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NA success rate
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04/28/2008 23:26
kdenkler 
04/28/2008 23:26
kdenkler 
Re: NA success rate

NA is a great first step. And then can be the second or third steps depending on the choice of the patient.
Limited fasciectomy had a 5% major complication rate in this study. NA did not.
I have advocated starting with NA, then the patient can decide later if they want it "cut out", further needled, or wait for the enzyme dissolution (Xiaflex technique).
The power of NA is it puts the secondary decisions in the patients hands.
With open surgery, the only second choice is an even bigger open surgery with an even higher complication rate than for "virgin" Dupuytren's.

04/29/2008 08:59
Dyingbreed45 
04/29/2008 08:59
Dyingbreed45 

Re: NA success rate

Hello everyone! This is excellent. All of the responses of NA procedure of real people having this over OS as a first, second and third approach. Even though it is only a needle used from what videos I have seen. Is there scar tissue developed in the areas where the needle breaks/dissects the DC cords and nodules? How many times "can" this procedure be done? Thank you everyone giving there stories good or bad. It is good to hear some bad stories because we all know that bad things may happen through any kind of surgery wether it is invasive or not.
Got Dups the hard way,

Dyingbreed45

04/29/2008 13:41
Ellen MG

not registered

04/29/2008 13:41
Ellen MG

not registered

Thanks Dr Denkler--another question about radiation

Thank you Dr Denkler. Where does radiation fit in? Or steroids? Would you recommend ithem for someone who already has nodule and cord with contraction? What if someone starts to develop a new nodule?

04/29/2008 17:42
kdenkler 
04/29/2008 17:42
kdenkler 
Re: NA success rate

Steroids injected into nodules or cords have mild collagenase activity. The real collagenase (Xiaflex) will be better and much stronger. Steroids cause tissue atrophy and that is what is intended when it is injected directly into Dupuytren's nodules or cords.
NA does cause trauma, scar tissue, and fibroblast ingrowth which can morph into new Dupuytren's. Steroids are powerful antiinflammatory agents and can help inhibit this process. The French rheumatologists that developed NA started with repeated doses and injections of steroids into the Dupuytren's. One day, Dr. Lermusiaux in the 1970's was challenged to "jab" the Dupuytren's while he was injecting. The cord successfully ruptured and voila, NA started.

NA does not break up nodules well, that is where injections are needed. NA can release tension on nodules which with the cortisone tends to soften and shrink the nodules.

Radiation has nice potential for early stage Dupuytren's as it can weaken the fibroblastic potential in the areas of the radiation therapy. Plus the radiation doses are not to kill cancer (very high) but rather are inhibitory (low doses) to prevent future growth of the Dupuytren's tissue. Radiation will not straighten bent fingers. NA can be done pre radiation therapy.
NA can be repeated multiple times, but NA does leave areas of scar which can tear at subsequent repeat NA procedures.

05/04/2008 02:54
just me

not registered

05/04/2008 02:54
just me

not registered

Re: NA success rate

1 year ago this week i had NA on both hands by Dr. Kline. contactions between 90 degrees(left hand, little finger) and 5-20 degrees on four other fingers, cupping of palms, approx 15 degrees, with nodules and cords in palms. 13 years ago i had open hand surgery on the left little finger as it was the only area effected at that time(contaction was approx 45 degrees). althought i would never probably get open surgery again, i was really disappointed that my DC has returned to almost pre-NA levels of contraction on all treated areas and new areas are appearing. as my insurance denied NA, it was $3200 out of pocket for a year of relief. now im at the point i need something done again, little finger is getting in the way to often. i think i will try some Dr, in calif this time as the air fare/hotel for Kline is hard to justify, althought Dr. Kline was a great guy and a pleasure to have do the NA proceedure and i did have full release of all contrations. by the way, i sure dont look forward to having my hand poked with those damn needles again. the cords and nodules of my DC are very painful and shoving a good sized needle in them was an experience i dont look forward to repeating. i hate this disease!

p.s. 48 y.o. male, first noticed DC at age 30

05/04/2008 04:00
Wolfgang

not registered

05/04/2008 04:00
Wolfgang

not registered

Re: NA success rate

To "just me": Your frustration is understandable ... have you tried wearing a night splint for a longer period of time? Some people report that it held back contraction and that it even extended the range of motion again. Specifically after NA it seems to make sense to wear a night splint for several months or even 1/2 year. If the night splint is comfortable, like the one on http://www.dupuytren-online.info/dupuytr...echniques.html, the benefit might exceed the inconvenience. The cost is not a big deal either.

