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Rock climbing link to Dupuytren's disease (Read 56513 times)

Bonjoy

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 No, i'd think the opposite, the micro traumas being a result of more strain through less tissue rather than big holds jabbing into palms. Besides I never postulated that it was palmar fascia trauma caused by climbing that caused the predisposition to DC, it could be some other climbing related factor for all I know, such as increased normal growth in the area, or an increase in some metabolic substance in the area caused by the type of hand use.
 

GCW

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I think this is more likely.  We know it's myofibroblast related, and as I said above direct trauma hasn't been shown to cause it.  Dupuytren's is far more complex and much less well understood than many think.  For example, fingers involved.  Generally it's mostly ring and little, is this different in climbers?

Bonjoy

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 Yes they tend to be the first affected, which is why i'm not quick to jump to the conclusion that trauma is the initial stimulus, as these fingers are not exceptionally more likely to be injured than others. I see a relationship between climbing and DC, but I'm not suggesting it's as simple as climbing related trauma = DC.
 One possibility may be that small undetectable disease events occur in the hands of susceptible individuals at this location, but if unaggrevated pass without progressing to anything physically apparent, however due to climbers regularly stressing the area the likelyhood of one such event progressing and snowballing into DC is greatly increased. The fact that early radiotherapy has good results (ie remove one small nodule and sometime the condition is stopped for good) would suggest that the presence of DC affected tissue leads to more areas becoming affected.
 Enough dancing on this pinhead. You know and I both understand this as little as the next man and only marginally less than the experts.

GCW

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Don't sweat it BonJoy- even the experts ain't that expert on the field.  But there's a lot of good research going on at the moment.

Bottom line?  If you want treatment see a hand surgeon.

My original point was that the study quoted isn't of high quality and adds little to what we assume anyway.  I need to post more clearly.   :guilty:

Bonjoy

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Just ran a quick SCIENTIFIC study on the contacts in my mobile that I know have DC. Of the climbers 18.9% had DC (7 out of 37), as compared to 0% for the none climbers (0 out of 50 approx). Obviously not the most rigorous of studies but enough to convince me of a link

GCW

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Gotta love SCIENCE!!
So 18.9% compared to population mean of 5 to 25% depending on country (generally 5-15% of over 60s).  This is obviously a non-age/ gender etc matched grouping you have.  I assume they are young so I agree there's summat goin on.

I don't suppose you did a survey of how many and which fingers were involved?  Family history?  Laterlity?  I'm not taking the piss, I'm genuinely interested.  Oddly I was thinking about this earier this year.   :-\

Johnny Brown

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Cheers BJ. As you mentioned, I think nipping it in the bud will be worth some risk

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For example, fingers involved.  Generally it's mostly ring and little, is this different in climbers?

To the idle thinker, these aren't obviously the most stressed fingers in climbing. However I reckon 90% of those who pop a tendon do it on the A2 of the ring finger. I think this is also the tendon most commonly affected in Dupuytrens.

Teaboy

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Strange this should appear on here today as I was at the Jorvik Centre in York at the weekend reading about how it was indicative of Viking ancestry (passed down through the mothers lineage) which is good news as I've always thought I was Welsh. I've got one on my right hand, I'm 37 yrs old, been climbing 20 years and enjoy going out and quite nights in with a bottle of wine. Oops, wrong site!

GCW

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I think this is also the tendon most commonly affected in Dupuytrens.

Sorry to be anal, but the tendons are completely unaffected in Dupuytren's.  It's all fascia.

richdraws

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Have any of you fine freaky fellows affected by Dupuytren's disease been playing around on the rings? Particularly doing false grips work like muscle ups? I have a strong feeling mine was caused by still rings exercises. Currently it is only ever exacerbated by jug pulling types of climbing (usually indoor).

Monolith

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Good to hear that within climbing-related medical discourse, the crimp isn't getting a bad wrap for once.

SA Chris

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Strange this should appear on here today as I was at the Jorvik Centre in York at the weekend reading about how it was indicative of Viking ancestry (passed down through the mothers lineage) which is good news as I've always thought I was Welsh.

Mine is on my right hand, although i am (predominantly left handed). My family tree roots, however, disappear in Eastern Europe somewhere, so there is a vague possibility of Viking links.

Johnny Brown

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Ah, that explains my strong Nordic 'look'. Saw Dense last night, he has it too, the lumps I mean not the 'look'. Does that alter your phone stats Bonnos.

Bonjoy

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You think I have any old riff-raff in my phonebook?
Well yes actually it does, 8 out of 37 = 21%

GCW

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I wonder if locality (ie rock type you usually climb on) affects risk.  If we assume direct PF injury is contributory (which it may not be), sloper shufflers may be at higher risk, whereas crimpers' risk may be lower.
What about warm up/ down/ stretching routines?  Does a good palmar massage and warm-down stretch post-climb reduce your risk? 
Does taking NSAIDs peri-climb affect it? 
Do top end climbers drink more alcohol (which has been partially implicated)? 
Is there a greater genetic input in climbers?

