Hello All,

I am considering NA to treat my bent left ring finger. From what I've read, I understand that the disease might recur. Do you know whether post-NA recurrences tend to be more virulent than the pre-NA condition? If you have experience with Dr. Denkler in Larkspur, CA, I hope you'll tell me about it. I appreciate your advice. Best regards, Kay

hi Kay
Studies show that post NA recurrence rate is somewhat higher than after open surgery but I don't know if I've seen anything about whether recurrence is more virulent. By that I think you mean a worse bend and/or more locations. I can tell you that in my own case, after traditional surgery the contraction did come back worse and faster and the line of the affected tissue seemed to extend further down into my hand.

After two traditional surgeries in less than two years, I checked into NA because each surgery beat up my hand more and I was afraid pinkie would end up useless. So I emailed pictures to Dr. Denkler and eventually had Dr. Denkler perform NA on pinkie pip joint and got a good result. And that was 17 months ago and it is still holding up with only a degree or two of recontracture. So if I ever get this disease in another finger, I will definitely get Denkler to do NA. And if the contracture comes back badly enough in the pinkie, I will do it again. I would much rather get the NA every couple of years than have open surgery because it just doesn't beat up your hand so much and recovery time is quick. Send him some hand pictures and he can help you decide if its time for NA. hope this helps.

Kay,

Kay,

The higher recurrence rate from NA is because the diseased tissue is not removed, just broken to release the finger(s). The goal of OS is to remove *all* the Dups tissue to try and avoid recurrence. Unfortunately for us this doesn't work so well or we'd *all* just have one round of OS and be done with this disease.

The choice between NA and OS as an initial procedure is a balance between a lower probability of recurrence with OS Vs the non invasive nature of NA. There are no reports of NA triggering more aggressive growth. In fact most experience a softening of the nodules because the cords connecting them are broken. In my case NA stopped the disease, at least for now. While it can be repeated as needed, OS is the next step if NA does not sufficiently slow the disease. Prior NA does not effect OS. However, prior OS can negatively effect NA due to resulting scar tissue.

Essentially, a very good case can be made for looking at NA as the logical first step in treatment, reserving Open Surgery should NA not prove to be sufficient.