[slackline]

What are the odds of a big study into a climbing link to DC?

N = 498...

A J Logan, G Mason, J Dias, N Makwana (2005) Can rock climbing lead to Dupuytren’s disease? Br J Sports Med 39:639-644 doi:10.1136/bjsm.2004.015792 Alternative PDF

Note the section on sources of bias with 60% of contractures being self-reported and not clinically diagnosed/confirmed.  The authors note the potential for bias in respondents too.

Cites previous work for those interested (PDFs can probably be found in the normal way, i.e. Google Scholar).

[haydn jones]

Pretty sure i've got the the first sign of a nodule on my palm ring finger tendon, sometimes hurts when i grabobjects like  poles and door handles ect or if i just catch it wrong, but gives me no pain when i crimp ect.

theres a a distinct lump there that i've had for a couple of months and one thing i've noticed is that the skin on the lump does not sweat at all, anyone else noticed this?

anyway, I know its a slow disease but how slow is slow, will it be 10years before i have to get "the snip" or 50? ect
or does it change from person to person

[haydn jones]

just reading through the comments i saw SA chris also had a callous form on top of his lump, interesting, i wonder why that happens...

[galpinos]

anyway, I know its a slow disease but how slow is slow, will it be 10years before i have to get "the snip" or 50? ect
or does it change from person to person

Since first noticing it 10 years ago mine has got no worse really, however I climb neither as hard nor as often as you.

I do have it in the family though (bad case in my father thought to be made worse by bowling at the time....)

[Johnny Brown]

Similar, ten years little change. Get in the habit of massaging it occasionally and stretching your fingers back. I think BJ's got considerably worse over the same period, though it started when he was younger.

[Bonjoy]

Yeah, it's massively variable between individuals. I know a few other climbers who have got to the Op stage within approx ten years of getting first signs, but I know many more than that who have been luckier and had much slower development.

[haydn jones]

so is massage and stretching everyday (already do this from just doing my climbing rehab excercises) actually meant to stave off the contracture?

[slackline]

Go and see a hand specialist.

[duncan]

just reading through the comments i saw SA chris also had a callous form on top of his lump, interesting, i wonder why that happens...

A callous is a protective adaptation to abrasion and mechanical stress. A harder cord in the fascia would increase the mechanical stress on the overlying skin.

so is massage and stretching everyday (already do this from just doing my climbing rehab excercises) actually meant to stave off the contracture?

Evidence - which I don't have to hand (!) - is that gentle continuous stretching from a splint doesn't make any difference. However studies had small numbers of participants and were of short duration so this finding was almost inevitable. I doubt if doing gentle stretches and self-massage gently will do any harm.

What slackers said of course.

[Johnny Brown]

I bet all you'll get from a hand specialist (assuming you can get a referral) is 'Hmmm, we'll have to wait and see. Come back if it gets worse.'

[fried]

I thought I'd read that massaging isn't recommended, I'll try and find some links.

[Johnny Brown]

My physio reckoned it wouldn't do any harm, and might help. I don't go mad, just when it irritates me.

The only thing that seem to affect it is Vitamin C intake. Hit the berocca after a cold and it flares up.

[Lund]

Hit the berocca after a cold and it flares up.

No point you doing that.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000980.pub4/abstract

[petejh]

I've had 3 lumps on the pinky and ring tendons on the RH and 1 on the LH for over ten years and which seem to have remained stable. Occasionally they tighten up and I massage them hard with the knuckles. One of the treatments is breaking them up with a big fuck-off needle so I figure massaging them hard can't do any more harm than that.

[Paul B]

I've had what I believe to be a contracture in my LH for about 7-8 years now and since the initial pain and settling down period it has been fairly stable and without issue.

However, I'm now developing the same in my RH and it hasn't yet settled and is causing quite a lot of pain and general weakness in the back half of my hand (shaking hands for instance is very painful). I'm also finding that it seems to be affecting the joint nearest my hand on my ring finger which feels constantly under tension.

My LH issues were worst after my Euro climbing trip, pocketed venues seemed to really aggravate things and my RH issues first appeared after a stint of pocket climbing.

I try not to massage or stretch the nodules as that seemed to slow the stabilisation in my LH (he says with no benchmark), I'm assuming climbing regularly provides enough breakdown/stretching.

[Johnny Brown]

Hit the berocca after a cold and it flares up.

No point you doing that.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000980.pub4/abstract

Doesn't look like you read that very well:

The failure of vitamin C supplementation to reduce the incidence of colds in the general population indicates that routine vitamin C supplementation is not justified, yet vitamin C may be useful for people exposed to brief periods of severe physical exercise. Regular supplementation trials have shown that vitamin C reduces the duration of colds, but this was not replicated in the few therapeutic trials that have been carried out. Nevertheless, given the consistent effect of vitamin C on the duration and severity of colds in the regular supplementation studies, and the low cost and safety, it may be worthwhile for common cold patients to test on an individual basis whether therapeutic vitamin C is beneficial for them. Further therapeutic RCTs are warranted.

