Misclassifying climber adaptation: dorsal PIP synovial thickening in asymptomatic rock climbers meets ultrasound criteria for synovitis.
7 affiliations
- 1Anatomy and Physiology Department, Rocky Mountain University of Health Professions, Provo, Utah, USA.
- 2Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA.
- 3Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA.
- 4The Climb Clinic, Golden, Colorado, USA.
- 5Physical Therapy, Deustuko Unibersitatea, Bilbao, Spain.
- 6Orthopedic and Trauma Surgery, Sportsmedicine, Klinikum Bamberg, Bamberg, Germany.
- 7Radiology and Imaging Sciences, University of Utah Health, Salt Lake City, Utah, USA.
Abstract
Objectives
To establish normative sonographic values for proximal interphalangeal (PIP) joint synovium, effusion and cartilage in asymptomatic adult rock climbers and to assess whether rheumatoid arthritis-derived ultrasound criteria misclassify normal climber adaptation as pathology.Methods
Cross-sectional study of 160 asymptomatic adults (80 climbers with ≥5 years' experience, 80 non-climbing controls) recruited from a sports medicine clinic in Salt Lake City, USA. Long-axis greyscale ultrasound of the middle and ring finger PIP joints measured dorsal synovium at the middle phalangeal base and the proximal phalangeal neck (dorsal recess), dorsal effusion, volar cartilage and volar effusion at 0° and 90° flexion. Images were measured by a blinded investigator. Groups were compared by Welch's t-tests (Bonferroni threshold p<0.004); years of climbing were tested as an exposure proxy.Results
Groups were matched for age, sex and hand scanned. Climbers had greater synovial thickness and effusion at every landmark (all p<0.0001). The most discriminating measure was dorsal synovium at the proximal phalangeal neck: 2.08±0.29 mm in climbers versus 0.97±0.15 mm in controls (middle finger). Volar cartilage did not differ (both p=0.32), flexion to 90° produced a negligible (≤0.03 mm) increase in volar effusion and years of climbing were unrelated to synovial thickness.Conclusions
Asymptomatic climbers have baseline PIP synovial thickening meeting McNally greyscale criteria for grade 1-2 synovitis despite absent symptoms and preserved cartilage. The dorsal recess at the proximal phalangeal neck is the site at which standard criteria most consistently misclassify climbers and is proposed as the primary reference landmark; climber-specific thresholds are required.
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BibTeX
@article{farley2026misclassifying,
title = {{Misclassifying climber adaptation: dorsal PIP synovial thickening in asymptomatic rock climbers meets ultrasound criteria for synovitis.}},
author = {Jedidiah Farley and Jared Vagy and Kevin Cowell and Xeber Iruretagoiena and Volker Rainer Schöffl and Paulo Miro},
journal = {BMJ open sport \& exercise medicine},
year = {2026},
month = oct,
doi = {10.1136/bmjsem-2026-003509},
url = {https://europepmc.org/article/MED/42968941},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Misclassifying climber adaptation: dorsal PIP synovial thickening in asymptomatic rock climbers meets ultrasound criteria for synovitis.
AU - Jedidiah Farley
AU - Jared Vagy
AU - Kevin Cowell
AU - Xeber Iruretagoiena
AU - Volker Rainer Schöffl
AU - Paulo Miro
PY - 2026
DA - 2026/10/28
JO - BMJ open sport & exercise medicine
DO - 10.1136/bmjsem-2026-003509
UR - https://europepmc.org/article/MED/42968941
AB - Objectives To establish normative sonographic values for proximal interphalangeal (PIP) joint synovium, effusion and cartilage in asymptomatic adult rock climbers and to assess whether rheumatoid arthritis-derived ultrasound criteria misclassify normal climber adaptation as pathology.Methods Cross-sectional study of 160 asymptomatic adults (80 climbers with ≥5 years' experience, 80 non-climbing controls) recruited from a sports medicine clinic in Salt Lake City, USA. Long-axis greyscale ultrasound of the middle and ring finger PIP joints measured dorsal synovium at the middle phalangeal base and the proximal phalangeal neck (dorsal recess), dorsal effusion, volar cartilage and volar effusion at 0° and 90° flexion. Images were measured by a blinded investigator. Groups were compared by Welch's t-tests (Bonferroni threshold p<0.004); years of climbing were tested as an exposure proxy.Results Groups were matched for age, sex and hand scanned. Climbers had greater synovial thickness and effusion at every landmark (all p<0.0001). The most discriminating measure was dorsal synovium at the proximal phalangeal neck: 2.08±0.29 mm in climbers versus 0.97±0.15 mm in controls (middle finger). Volar cartilage did not differ (both p=0.32), flexion to 90° produced a negligible (≤0.03 mm) increase in volar effusion and years of climbing were unrelated to synovial thickness.Conclusions Asymptomatic climbers have baseline PIP synovial thickening meeting McNally greyscale criteria for grade 1-2 synovitis despite absent symptoms and preserved cartilage. The dorsal recess at the proximal phalangeal neck is the site at which standard criteria most consistently misclassify climbers and is proposed as the primary reference landmark; climber-specific thresholds are required.
SN - 2055-7647
ER -