Randy
My contracture consists of both the big knuckle
and also the PIP joint of my pinkie finger. Initially
the contracture was Stage IV @ 145 degrees which was reduced
to 85 degrees (1st Session of NA) and the to 45 degrees
three months later at my second session of NA with Dr. Eaton.
I felt great improvement the first time, and lesser the
second time, and hence my statement about what I feel diminishing returns. Each time I felt relief having the chords severed by the needle (much like the thought of a rubber band under tension being cut), but am not overjoyed at the chords returning so rapidly. (3 weeks or so after NA they seem to be noticeable in their return.) The use of a night-time finger splint seems to prevent the contracture from increasing, but it is evident the disease is still there.

While I agree totally with the advantages of NA over invasive surgery, it is still treating the symptoms rather than the cause. I don't hear anything about research underway to determine and cure the cause of DC. As little attention in the medical community that has been given to the superiority of NA over surgery does not bode well for what, if anything, is being done to seek a cure. That is really what all of us need, since both NA and surgical treatments (and that includes collegenase, as I understand it)are at best a holding tactic. Is anything happening out there to find a cure--and if so, can we do anything to encourage/facilitate it?

Sean,

There is absolutely no reason to look at NA Vs Invasive limited fasciectomies as an "Either/Or" proposition, as your last post suggests. Firstly, we have no definitive long tern study comparing reoccurrence rates between the two. Beyond that, population statistics are one thing, but on an *individual* basis, there is no way to know whether a *particular* patient will have unacceptable reoccurrence after NA or not. That being the case, there is no reason someone should jump directly to the far more invasive procedure before attempting the newer, far less invasive approach (NA is only "new" as it is a new twist on a very old procedure)

Since reoccurrence can be an issue for *both* procedures, one should keep in mind that NA can be repeated *indefinitely*, whereas surgical repeatability is *limited*. Also, surgery can make NA impossible, whereas NA has no bearing on future surgery should that become necessary. Now that NA is available in the US with a good track record, the decision to go with full surgery needs to be weighed against what has finally become a real option until an actual "cure" can be found.

Sean, this is *real* complicated, so watch this carefully from my earlier post:

"Definitive Long Term Study" means................."Definitive Long Term Study".

I didn't say Eaton's data isn't valid (though we don't really know what his data is). It is preliminary. He's only been at it for one year. I grant you that NA appears to have a faster rate of reoccurrence. However we don't have a good 5 year study to give us good numbers to know exactly what "Sooner" means. It could be 50%. It could be 5%. In fact, a randomly assigned scientific study would be better than studying retrospective data, but that's not going to happen. The French study reported:

A comparison of medical fasciotomy with surgical fasciectomy, reported in 1993 (Badois and Coll.), showed that short-term outcomes were comparable.
The five-year recurrence rate is high (>50%) with both procedures, however, needle fasciotomy can be repeated as often as needed, whereas start again surgical procedure is hazardous

I doubt this is not going to be *Definitive* enough for the American Surgeon who, as Eaton puts, it has a long standing and strong tradition of doing fasciectomies. But now, based on what he's learned about the benefits of NA, it's only a "matter of time" until that tradition changes. I don't think he is Lying.

Sean, please replace "before attempting" with "before attempting *to be treated with*" and you'll feel much better.

A good question for Eaton: What is the percentage of those inquiring who can benefit from NA. I'm going to guess > 80%. I'd love to have all this data.

Had NA performed by Eaton less than 1 week ago:

HISTORY: Right hand started with palmer nodules 18 months ago. The ring finger PIP became effected, and over 15 months went from 0 to 30 degrees. The pinkie has a cord effecting the MCP, but minimal contracture. Also minor cords in palm creating minor palm contraction effecting palm flatness.

CHOICE: Having had Open Surgery on my left hand two years ago with serious complications (RSD + permanent nerve damage), I opted for NA on my right hand(Daaaa). I chose Eaton because he is currently the most experienced American CHS doing NA. (Plus that discount for being "on the take" that some of our more paranoid posters seem to imagine ;-) At only 30 degrees I could have delayed, but knowing that the PIP is more difficult, I took proactive measures. 30 is plenty, thank you.

PROCEDURE: 04/11/05 Five needle insertions were made in the palm to release minimally discernible cords. An attempt was made at the base of the ring finger (MCP) to sever a chord. However unsuccessful do to lack of contraction (A High Class Problem). Then, a single needle insertion *immediately* released the ring PIP to Zero degrees. In all, seven needle insertions. About 20 minutes listening to his great “Oldies” radio station.

OUTCOME: Ring finger PIP fully restored. To be put in nightly splint to reinforce correction. It is stiff in the morning but not for long. MCP joint of pinkie was not sever enough to attempt release (Darn! I was hoping for a 2for1). Palmer aria not completely released (not sever enough) The palm *will* go 100% flat with slight effort. Full finger flexation restored.

PROGNOSIS: Due to the speed at which I went from 0 to 30 degrees, and the arias that were not as yet treatable with NA, I can only assume additional NA within 1-2 years. I may be more fortunate, but I'm not counting on it.

INTERVIEW:

RBH.: "Of all the perspective patients who contact you, what percentage can you help?"

Eaton: "Nearly All"

RBH: "Should NA become a commonplace first line procedure for Dups, what percentage of all suffers will be able to forgo Open Surgery indefinitely?"

Eaton: "A little soon to know, but something well over 50%."

COMMENTARY: Well over 50%? Yipes! No, NA doesn't *begin* to make Open Surgery obsolete. It just makes the *majority* of OS currently being done completely UNNECESSARY. If Eaton is correct (and who else do you ask?), over half of us needing a procedure will *never* go under the knife. That, my friends, is the bottom line. I certainly respect the personally informed choice by some to go for OS. Be my guest. It's *all* yours. Compared to Open Surgery, the downside of NA's higher rate of recurrence is easily offset by:

1) Safety: Eaton's nearly 1000 procedures without incident. Try *that* with OS.

2) Effectiveness: The average restoration of a PIP contraction of 45 degrees is back to about 17 degrees. Some worse, some better. 17 is the *average*. Internal scaring makes it so. Outcomes back to Zero with Eaton's NA are now commonplace. He's getting better!

3) Recovery: I'm back to playing drums. No pain. Need I say more.

4) Cost: about 10% of OS. (For me: $700 Vs $7,000)

5) Pain: *Nonexistent* compared to OS.

6) Repeatability: Nearly unlimited. No so with OS.

7) Something to amaze and amuse my friends who have now seen me undergo *both* OS and NA.

CREDITS Many thanks to: Walt Stagner, The Real Francis, Patty, Charlie, toM, Mary Beth, JERRY, E. Wicks, George Barbarow, Anon, jim h, Quicksilver, Don Westen...........