Hi Lorrainehart,
You should consider NA or PNF. Dr Stewart FLEMMING at Fremantle Hospital is listed as carrying out NA on this site. I recently had the procedure on both Index fingers in Adelaide. It takes about 20 minutes or so. You will need to wear a night splint after.
My out of pocket expense was $480 for each finger. Collegenese has been approved for use in Australia ,but too expensive and NA. does the same. Dont wait too long.

Edited 07/22/15 19:01

I had my first NA treatment of my hands done in March of 2007 followed a month later with X-ray treatment in Germany.
I had the Xiaflex injections done on one hand in March of 2011.
I had Xiaflex injections done again in July of 2013 and again in November of 2013.
The last time the Xiaflex was injected the hand surgeon, Dr. Denkler of Larkspur, California did a NA procedure while doing the manipulation required with the Xiaflex.

This last procedure produced much better and longer lasting results. Dr. Denkler is a certified hand surgeon with experience in fasciectomy, NA, and Xiaflex injections having done all of these procedures on hundreds of patients. This is very important as he could make a better assessment of what procedure or combination of procedures would produce the best results in my case.

The Xiaflex injections were done in the morning of the first day. The enzyme works for less than 12 hours. There is a resulting swelling of the hands that takes place over a period of days. The first time I had the injections done the swelling doubled the size of my hand and resulted in the skin tearing loose and a recovery time of 4 weeks.

The last time that the Xiaflex was injected I conferred with Dr. Denkler and when he told me that the enzyme's effect lasted less than 12 hours I asked to have the manipulation done of my hand the afternoon on the day following the injections which were done in the morning. As he applies a general anesthetic that numbs the entire hand prior to doing the manipulation he was able to take advantage of the situation to use NA where the enzyme had not been entirely effective in releasing the underlying tissue.

Dr. Denkler mentioned that NA in general is more effective but Xiaflex is safer where there are nerves which might be damaged by the NA procedure. By using the Xiaflex first and then the NA the following day the net result was much greater than would be possible with either procedure alone.

The last time that Dr. Denkler did the injections and the NA he applied the local anesthetic to the vein at my wrist and this immediately numbed the entire hand and was much less painful than having multiple individual injections of the local all over my hand and fingers. I highly recommend this approach.

As for surgery there is a 6% chance (at least 4x greater than with NA) of permanent nerve damage to the hand. The principle reason for this is that the surgery takes more than 90 minutes and during this time most surgeons simply apply a tourniquet and completely stop the flow of blood to the hand and to the nerves.

Recovery with surgery is also measured in months as compared to NA alone where I had 100% use of my hands the next day and with Xiaflex the full recovery the second time with the new process was one week.

There were 8 doctors approved to perform the Xiaflex injections that were closer to home but they did not have the experience with either NA or Xiaflex to decide which would provide the best results or present the least risk. A couple were sports medicine doctors and not certified to perform hand surgery of any kind.

At this point in time my experiences leads me to conclude that a combination of Xiaflex followed by NA will provide the best initial results and delay recurrence the longest.

There have been studies by organizations of hand surgeons with studies involving many patients in Europe. NA is too new in the USA for similar studies. I researched this carefully when the first hand surgeon I met with told me that risks for NA were 6x as high as with fasciectomy but he had no references to provide me. But the information is online only difficult to find free non-subscription sources. My own research was done over a period of months prior to my getting the NA procedure done in California and the XRT performed in Essen, Germany.

With the fasciectomy risk there is the paper written by Dr. Denkler and presented at the annual convention of hand surgeons:

Surgical Complications Associated With Fasciectomy for Dupuytren's Disease: A 20-Year Review of the English Literature by Keith Denkler, MD

http://www.eplasty.com/index.php?option=...&Itemid=116

NA complications includes procedures done for "trigger finger" and by all doctors over a period of decades. This procedure was first developed in France and surgeons including Dr. Denkler had to go to France to learn the procedure.

All surgical procedures involve some level of risk. Even cortical steroid injections when overdone (usually with athletes) have led to burst tendons and permanent disability.

Don't expect a surgeon to talk about complications or recovery as they are very seldom involved in post surgery for patients. The surgeon who wanted to perform the fasciectomy told me to go ask a physical therapist if I wanted to know about post surgery physical therapy and the recovery interval to expect.

The thing I find strange is that you have said is NA was done when the hand was totally numb. This is not the usual reported technique or practice. The surgeon doing NA is working blind using feel and relying on the patient to report if it gets too close to a nerve. So usually only partial or local numbing at point of entry is done. If the needle approaches a nerve the patient feels slight electric shocks and can provide this feedback to the surgeon. This is essential to ensure NA does not result in nerve damage especially for those cases where cords are close or intertwined with nerves.

Xiaflex is still available and has not been taken off the market. With a standard NA procedure the doctor will make multiple injections of lidocaine before starting the NA procedure and doing so with the patient's hand completely numb. A competent hand surgeon is not going to do this procedure without a local anesthetic.

Instead of 6 or more injections into the hand, the doctor made a singel injection at my wrist and this was less painful. Of course the hand surgeon I used, Dr. Denkler in California has more direct experience with NA and with Xiaflex than any other doctor in the United States.

NA is a surgical procedure where the doctor inserts a "scapel" and pulls the surface tissue away from the lower layer. The Xiaflex enzyme dissolves tissure. With Dr. Denkler I had a surgeon with a great deal of experience with traditional fasciectomies and with NA (he trained in France) and with Xiaflex so he had options. The older surgeons who only have performed fasciectomiers are cluelss about NA or Xiaflex and not to be trusted for advice.

With a fasciectomy a tourniquet is applied to the arm and the muscles and nerves are without oxygen for 90 minutes and this often results in serious post surgery complications. No unusual for it to take a month or even a year to regain strength in the hand after the operation as compared to NA where 24 hours later I had full use of my hand.

In February of 2011 Dr Denkler did the combination NA and Xiaflex injections on my hand and now 10 years later my hand is still OK and I can place it flat on a table with no effort. The cost for the NA along with the Xiaflex treatment was the same as if I had only the Xiaflex injections done.