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Should I do NA--would like opinion
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04/10/2010 04:11
Raymond

not registered

04/10/2010 04:11
Raymond

not registered

Should I do NA--would like opinion

I’m wondering whether or not to do NA and would very much appreciate the thoughts and advice of others who are more knowledgeable and experienced. I’ve had DD in both hands for 8 years. In both hands there is about a 20-25 degree MCP contracture from the palmar cords under the ring fingers. There has been no further contraction in the last 3 and a half years—everything seems quiet/inactive. I have no real disability and no limitations on the use of my hands and no pain—just the feeling of tightness that comes with not being able to fully open the hands.

I understand that NA will not prevent any future contracture—or any part of the disorder. It will just release the present contracture—therefore, it is just for comfort’s sake. In one of his postings, the much respected Dr. Keith Denkler, mentioned that scar tissue from NA could “morph” into DD tissue and then begin the process again. Also, although the reported chance of side effects with NA are miniscule, still they exist as with any surgical procedure, and thus one always pauses to make sure a procedure is really necessary. It also seems to me that it might be good if I try to limit the number of NA’s, because I may need several during my lifetime if the DD becomes active again, which I know is possible (maybe even probable). I’m “only” 63.

I’ve lived in east Africa while all this has gone on but will now return to Canada for a brief visit and thus can have NA there or in the US—or even in France or Germany on the way back. Or, I can just continue watchful waiting and live with the deficit I have which is possible to live with without difficulty.

Any thoughts or opinions or advice would be most welcome.

Raymond

04/10/2010 16:48
callie 
04/10/2010 16:48
callie 
Re: Should I do NA--would like opinion

My opinion is that you should do nothing. I have seen many people who had Dupuytren's similar to yours and it never progressed the rest of their lives. But, messing with Dupuytren's can easily activate the disease. The longer you can keep it dormant, the better.

04/10/2010 17:40
jimh 
04/10/2010 17:40
jimh 
Re: Should I do NA--would like opinion

Agreed - if it's not bothering you, don't do anything. NA is safe but there is always the very slight possibility of nerve damage.

04/10/2010 21:21
LubaM. 
04/10/2010 21:21
LubaM. 
Re: Should I do NA--would like opinion

NA is a good option instead of surgery...but if it hasn't progressed in over 3 yrs...just wait...keep taking measurements, and if the contracture gets worst NA should be your first choice of treatment.

04/11/2010 00:03
flojo 
04/11/2010 00:03
flojo 
Re: Should I do NA--would like opinion

I agree, if it starts to be active again, then do NA. There is evidence that you can "wake the sleeping giant" by any trauma to the hand.

Something to keep in mind - As I understand it, the longer fingers are contracted and the greater the degree of contracture, the harder it is for the tendons to stretch back out.

04/12/2010 05:38
Raymond

not registered

04/12/2010 05:38
Raymond

not registered

Re: Should I do NA--would like opinion--thanks for yours plus a thought

Thank you Callie, JimH, Luba, and Flojo for your advice--and thanks for all of the postings of yours over the last years which provided such good information and experience. OK, I'll probably delay. Flojo--I was thinking to add to your last sentence. My understanding is that the only problem with waiting for contraction release comes if the contraction is 60 degrees or over--then the tendon shorten and the release--no matter what kind--is less successful. But if the contraction is 50-40-30-or 20-25 like mine--or even less, then no matter how long one waits, the tendon lenghth will still be intact and the release will be complete. From what I've read, your doctor is Dr. K. Denkler--it would be interesting to have his confirmation on this at some future date.

Again, thanks.
Raymond

04/12/2010 06:24
LubaM. 
04/12/2010 06:24
LubaM. 
Re: Should I do NA--would like opinion

Raymond,

From my own experience and from what I've read through the years on this forum..... I know its not so much the degree of contracture, that matters, but it also depends which joint is contracted and on which finger...

I believe that the hardest joint to correct is the PIP (the middle joint) on the small finger... no matter what the contracture is... so keep a close eye on the development of your disease.

04/13/2010 08:57
Raymond

not registered

04/13/2010 08:57
Raymond

not registered

yes, you are right Luba

Yes, you are correct Luba--I should have been more specific--the 50-60 degrees I mentioned is only for MCP joint, which is what my situation is. Yes, I've also heard that for PIP joint almost any degree is difficult to correct fully--especially on "pinky" as you say. And thank you for your advice to watch carefully, which I will do.

Raymond

04/13/2010 14:24
LubaM. 
04/13/2010 14:24
LubaM. 
Re: Should I do NA--would like opinion

Raymond,

In your post of 4/10 you said 20-15 degrees...now you mention 50-60 degrees in the MCP joint...if it really is around 50 degrees, keep a close watch. I don't have much experience in MCP joints, since my only contracture is a PIP pinkie finger, but you don't want to let it go much further ...

If you are on a trip to Canada and can stop in Florida on the way back, please consider consulting with Dr. Eaton for an easy MCP joint correction with NA.

Luba

Edited 04/13/10 17:27

04/14/2010 05:47
Raymond

not registered

04/14/2010 05:47
Raymond

not registered

clarification and thanks

Luba, thanks for your concern--I guess I wasn't clear in the postings. The contraction in both hands is MCP only and 20-25 degrees. What I wrote last is that I've heard that it is not until 50-60 degrees for an MCP contraction that the tendon begins to shorten and thus make complete release of the contraction less likely. It is for this reason that I feel comfortable with thinking about waiting for NA--as I mentioned there has not been any further contraction for 3 years. And as you rightfully added PIP--especially in small finger--is a completely different thing. OK, I hope that was clear--but will always keep in mind contacting a good NA doctor if things change--and will certainly be alert to any change.

Thank you again.
Raymond

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