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My local hand surgeon does not support this approach and the local authority would not provide treatment locally or fund the treatment in Dorset. Their decision was evidently based on the current lack of documented/proven clinical benefit of this approach.

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I've just written to Poole Hospital.



Edited at 04/10/08 22:53

What state was your hand in before treatment? Just nodules, cords or did you have any contracture? Did you have to see a hand surgeon at Poole as well or have any other tests before your radiotherapy treatment?

Part 1 answer to TrevB

I have the disease in both hands. The left hand is in the very early stages with only very slight signs of nodules. The right hand is more advanced with several obvious nodules and cords. Contracture is present (table top test) but no loss of mobility/functionality.

Advice from my local hand surgeon was to wait until 40 degree distortion and then have an outpatient operation. He would not offer any alternative solutions and was quite firmly against my counter suggestions of investigating the efficacy of either NA or radiology. Could it be that hand surgeons don't want to lose the 'business'? I sincerely hope that this is not a factor but I certainly didn't hear any rational or evidential reason why, in the UK, these comparatively non-intrusive treatments are not taken seriously.

At Poole Hospital, I met only the consultant radiologist, and no hand surgeon. Other than answering several state of general health type questions, no pre tests were involved.

Please bear in mind that you will need a letter of referral from your GP in order to attend the Poole facility.

Part 2 answer to Newman

I totally agree that there is a wealth of data and experience available outside of the UK and, in particular, in Germany. I have absolutely no idea why the UK is so reticent to move forward with alternatives. On the basis of cost alone, I would have thought that the NHS would be interested in looking at competing solutions. I also know that Ledderhose has been successfully treated by the consultant in Poole. Fact is, Poole is the only UK hospital that I could find that is currently offering radiation for this disease.

Has anyone ever approached the NHS or NICE to ask about the availability of alternative approaches? If so, when was this and what was their reply?

Hi Australia Calling.
I do not know anything about the English Health. In Australia you get a referral from your GP to a specialist be it a hand surgeon or oncologist. We have both a Private and Public Health system where we have the choice of doctor anywhere. You must remember the surgeon generally has little to do with Oncology. They are all experts in their own field. In Australia at the moment there is only One oncologist, who is in Perth, in the West of Australia, listed on the Dupuytren Society Web. I have been active in trying to get other oncologists to provide the service to patients by sending emails , but it takes time and of course some dont reply. GP 's generally refer a hand problem to a surgeon, there lies the first problem as the chance of the surgeon referring to an oncologist is very low as they know nothing about the low dose radiotherapy treatment. It will only happen to patients who ask the GP to refer direct to the oncologist. The other problem is the GP's have been taught to do nothing until it time to see the surgeon and by that time radiotherapy is of little use. RT is best on the nodules before the cord is formed. I think it will take a generational change to get change. One of the oncologists here- DR BORG (Adelaide) is keen to offer the treatment. He is a forward thinker and has an interest in the treatment of non malignant disorders. He also lectures at the University. This type of person will bring new ideas forward. The Cost of RT here is a few hundred dollars. A simple operation (private) which I had in June 07 on my little finger cost the Medical Benfits Fund $2000 Big difference -besides the time I had to recooperate. Regards

Edited at 04/12/08 05:49

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There was one opinion (medical I think) on the site that suggested a NA now and to wait for the Collagenase seemed to be a sensible approach.

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I'm no expert but if there's contracture then NA looks like the best 1st option if suitable http://www.dupuytren-online.info/NA_list_UK.html , possibly supplementing that with radiotherapy if you can find anyone to do it (you may need to travel)

If there's no contracture then it's wait and see or consider radiotherapy either here or abroad.

And although final trials of collagenase are ongoing, who knows when/if NICE will approve it for use (I think its down to them?)

Trying to avoid open surgery seems to be the best policy if possible but it's all about individual choice and suitabilty and being confident with the medical advice given . Others may have a different view?




Edited at 04/14/08 11:40