Bearing in mind I don't eat any fruit or veg.

[slackline]

I bet all you'll get from a hand specialist (assuming you can get a referral) is 'Hmmm, we'll have to wait and see. Come back if it gets worse.'

Personally I'd rather that (with correct monitoring) than an Internet diagnosis.

[Bonjoy]

Each to their own, but I think your position looks rather kneejerk for someone who believes in evidence based behaviour. On the one hand you have a mixed bag of ‘hand experts’ of varying levels of experience, many/most of whom outside of Sheffield will most usually have come across DC in elderly white men and alchoholics. Read around on the subject and it looks like a large proportion of  the ‘experts’ will channel you toward open hand surgery without pointing out or discussing the pros/cons of the (IMO better) needle op. I tend to think this is because they generally deal with elderly sufferers so aren’t used to dealing with people who will have to manage this condition for a fair proportion of their lifespan rather than a decade or two at the end. On the other hand you have a mixed bag of climbers with varying levels of experience of the condition the therapies and how these relate to the hand intensive activity of rock climbing; many of whom are quite bright and have looked into the subject at length and consulted with ‘hand experts’ of all colours. IMO there is definitely value in the wisdom of the crowd in instances like this which relate to a very specific interaction between a physical activity and a disease. Academic knowledge does not always trump firsthand experience. Surely it’s a case of taking every source of info on its own merits anyway. But each to his own.

[Oldmanmatt]

It's been five years since I noticed it.
Ring finger on both hands, but way more pronounced on the left.
No real change. No real problems except occasional over abrasion issues after too much granite sloper action...

[slackline]

Each to their own, but I think your position looks rather kneejerk for someone who believes in evidence based behaviour. On the one hand you have a mixed bag of ‘hand experts’ of varying levels of experience, many/most of whom outside of Sheffield will most usually have come across DC in elderly white men and alchoholics. Read around on the subject and it looks like a large proportion of  the ‘experts’ will channel you toward open hand surgery without pointing out or discussing the pros/cons of the (IMO better) needle op. I tend to think this is because they generally deal with elderly sufferers so aren’t used to dealing with people who will have to manage this condition for a fair proportion of their lifespan rather than a decade or two at the end. On the other hand you have a mixed bag of climbers with varying levels of experience of the condition the therapies and how these relate to the hand intensive activity of rock climbing; many of whom are quite bright and have looked into the subject at length and consulted with ‘hand experts’ of all colours. IMO there is definitely value in the wisdom of the crowd in instances like this which relate to a very specific interaction between a physical activity and a disease. Academic knowledge does not always trump firsthand experience. Surely it’s a case of taking every source of info on its own merits anyway. But each to his own.

I've no problem with taking every source of information and judging it on its own merits that is as you say a good thing.

The problem I have with people posting on forums in the style Haydn has done is there is no indication that any other source of opinion is being sought in conjunction with this, which is why I suggested seeing an expert who will have plenty of first hand experience not only of old alcoholic Caucasian males but also, if this thread is anything to go by, increasingly climbers.  Haydn hasn't even posted a picture of the affected site as Matt has sensibly done so that others can actually see what is being talked about.

It is useful this thread exists, as well as other things such as POD's article of his experience.

If my post comes across as overly zealous for seeking a trained professionals opinion its simply because there is no evidence from many posting here that it has been sought in conjunction with posting in this thread, although if I remember correctly without re-reading the whole thread you have done and have also perhaps received needle treatment.  With the particular post you responded to I genuinely think that documenting disease progression is worthwhile, and something all of those with concerns should be doing to take to the 'expert' when they decide to go.  Without photographing at regular intervals (ideally medical imaging so its consistent over time) there is huge bias in an individuals ability to recall the stages of progression.  I've a friend who suffer from crippling bad backs, it comes and goes, and he can't work out what aggrivates it, my suggestion, keep a diary of your daily activities and see if any patterns emerge.

This isn't that dissimilar to keeping a training or climbing diary of what you have done, since minds are fallible and easily biased.

Given everyones vested interest I genuinely think, as I recall I've written before in this thread, that those seeking treatment should speak to the medical experts who are treating them and encourage them to investigate the epidemiology further given the increased participation in Rock Climbing and perhaps, if the anecdotal evidence being posted here might suggest, in turn incidence of Dupuytren's Contracture in the sub-population of those who engage in rock climbing.

With regards to being channelled towards hand surgery by 'experts' that is likely because at present that is the treatment for which there is the most evidence to support its efficacy.  In comparison the needle treatment was only developed ~20 years ago according to PODs article and as such there is less evidence to support its efficacy.  Thats not to say it should be ignored, rather, as McLeod advocates in his new book, you should discuss your knowledge of the area (in this case the possibility of needle therapy) with your consultant and explore the options.  I didn't suggest blindly taking the advice of an 'expert', rather that their opinion should be sought.  As with the epidemiological aspects they may actually be interested in conducting a clinical trial to compare the efficacy of the two (or more) treatments to improve the body of knowledge as to best practice for treating the condition.  This wouldn't be hugely dissimilar to how many other areas of treatment investigate and test the efficacy of competing treatments, for example this study comparing two methods of surgery for hemorrhoids that I'm working on.

