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Hello from a forum newbie and question about NA
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06/07/21 01:35
Like2bake 
06/07/21 01:35
Like2bake 
Hello from a forum newbie and question about NA

I’m new to this forum, and I first want to say hello and thank you to everyone for the informative posts. I’m a 60-plus woman diagnosed last month with Dupuytrens during an appointment that I’d scheduled to discuss surgery for trigger finger (it’s the middle finger of my right hand that’s affected with both conditions; to make matters even more complicated, I had a ganglion removed from the base of the same finger over 30 years ago). The doctor, who is a highly regarded hand surgeon, recommended doing a trigger finger release and a local palmar fasciectomy at the same time. Because I hadn’t expected the DD diagnosis and didn’t know anything about DD, I wasn’t prepared with questions, but my gut told me not to rush into anything. And the more I’ve read, including today on this forum, the more uncomfortable I’ve become with going straight to surgery, especially for the DD. The surgeon looked at my hand only cursorily, and didn’t discuss NA with me.

Next week I have an appointment for a second opinion with another well-regarded surgeon who specializes in the upper extremities, and while he doesn’t do NA either, I’m hoping he can give me a better idea of which condition is causing the different symptoms I’m experiencing, and whether treating the DD first might make more sense, in case that is what is causing the mild contracture (I also have a nodule with a little cording that I only recently noticed).

There is a question at the end of this long explanation of what brought me here, and that is, for NA, how important is it that it be guided by ultrasound? Ultrasound makes a lot of sense to me, but I’m not sure that any hand surgeon in my area does ultrasound-guided NA (I know of one who does NA without it).

Thanks again, and I expect I’ll be back with another question or two or three after I’ve gotten a second opinion.

06/07/21 08:04
spanishbuddha 

Administrator

06/07/21 08:04
spanishbuddha 

Administrator

Re: Hello from a forum newbie and question about NA

Hi and welcome to our forum.

It's not clear from your description how much of a contracture you have or where the cord is, palm, finger(s), or both? Ultrasound is not usually used or needed when performing NA, as either the cord is already prominent and easily felt with the needle tip, or by stretching the hand the cord can be made to be visible under the skin prior to needle entry, and thereafter felt tactically with the needle. It does require an experienced doctor in the technique. The cord is usually very hard compared to surrounding tissue and easily distinguishable with the needle tip, but experience counts.

Mild trigger finger is often treated at first with splinting and/or steroid injection. A common unfortunate side effect of surgery, including for DD is a flare up, or recurrence of DD, so since it seems you are in the early stages of both you are wise to proceed cautiously.

Have you seen our list of Drs treating via NA? https://www.dupuytren-online.info/NA_list_North_America.html

Edit to add: There's a good description of NA by Dr Gary Pess on YT https://youtu.be/1BURdqs3a4U and there are also videos of the procedure on a patient there if you want to in investigate further.

Best wishes

Edited 06/07/21 08:33

06/07/21 17:10
Like2bake 
06/07/21 17:10
Like2bake 
Re: Hello from a forum newbie and question about NA

spanishbuddha -- Thank you so much for your response to my post. I had left out that I've already had two steroid injections for trigger finger; the first one worked for about a year and a half; the second one never completely worked, although I haven't had a repeat of the severe locking episode that prompted me to get a diagnosis and an injection in the first place.

I need to look at some pictures of cording, because I may be misinterpreting what I see on my palm. What I'm seeing extends a little below the nodule. I'm hoping that the experienced surgeon I see next Monday will be able to tell me what's what. He offers the enzyme treatment, so at least he's open to alternatives to surgery.

I'm not yet familiar with the different stages of DD or how to determine the angle of contracture; I plan to educate myself more between now and my appointment. The contracture isn't nearly as severe as some of the pictures I've seen. I also don't know how much is DD and how much is trigger finger. I can tell you that I can't close my middle finger when I try to make a fist, and that I have mild pain in the center of my palm with some activities (like chopping vegetables or lifting a big, full coffee mug).

Thank you for the link to the YouTube video on NA -- I will look at that later today -- and the info on NA and ultrasound. Also, I had checked the list of providers -- I'm in the greater Washington, DC area and I saw that the list contains several doctors in Richmond. Richard Barth is the one hand surgeon I know of in my immediate area who offers NA.

Again, many thanks.

Edited 06/07/21 17:41

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