Wolfgang

Quote:



1 year ago this week i had NA on both hands by Dr. Kline. contactions between 90 degrees(left hand, little finger) and 5-20 degrees on four other fingers, cupping of palms, approx 15 degrees, with nodules and cords in palms. 13 years ago i had open hand surgery on the left little finger as it was the only area effected at that time(contaction was approx 45 degrees). althought i would never probably get open surgery again, i was really disappointed that my DC has returned to almost pre-NA levels of contraction on all treated areas and new areas are appearing. as my insurance denied NA, it was $3200 out of pocket for a year of relief. now im at the point i need something done again, little finger is getting in the way to often. i think i will try some Dr, in calif this time as the air fare/hotel for Kline is hard to justify, althought Dr. Kline was a great guy and a pleasure to have do the NA proceedure and i did have full release of all contrations. by the way, i sure dont look forward to having my hand poked with those damn needles again. the cords and nodules of my DC are very painful and shoving a good sized needle in them was an experience i dont look forward to repeating. i hate this disease!

p.s. 48 y.o. male, first noticed DC at age 30


05/06/2008 00:26
Luba

not registered

05/06/2008 00:26
Luba

not registered

Re: NA success rate

Regarding NA success rate:

I had NA done by Dr. Denkler, July 2006 on small finger, PIP joint that had a 45% contracture. The finger was perfectly straight right after NA (I have nothing but possitive comments on Dr. Denkler and his staff, and the procedure itself). Unfortunately, only 6 months after NA the finger started to contract again. Less than one year after NA it was back to the original contracture of 45% and now I have an added boutonierre contracture of +5% last joint of the same finger.

I have been seeing one of the top orthopedic surgeons in the L.A. area and was considering surgery because of the rapid recurrence...however, he was very honest with me and said that the recurrence after surgery on a PIP joint on a small finger is over 90%. Having seen the wounds on people post OS at the therapist's office and considering the high recurrence rate I'm not rushing into it...I'm waiting for the collagenese to be FDA approved and also considering a second NA, hoping that next time it will last longer (maybe I wasn't aggresive enough with therapy and wearing a night brace long enough).

I'm considering going back to Dr. Denkler for consultation and possible NA. We are also planning a trip to France in September and there would be a possibility for me to have it done by Dr.Lermusiaux.

I would appreciate comments/suggestions.

05/06/2008 04:09
Wolfgang

not registered

05/06/2008 04:09
Wolfgang

not registered

Re: NA success rate

To Luba: this is what I would do - have NA repeated and then try a night splint for a longer period of time. For the time being the night spling seems to be the only thing delaying recurrence (except for dermofasciectomy but that's major surgery).

Wolfgang

05/06/2008 06:13
Luba

not registered

05/06/2008 06:13
Luba

not registered

Re: NA success rate

Thank you Wolfgang for your quick reply.

I think you are right about trying another NA, especially since my orthopedic surgeon said there is a 90% chance of re-ocurrence after a small finger PIP open surgery. I should try a second NA before even thinking of surgery, even though the first NA only held six months.

I have read on this forum about collagenese and am not so sure I should wait (I understand that it won't be available, after approval of FDA, until 2009/2010), and truly we don't know what the re-ocurrence rate will be since its only now in final trials.

My next question to you is: given the choice, would you have it done by Dr. L. in France versus a Dr. in the States? (I have confidence in Dr. Denkler who did my first NA), but I am planning a trip to France in September anyway, so I have that choice. Thanks.

05/06/2008 14:08
DON

not registered

05/06/2008 14:08
DON

not registered

Re: NA success rate

Wolfgang, where can I purchase a glove lokr the one you posted a link to above?

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