Bruce:

Drs. Denkler & Benhaim both suggested hand therapy for me after my 8/13/2006 N.A. procedure.

I stared the therapy about 5 or 6 days after the procedure, and I continued until my insurance ran out (about 4 months later).

I generally went twice per week, sometimes three times per week.

I definitely think that the therapy helped maintain the good results of the N.A. that Dr. Denkler performed - both in terms of range of motion & degree of contracture.

But, man, is hand therapy ever expensive!

The street price at Mission Hospital in Southern California was approximately $200 per session. Yikes.

Fortunately by the time I needed the therapy I was at 100% coverage with my health insurance company for the rest of 2006.

Mark

Over two years ago I had a 35 degree pinkie PIP contracture straightened by Eaton to about 5 degrees. I was given splint to wear at night for a few months. No physical therapy of any kind except to slowly open and close the hand a few times after removing the splint in the morning. It was stiff.

If you are going to try NA it is best to do so ASAP, especially where a PIP is concerned. Once they get bent for a long time the muscles and ligaments are no longer capable of coming back and keeping it fully straight again. I should have had it done at 20 degrees or so. No therapy should be required if you catch it early.

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As a side note, I had the surgery in one state and the therapy back home in another where no one does NA. The therapists called it 'a miracle' and said in 20 years they hadn't seen a result like mine.

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One can only assume that your therapists had never worked on an NA patient in the last 20 years.

I'm getting the feeling that fingers with the larger NA corrections are the ones that need therapy. Mine was only 35 d.

90-95 degree (depending upon who did the measuring) litttle finger PIP was NA'd by Dr. Denkler on 11-3-06. Yes, PT may be unnecessary with smaller contractures but in my case I was told in no uncetain terms to just do it and do it with a certified hand therapist. Had PT ~4-6 weeks. End result is contracture of about 15-25 degrees (what a difference)! My PT had seen some Dup's folks before. One of the PT's (not my primary person) had been involved with some collagenese testing/worked some with Dr. Benahim at UCLA and had some NA awareness. Both PT's thought the results were great. Before visiting, Dr. Denkler, I had a consult with a well-regarded traditional CHS who thought OS was the only way to go although he did allow as "I was free to explore NA if I wanted to". He had heard of it. On the other hand, my GP, when told I was considering NA, and after listening to me talk about my research of same, said in essence - "go for it." He has since seen the results and said it looks great - tells his other Dups patients (just a few) to look into it. Was told to wear a night splint for 2-3 months but still doing it by choice as well as cetain exercises.

Physical therapists are probably in the best unbiased position to evaluate the relative results of OS Vs NA. I am not surprised at the PT reactions that are beginning to surface now that limited PT is being suggested after NA. I wonder if my final 15d on my 2 year old PIP NA would have been 5-10 with PT. It's of little consequence however, as 15d is no bid deal.

Here *is* a big deal though:

"It is .....wrong that Wolfgang is having to fund this site for our benefit entirely out of his own pocket."

Amen Bstenman!

I've spent time with Wolfgang in Germany and I can tell you we are all quite fortunate to have a guy like this step up and do this. I believe that it is a moral imperative that those who have benefited from this site should in turn help *others* by contributing to it's future. We aren't saving lives here or creating World Peace, but lives are being benefited by this effort. Wolfegang is a man of modest means and his display of unselfish giving to this community should not be rewarded with *indifference*. The Dupretrens Society needs your help.

<Sorry for the proceeding shameless but necessary plug :) >