I consider another NA, get acupuncture treatments along with stretching exercises, or move forward with the surgery?

Thanks a million for your help and guidance. I have read many of the articles and comments in this forum and appreciate the work done by the International Dupuytrens Society on our behalf.

Jack

Hello SB,

Thanks for your response. It is most appreciated. Following is my response to your questions:

Several weeks ago, I spoke with the doctor who recommended surgery with respect to his experience in doing this type of surgery. He told me that he had done "several 100 cases like yours" and "all my patients have regained full use for activities of daily living". The doctor also stated that "I have not had a dupuytren's case with function that was worst after surgery even if the contracture returned".

Tomorrow, I will speak with the second opinion doctor who recommended NA using Doppler ultrasound regarding his experience doing this type of procedure. I will report back when I have statistics on his results.

Regarding your question about Xiaflex, Kaiser, my insurance carrier, does not cover it. Therefore, I would have to pay for this out of my own pocket.

What can you tell me about NA using Doppler ultrasound for my condition? This seems to be a better option than surgery. What do you think?

What can you tell me about acupuncture for Dupuytrens? Have you heard of any successes?

As I mentioned in my original note, although I have a 30 degree contracture in the little finger of my right hand, I have full functionality of the entire hand with absolutely no pain. I have been doing daily hand exercise along with applying Vitamin E at night for the past two weeks and will continue indefinitely if I can stop the contracture.

I would like to avoid any type of surgery if possible. What can I do besides what I am already doing?

Thanks again for your help.

Jack

There is no overall consensus on the benefits of Acupuncture for DD. Someone on here who has Acupuncture along with TCM states a success including reversal of contracture, another person says the months they spent using Acupuncture were a waste of time and they wish they had conventional treatment earlier.

NA is usually done under a local, at point of needling, anaesthetic, and relies on the patient reporting electric shocks and tingles if the needle gets close to a nerve. If the cord and nerves are intertwined this will be more critical. I have no knowledge of or experience of how well ultrasound would assist with this. Skill and experience would be key.

Surgery will include the same challenge, but the surgeon will have a visual view of the cord and nerve, but the surgery is not a mere cut of the cord but dissecting and removal. So skill and experience remain just as important.

Callie has given a view of surgery. Whilst not in anyway disagreeing, given your current hand function my own personal inclination would be to try NA first, if and only if the doctor could demonstrate the necessary prior experience. If they could not, I would want the same from my surgeon doing surgery.

Hello Dawn,

Thanks for your note and for your suggestion that I consider NA as a first step. Yesterday, I sent a note to the doctor who recommended NA to ensure that what he told me when we met is still the case. Once he responds to this question, I will ask him about the number of times he has done NA on a little finger and the results of his procedures. I agree that it is mandatory to minimize any near or long term complications after the surgery.

I have read about your case on the forum and want you to know that all of us that have Dupuytrens are praying for your full and complete recovery without pain.

Jack

Hello Callie,

I want to respond to your note to congratulate you on a successful surgery. Based on everything I have read in this forum, I get the impression that most surgeries are followed by extensive rehabilitation and much pain. We are all thankful that your surgery and your rehab were successful.

I get the impression from your note that your little finger had a problem similar to mine, ie: the cord was not only travelling along the finger but was also wrapping itself around the nerve and artery. Please confirm this at your convenience.

You mention that you had a 90 degree contracture. How long did it take for your contracture to go from 0 to 90? I have had Dupuytrens for over eight years and my little finger contracture has moved only 30 degrees in this time period. I am wondering if my contracture movement will remain slow or whether its movement is unpredictable.

Did you consider NA with Doppler ultrasound to ensure that neither nerves or blood vessels were at risk?

Thanks for your response.

Jack