Eric Schulz, a fish data specialist for Portland General Electric who lives in Madras, Ore., noticed a lump forming under the skin on his right palm about 10 years ago. Gradually, his little and third finger contracted.
"It became a problem three or four years ago," Schulz said, when the disease progressed. The ailment, Dupuytren's disease (pronounced DOO-pa-trens), thickens the hand's connective tissue, creating nodules and cords and often drawing the fingers permanently into the palm, which eventually can be disabling.
"I worked around it, but sometimes it hurt," he said. "You can't wash your hands. There was a computer function that I couldn't do. I just got tired of it."
He could have undergone hand surgery, as thousands of Dupuytren's sufferers have, enduring swollen fingers and pain for weeks before his hand recovered.
But on Oct. 12, Schulz straightened his fingers with ease almost immediately after Dr. David Kline in Ontario performed a 30-minute procedure.
Kline, who also has the disease, first saw the procedure in a French basement when it was performed on him by the doctor who created it.
The needle release cost Schulz much less than conventional hand surgery: $650 per finger compared with about $10,000 for standard surgery.
Kline, an Ontario emergency room physician, is one of just seven U.S. doctors who specialize in needle aponeurotomy, a procedure in which the beveled tip of an ordinary hypodermic needle is inserted in the palm or finger to sever the diseased cords causing the contraction.
The procedure, done with a local anesthetic, was developed about 30 years ago by French rheumatologist Dr. Jean-Luc Lermusiaux at Lariboisiere Hospital in Paris, where Kline trained in 2005.
It is widely used in Europe, but has been slow to become known and accepted in the United States, as has radiation treatment for early onset Dupuytren's (see box at right).
Reagan, Thatcher and Captain Hook
"Hand surgeons don't really respect it," said Kline, who refers to needle aponeurotomy as a nonsurgical procedure because no incision is made.
Hand surgeons say they are cautious about recommending needle aponeurotomy or oppose the procedure as too risky.
At least one says the procedure is surgery.
"You're still making holes," said Dr. Lisa Rendon, a hand surgeon with Idaho Hand and Wrist in Boise.
"You're still cutting. There still is high risk with it. There can be complications."
The disease is named for Baron Guillaume Dupuytren, Napoleon's surgeon, who was one of the first to define it in 1831. The cause is unknown. It is most prevalent among people of northern European descent.
President Ronald Reagan and former British Prime Minister Margaret Thatcher had it. James Barrie, author of "Peter Pan," had a contracture of his right hand thought to be Dupuytren's and said to be the inspiration for Captain Hook's hook.
Pros and cons of surgery
In the United States, an estimated 3 percent of people have Dupuytren's, and one in four middle-aged or elderly people will develop the disease in their hands or feet, where it's called Lederhose disease, doctors say.
Hand surgeons frequently recommend varying degrees of surgery, from small incisions through which the contracted tissue is cut with a scalpel to fully open surgery where the fascia — the connective tissue — is removed.
The decision depends on the progression of the disease and the patient, doctors say. Sometimes the skin at the site is replaced with a skin graft.
"Hand surgery is painful, has a long recovery, and greater potential for infection," Kline said. "It can only be done once or twice."
The chance of the disease recurring is about 40 percent with surgery and 50 percent with the needle aponeurotomy, he said.
Hand doctors said the advantage of opening up the hand instead of going in blind with a needle is that the surgeon can see what is being cut and is less likely to hit a nerve or tendon.
"You can divide a nerve," Rendon said. "You can injure a nerve. You can even divide some of the tendons."
RATE OF COMPLICATIONS LOW, DOCTORS SAY
Rendon said she has performed needle aponeurotomies in a few cases when the patient has a lifestyle constraint, such as a musician who plays in an orchestra and wants the least invasive treatment or someone who can't tolerate major surgery.
"In certain situations, either technique can be successful," Rendon said. "A lot has to do with the patient's choice. As more patients hear about it, it will probably be in more demand."
But Rendon cautions that hand surgeons have specialized knowledge and training in the anatomy of the hand, and she would recommend that any doctor doing needle aponeurotomies have the same competency level.
Doctors who have performed thousands of needle aponeurotomies say their procedures have comparable or lower rates of complications than surgeries.
When Lermusiaux's group reviewed the results of almost 4,000 needle procedures in 1995, they found less than 1 percent resulted in nerve injury, and the occurrence of infection, bleeding and tendon injury was even less. The Hand Center in Florida said its incident rate is less than 0.2 percent.
Of 1,300 procedures Kline has performed in the past few years, he said there were no infections and only one case in which a tendon ruptured. Patients come from across the United States and other countries, he said.
Emergency room doctor has surgery
Pain is minimal, and healing time is much less, about 24 hours with no heavy lifting for at least a week with the needle, compared with months of not using the hand and undergoing therapy after surgery, he said.
Kaye Cloud, a Montana horsewoman and massage therapist, says needle aponeurotomy helped her. Standard surgery would have forced her to refinance her home, she said. She flew to Ontario Oct. 12 to have Kline straighten her ring finger.
"I would have had to refinance my home to pay for it," Cloud said. "This is such a great alternative."
Kline has had the needle procedure twice — the first time in 2002 in Paris, where he paid 40 Euros, about $55, for a 15-minute procedure that set him free from 10 years of contracted fingers, which made it difficult to play guitar or put his hands in his pockets.
"As an ER doctor, I couldn't be out of work six months," he said.
There is no limit to the number of times a patient can have needle aponeurotomy done, Kline said.
"This is really a good technique," he said. "You can repeat it until you're dead."
Schulz said he was amazed by the results.
"That's great," Schulz said as he bent and straightened his fingers just after his procedure finished. "I think it's going to be fine."
Sandra Forester: 377-6464
The Idaho Statesman is pleased to offer this opportunity to share information and observations about what's in the news. Some comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate but ask that you remain on topic. Comments that are profane, personal attacks or otherwise inappropriate are subject to removal.
@Nyx.CommentBody@