New treatment helps those with hand disorders

5/9/2006 5:55 AM
By: Ivanhoe Newswire

(SAN FRANCISCO) - Imagine not being able to straighten your fingers. That's what it's like for about 7 million Americans who suffer from Dupuytren's Contracture. Until now, a risky surgery was the only fix. But now there's an easier solution.

"If I would go to the opera or the symphony, I couldn't clap," Mike Smith says. "It started physically interfering with things that I did, and I also knew it would get worse." But today, he can use his hands even though he has Dupuytren's Contracture -- a condition that if untreated, prevents his fingers from straightening.
Dupuytren's causes the fibrous tissue in the palm of the hand to thicken and tighten, forcing fingers to contract. Doctors recommended surgery, but it can take a long time to recover.

"What they do is they start to cut here, and they zigzag down and filet open the finger, core it out and re-stitch the skin," Keith Denkler, M.D., a plastic surgeon at University of California, San Francisco, tells Ivanhoe.
Instead of surgery, Smith opted for an alternative treatment called needle aponeurotomy, or NA. Instead of a scalpel, Dr. Denkler inserts hypodermic needles to cut the contracted tissue and straighten the patient's fingers. The hand is numbed with local anesthetic.

"The advantage of this procedure over traditional surgery is a very rapid recovery," Dr. Denkler says.
Surgery takes months to recover and often requires skin grafts and physical therapy. With the NA technique, the hand is bandaged for just a couple of days. Patients can perform stretches without a therapist.

"I'm very satisfied with the outcome," Smith says. It's no wonder. Mike's finger went from unusable -- to nearly perfect.

Another advantage of this technique is that it requires no hospital stay. Dupuytren's strikes men twice as often as women. It is most common in populations of Northern European descent and tends to run in families

DUPUYTREN'S CONTRACTURE: The American Academy of Orthpaedic Surgeons describes Dupuytren's contracture as an abnormal thickening of tough tissue in the palm and fingers. This can cause the fingers to curl. This disorder is more common in men than in women. It becomes more common with age. What causes Dupuytren's contracture is not known. Doctors do know it is most common in people of Northern European or Scandinavian ancestry. It is associated with smoking and drinking. Certain medical conditions such as diabetes, thyroid problems and seizures also put people at higher risk. This condition usually occurs gradually. Doctors say it may start as a small tender lump in the palm. Tough bands form, causing the fingers to bend toward the palm. The ring finger and pinkie finger are most commonly affected. Surgery is usually recommended when the patient cannot straighten the fingers and has significantly limited hand function.
TREAMENTS: According to The American Academy of Orthpaedic Surgeons, surgeons will treat Dupuytren's contracture by dividing or removing the thick bands that are bending the fingers. In some procedures, the surgical wound is left open and allowed to gradually heal. Skin grafts are sometimes needed. Risks include nerves and blood vessel damage and infection. Swelling and soreness is expected, but severe problems are rare. Cosmetic surgeon Keith Denkler, M.D., says the possible nerve damage is unacceptable to some people. "What they do with traditional surgery ... They start to cut here and zigzag down and filet open the finger, core it out and restitch the skin," says Dr. Denkler. With traditional surgery, 10 percent of patients see little or no improvement. If the surgery is not a success, splints may have to be added.
NEW TREATMENT: Dr. Denkler says a new way to correct the deformity offers faster recovery. It's called needle aponeurotomy. Instead of a scalpel, Dr. Denkler inserts hypodermic needles to cut the contracted tissue and straighten the patient's fingers. The hand is numbed with local anesthetic. Traditional treatments will often takes months to recover from. Skin grafts and physical therapy are often needed. With the needle aponeurotomy, or needle release, the hand is bandaged for just a couple of days. Patients can perform stretches without a therapist. The treatment originated in France. Research has shown the procedure must sometimes be repeated several years later. As much as 50 percent of patients will need the procedure again in five years.

ADVANTAGES:
• No hospital stay
• Usually no physical therapy
• No scarring
• Less invasive
• Faster healing

Natalie:

I had Dr. Denkler do NA a week before you did.

Same experience as you....

Keith is a great guy & a great surgeon.

For my N.A. follow-up, I'm seeing Prosper Benhaim (UCLA), who is much closer to home for me.

Dr. B. is another wonderful Hand Doc, one who does NA in Southern Cal. He is working as a team with Dr. Denkler & my hand therapist to keep my hands in working order.

I'm glad you're helping to spread the word.

Mark

I think that the "norm" after NA is just exercising to help keep the finger straight...however in my case...in view of the swelling due to "tendon repair in PIP joint" therapy was necessary and did help... but....

Swelling is still present after two months...anyone has experience with therapy/swelling after NA?...would like to hear their thoughts. Thanks.


Mark D.....you mention a team of both Drs. and therapist...what exactly do you mean? I live close to UCLA, so going to Dr. Benhaim is a possibility for me...what exactly is he doing for you.

Luba:

Before I heard that Dr. Benhaim (UCLA) does N.A., I had made arrangements to have the procdure done (last month) by Dr. Denkler (in San Fran).

But, because I live in Orange County, I thought it would be prudent at least to meet Dr. Benhaim before my N.A.procedure.

So, I set an appointment at UCLA with Benhaim a few months ago.

I liked Benhaim very much.

When I told Benhaim that I had already made N.A. arrangements with Denkler, Benhaim offered to be my "local CHS."

So, I periodically go to Benhaim to see how my hand is doing.

I've now seen Benhaim twice, and will go again in a another few months.

I find this extra layer of local care to be terrific.

Plus, Benhaim & Denkler know each other well. So, they can easily coordinate their efforts.

Hope this helps.

Mark

Natalie,

I pretty much do the same exercise as you, opening and closing fist....only in addition to that, and of course wearing the splint at night, I massage the swollen PIP joint (with handcream) pushing up on the swelling towards the MCP joint and beyond...3-4 times a day...

also I wear an elastic tight-fitting mini-sleeve (like a rubber glove for pinkie) most of the day.... and then I have a little contraption that slips on the pinkie and has a spring that stretches the finger, which I wear for 20-30 minutes a couple of times a day......I got both of these from the therapist.

its nice that we can exchange notes on exercise...I am grateful to this forum.