What if you presented documentation about the cost of surgery AND cost of NA for the same condition? We all know that surgery is going to cost a whole lot more. Seems like that would get the attention of the money grubbing insurance companies. Duh, they can save money if they do NA. Now, if they can make you go away and not do either, they will do that, I'm sure.

I appreciate the insight from everyone who has commented so far. One of the things that has become clear is that any research that has gone into recurrence, comparative cost of NA vs conventional surgery, etc., must be gathered. I don't believe that any conclusions can or should be drawn from our individual experiences, including mine where I saw my mother have seven surgeries (with all of the ensuing therapy periods). I do recall seeing at one time a study from France where it appeared that the recurrence was about equal, perhaps slightly more with NA.

Nothing is better than a research study published in a peer-reviewed journal. I have some experience in performing literature searches and intend to do this soon when I have some dedicated time and have sufficiently narrowed my search, however if anyone has run across any research, article citations, bibliographies, I would find it extremely useful if you would post them to this thread. Thank you.

By the way, my mother is 95 and in her case the growth has slowed so much that she has not had the need to do anything for years--probably 15-20 years!

Callie,

It's possible that advances have been made that minimize the invasive nature of the surgery and the physical therapy required afterward. For me it wasn't so much the surgery itself, but the recovery that mattered (and the fact that risk of nicked tendon/nerve and recurrence were approximately the same). I'm very active and found that I did not want to have "down time" because my fingers were full of stitches (and possibly grafts and scar tissue).

When I first compared surgery and NA, about 10 years ago, I was amazed by the lack of knowledge of NA. I visited a young, well-respected hand surgeon, trained at Johns Hopkins, who did not know about NA. I knew way more than he did! I hope that advances in microsurgery are making a difference for there are some conditions that would favor surgery over NA in my mind. I would want to be sure that the surgeon was familiar with NA and that surgeons are spending about as much time learning NA as they are new microsurgery techniques. If they are, then I would still need to be convinced that NA is not the first way to go.

The surgeries which I had about 10 years ago were fairly successful. And those microsurgical tools and techniques definitely came into play, because the surgeon cut a nerve and had to repair it on the spot - to the extent he could. (I still have numbness in one finger.)

In 2 important areas of my hand, the conventional surgery succeeded in releasing the contractures, removing all the bad tissue, and there's been no recurrence. I definitely appreciate that result. But everything else about the surgery was an enormous hassle - months of tedious recovery during which I had to do everything one-handed and couldn't be physically active; tons of time spent in PT and exercises to maintain flexibility that might be lost to scar tissue.

Now I need another release, and there's just no way I'm going through that again. NA is preferrable even if it's only partially successful and has to be repeated every 2 years. There's just no comparison.

Edited 07/23/10 23:01

Wolfgang,
You really didn't do justice to the data by the statement you made. You said, "Van Rjissen finds an average recurrence period of NA of 2.3 years and of limited fasciectomy of 3.7 years, the latter being much better but still not impressive.". You left out the very important recurrence rate of 85% for NA and only a 23.8 percent for the limited fasciectomy group.

This is significant from the provided link:

"The recurrence rate in the PNF (NA) group was 85%. Recurrence occurred after a mean of 2.3yrs. None
had an extension at that time. Of the recurrences 9 were treated by LF, 25 again by PNF and 12
patients chose not to undergo secondary treatment. The recurrence rate in the LF (limited fasciectomy) group was 23.8%.Recurrences occurred after a mean of 3.7 years. One patient had extension of the disease (2.4%). Of
the recurrences 4 were treated by PNF, and the rest (6 patients) chose not to undergo secondary
treatment.
The recurrence rate of PNF was statistically higher than of LF(p = 0.00). The mean time to recurrence
of PNF was much shorter than that of LF and this was also statistically significant (p = 0.01).

CONCLUSIONS: Recurrences are far more frequent and occur sooner after PNF. Most patients that
had undergone PNF were nevertheless still satisfied with the result and chose it again as treatment
modality."

Edited 07/25/10 01:53