As we said before, I'd love to look at this properly but with the incidence as it is you'd need a large sample size of high level climbers to assess all these variables.  Shame really, it's a fascinating subject and the mechanism(s) would be interesting stuff.

I'm coming to the conclusion that SCIENCE is losing out to common sense on this one.   :o

bobkatebob

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Are you guys talking about Dupuytren's contracture?
It's not really a disease (in terms that most people think of a disease) as it is not contagious. It's basically like a type of RSI.

My Mum had one and she was a Physio (she hasn't done any climbing or building work).

She had an op to sort hers out. Her hand is fine now. If your Dupuytren's contracture is getting worse it might be best to go to your GP to see what they can do before things get too bad.

GCW

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Are you guys talking about Dupuytren's contracture?
It's not really a disease (in terms that most people think of a disease) as it is not contagious. It's basically like a type of RSI.
Thanks for clearing that up.
Now RSI, there's another one........

bobkatebob

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Thanks for clearing that up.

Hmmmmm......I'm still getting used to the multiple page set up on UKB  :oops:

BillA

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Sorry for the intrusion - noticed this discussion and thought I'd throw some things out for info -

I have early DC - a single lump in one hand with some evidence of tissue thickening. While hereditary, I believe that mine was "kicked off" by some hand surgery for a broken thumb as it appeared shortly thereafter. There seems to be a link between DC and the healing process - which may be the climbing connection. It's also why the radical surgery often causes it to come back worse that before the surgery.

Surgery is one option. A rather new option is needle aponevrotomy where the cords are broken up and the fingers released (advanced DC causes the smaller fingers to curl in). Check out www.handcenter.org. The latest and greatest news is an injectable enzyme treatment that is in stage 3 clinical trials and is showing great promise. The treatment simply dissolves the tissue buildup. Google Auxilium Pharmaceuticals and AA4500 for info. Hopefully, the drug comes to market soon.

Cheers.

Bonjoy

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AA4500 is collagenase. Injections of it are not aimed at removing the scarred tissue, they are aimed at creating breaks in cord formations just like NA does mechanically. Although it sounds good superficially I am highly sceptical that it will be better for climbers than NA. As collagenase breaks down collagen, injections of it into the hand extremely close to pulleys and tendons (which are made to a large extent from collagen) is a very risky business.

GCW

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Had a brief look into this, thanks for reminding me BJ.  There's only one article I have seen directly assessing Dupuytren's with climbing, which is the one we're talking about.  I'm still not sure about their conclusion that
Quote
CONCLUSIONS: This study further strengthens the hypothesis that repetitive trauma to the palmar fascia predisposes to the development of Dupuytren's disease in men.

LIST of more applicable papers- again, nothing concrete. :shrug:  Mikkelsen did note an increase incidence of DC in patients with recurrent palmar trauma, way back in the day.  Fairly good samlpe size but I haven't read the full article so I can't comment in depth.

BonJoy, there's a fair few articles on your percutaneous needle fasciotomy, seem OK results from what I've read so far.  Recurrence is high as I said before, but that's nothing new. 

SA Chris

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Just had a session down the wall, and it's the first time it's actually bothered me during a session. Bugger. Guess it's pulling on big jugs, which i don't normally do outside.

So does it seem now that Glucosamine is a bad idea? I am sure in a thread on this subject a while back (which i can't find now?) indications seemed that it was a good idea?

GCW

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No evidence it helps, and it's aimed more at joint problems etc.  BUT, it may be worth a go.  Your problem is the bilkiness of the tissue which is susceptible to irritation eg when using jugs.  I suspect nothing will help that, apart from avoiding jugs at the wall.  Give it a try and see  :shrug: Let us know.  [takes a while to have any effect remember]

dave k

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Want to find out how progressed my symtoms are relative to others

1) 2 obvious lumps in RH, 2 less obvious in LH- RH have been there for atleast 3 years/LH for about 1
2) Little  impact on climbing- except indoors on one particular hold/problem (avoiding it)
3) Have been waking in the morning recently with numb, tight/contracted fingers (little and ring)-this could optimistically be to do with sleeping on my RH or just that I have been training on crimps too much. Within 5 mins after waking its fine

Anyone actually know of someone with serious symtoms and how long this took to develop?

Or someone who has had an operation on it and its effectiveness?

Bonjoy

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Sounds similar to my condition after 3 years. I've had for 7 year and I don't have any contracture to speak of, although there's plenty of nodules. I can't put my hand properly flat on a table on my right or bend fingers back beyond straight, but they all still straighten out fully and climbing is fine except for dynos which are painful and some slopers. I used to get numbness in the last two fingers but assumed this was due to ulner nerve impingement related to my sleeping posture.