NA was originally suggested by British surgeons in the early 19th century but never became popular. In the late 20th century the technique was introduced again and improved by French rheumatologists. Unfortunately, "French" and "rheumatologists" did not make this method really popular with hand surgeons. Only when patients started requesting it a few hand surgeons learned NA and started offering it. In the USA Dr. Eaton was the pioneer of NA. After becoming an expert in NA he started training other interested surgeons. As NA is neither taught as standard treatment in surgical classes and no pharma company is pushing it, making it widely availabe is a slow process. Many hand surgeons are reluctant because for them it is a "blind procedure". They prefer seeing what they are cutting. Why are much more hand surgeons willing to provide collagenase injection where they don't see anything either? Only they can tell but I would think it is part due to great marketing and part due to the possibility to earn more. Nevertheless, NA is now quite available all through the USA http://www.dupuytren-online.info/NA_list_North_America.html. Surely not all doctors listed there have the same level of experience but the technique is fairly simple and I am pretty sure that they all can well treat a standard case, like a stage 1 MCP joint. The two doctors you are mentioning can adress also very difficult cases, like stages 3 and 4, recurrent or previously operated cases, PIP joint of the little finger etc..

Wolfgang

BRIANB:

---

Can anyone explain why there are so few really good Dr.s in the U.S. performing N.A. oh sure a lot them them attempt it ..but other than Dr. Denkler and I suppose Dr. Pess ...not a lot to choose from if you want quality work.. Dr. Eaton and France has been doing it for decades ... why so few experts in this procedures...could it be finacial..as N.A is not a big money maker ..