I may be able to contact an old colleague who I did some work with who was a plastic surgeon and worked on Dupytren's (he was looking at gene expression profiling in the affected areas) if anyone is interested (no idea if he will be).

But each to their own.

[Bonjoy]

I agree with most of that but I can’t see anything wrong with asking around your peer group prior to seeking specialist advice, especially if a condition is common among them. If it is DC, which is probable, then it is very slow progressing even at worse. Given this rate of progress I’d rate talking to folk who do the same thing as you, and who say they have the thing you think you might have, as a very logical first step. I can’t see anything in what Haydn wrote which suggested this was the end of his information gathering.

[slackline]

And at the same time there was nothing suggesting further information was going to be gathered which is why I suggested seeking it.

Its the same with every field, you could learn a lot about Statistics or Rope Access Techniques searching the internet and asking on forums, but when it comes to getting the job(s) done professional qualified/certified 'experts' are consulted and employed for their 'expert' knowledge.

[Bonjoy]

Well there you go. I'm joint head of rope access at our company and if I wanted a rope access job done on my house (if I had a huge house and didn't have time to do the job myself that is), I'd get a friend who I knew first hand was capable to do it rather than call in a qualified professional who I knew nothing about. Whether they held a current IRATA cert would be by the by. This is all rather hair splitting though I think. My point is that unauthorised sources of info are often as good or better than the authorised ones and it's easier to weigh up info from people you know rather than people you don't. I perceive a degree of professional inertia in the way DC is dealt with and as such, personal research, which can easily be dismissed as the dreaded 'internet diagnosis', is of high value.
Case in point: I recently spoke to a climber of roughly my age who I hadn't been in touch with for years. They called me out of the blue after being advised by a 'hand expert' to have open hand surgery. I told them my experience and the pros and cons of the two main options as I saw them. After going away and doing some more research and getting a consultation with the guy I had suggested they opted for the needle procedure. So far they are very happy with the outcome. There is no way of proving they got a better outcome as a result of the discussion, but I think they have, and they probably agree.
Likewise I only went for this option after speaking to a climber who had had open hand surgery on one hand and the needle op on the other. The former had been a disaster and the latter had been painless and effective. I know it's only a sample size of one, but it meant a whole lot more to me than a load of assurances from an expert with no direct reference to climbers.

[corset1975]

Just to add my two pennys worth. I am 39 with a family with no history of Depuytrens at all. About 5 years ago my hands started to curl and nodules began to appear, it was painfull to drive and my my little fingers were beginning to curl in.
I have been climbing for about 20years (badly) and consider myself heavy or fat, as you view it,  i weigh about 15stone and am 6ft 2 hall. I mainly boulder and as such i think my fingers have had a lot of strain above the national average. On top of that i enjoy wood working (i live a sad and boring life) which has a high level of hand impact trauma from hand tools etc.
I went to the NHS they said they would operate at 45 degrees bend. Which is a joke. I went to the a hand specialist down in essex (forgotton his name will have to look it up) and he was fairly open  about options he said that the needling does work but its best at slowing the symptoms and doesnt work for everyone. I personally couldnt see the point (no joke)
My symptons were early onset so I opted for radio therapy which was a bit scary but the risks seem low. I had two treatments 8 weeks apart over a week taking about 15mins each day. Initially all i got was a red dry palm but.....
two years on all my hard nodules seem to have softened, the constant tight sensation has gone, my fingers seem to be straighter and if you lay your fingers on a desk i can lift indiviually fingers that i couldnt before (depruytrens test). I can detect no new nodules developing. Evidence from germany seems to suggest that if treaated early this can can delay by 20-30 years but then again another report may contradict it.
Personally very happy but for all i know if i had done nothing they may not have got any worse....

[slackline]

I had an inkling you did rope access which is why I chose it as an example (I recall your pictures of working on the London Eye).

Using your friends is conditional on you knowing that your friends are capable/qualified.  Same is true of your long lost friend, they knew you had direct experience and clearly valued your opinion.

Nothing wrong with this at all if people are happy with that.

And you're right it is splitting hairs, but I felt Adams comment was  glib and read on its own implied not to bother seeking out a hand expert.  In the absence of any other form of advice being offered, or mention from Haydn that other avenues had been sought, I was suggesting that relying on an internet diagnosis alone without even having posted a picture for others to see the affected as Adam seemed to be suggesting might be unwise and to seek the opinion of a professional as well.

I think it will be really interesting to see how people's nodules develop over time and would encourage everyone who is suffering from contractures to get a confirmed diagnosis and to track their disease progression themselves with regular photographs (they'll be of some use when it comes to disscussing treatment).  It really would be great if more research could be done on the topic and I'd encourage anyone who is going to see a doctor or hand specialist to go armed with as much information as you can find, from this thread and elsewhere and ask them if they have any plans to do research on the sub-group of climbers who appear to be suffering from slightly higher incidence than the general population.