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06/08/2009 12:14
patandpaula 
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06/08/2009 12:14
patandpaula
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Re: New to this Site
Dr. Lewis, have you done NA on any pinkie fingers that only had nodules and no apparent cord? Or for that matter, any finger that only had a nodule that was causing contracture? I have been told the same that they cant do NA unless there is a cord coming down or up causing the finger to contract, and when it is only a nodule, there is nothing that can be done.
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06/09/2009 23:32
donlewismd 
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06/09/2009 23:32
donlewismd
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Re: New to this Site
I have done NA on many patients with mostly PIP involvement. Some have worked very well, and others no so well, but most have had some level of improvement. All providers agree that the PIP success is lower, as with open surgery and collagenase also. There probably is a higher risk of nerve/artery injury at the PIP level with any treatment.
That being said, I have done many quite successfully, but nothing in medicine is 100%! Isolated cords are always easier, and the more nodules or complex contractures tend to lessen results. Nodules will always remain present after NA as the procedure does not remove tissue as with open surgery. If I were you I would try NA as a first line and use open surgery as a backup if you are not happy.
Don Lewis, MD
www.dupuytrens.biz
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06/10/2009 13:08
Dell
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06/10/2009 13:08
Dell
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Re: New to this Site
Oops, I was wrong. My left ring finger is not bending at the PIP joint but at the DIP joint, the most distal joint, closest to the fingertip. Perhaps this is why Dr. Denkler said that NA won't help, as I sent him a photo.
Dr. Lewis, is NA effective on this joint? It isn't terribly bent yet. I notice it most when I'm using the keyboard. I'm bothered primarily by the deep ache in my palm. The cord and puckering there is moderately pronounced.
Many thanks.
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06/10/2009 20:06
donlewismd
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06/10/2009 20:06
donlewismd
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DIP
I have not done NA on patients with DIP involvement, as this is quite rare. I have done them open and it is well documented that DIP surgery does not do well, so I would extrapolate similar results to NA. I would be willing to try but there are risks of digital nerve injury and failure to improve as with PIPs.
Don Lewis, MD
www.dupuytrens.biz
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