I am wondering, too, callie. I believe that most surgeons wouldn't operate on a finger that has less than 25 - 30 degrees of extension deficit. A stage 3 or 4 finger is more difficult to operate on than a stage 1 (45 degrees or less). Therefore I would think that 30 - 45 degrees is probably a reasonable time for surgery. But in that case NA or enzyme injection might be additonal options.

Probably there also other aspects beyond the disease stage (or extension deficit) that may affect the decision. I was told that the finger adjusts itself to contracture meaning that joints, tendons and other tissue eventually restructure to better match the bent condition. I would think that a finger that has bent bent for 5 or 10 years will be more difficult to restore than a finger that has been bent only for a couple of years.

If I would be young (I am not but over 60) I would be more reluctant to have surgery because I would be afraid that the disease might come back quickly and I end of in repetitive surgeries. I would rather go for the non-invasive options and hope that those will delay surgery until I am 50+.

Last not least the decision when and whether to have surgery might also depend on the affected finger and joint. Surgery is easier in the palm than on the little finger. Not so much for the first surgery but in case of recurrence you might run out of options faster on the little finger, therefore I would, if possible, try to postpone surgery of the little finger but would be less concerned about a surgery of an affected MCP joint where the surgery is mostly in the palm.

You are asking a very good question but answering it seems to be difficult. The whole situation, including age, affected finger, disease progression, other reasons for or against surgeery probably all have an influence.

Wolfgang

callie:

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This is a question I have always wondered about. When is the right time for surgery? Is there a time when it is too late for surgery? My surgeon said there was a time when it is too late for surgery. My surgeon said about 40 degrees contracture was the optimum time for surgery (before the odds start going against surgery). Any thoughts?

".... since I am determined to not have surgery until I have tried everything else."

Wolfgang,

Very good. Then throw in the unpredictable parameters of individual healing characteristics and the solution is quickly not consistent. Back to square one.

You said, "I would think that a finger that has bent bent for 5 or 10 years will be more difficult to restore than a finger that has been bent only for a couple of years." I agree. In my case, I had rapid contraction (zero to 90 degrees in less than 18 months). My outcome was very good. Perhaps if I waited longer the favorable outcome might not have occurred.

I had RT 22 months ago and hands are good but i still have pain if i over work them and if you use or try and use fingers they get tired and start to shake. I also have the same problem with having no strength and trying to do something where you have to try and put your fingers together to get the job done. No such luck. But at least the RT did what its suppose to do and that was to put in in remission. I would do it all over again with RT without even thinking about it.

Edited 12/30/11 23:43