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Garrod’s pads or knuckle pads

These are lumps on the dorsal (back) of the finger joints, mainly affecting the PIP joint (the finger joint closest to the hand), and less often the knuckle! They can look like calluses or plaques on the skin, where the skin thickens and loses its elasticity. They are caused by fibrous tissue in or under the skin. The thumb does not tend to be affected.

This person has a Garrod’s pad on the PIP joint of the left little finger.

People who have Garrod’s pads often have Dupuytren’s Contracture as well, but Garrod’s pads can also be unrelated and caused by repeated trauma to the joint (for instance repeated sports or work trauma). All calluses on a finger joint are called Garrod’s pads, but not all are Dupuytren’s related.

Usually the pads do not cause any problems and do not need any treatment, but sometimes they can be painful. Steroid injections or in rare cases radiotherapy might help. Surgery to remove the pads is likely to result in scarring, and is usually not recommended. Keratolytics (e.g. salicylic acid or urea) to soften the skin can also be helpful.

Recent research suggests that it is possible that Garrod’s Pads are completely different from Dupuytren’s nodules and that the supposed correlation has been a result of misdiagnosed dorsal Dupuytren’s nodes.

Dorsal Dupuytren’s Nodules

Nodule on the ring finger ( the top one in the picture), PIP joint (middle of the picture) on the site of the little finger (a bit darker in colour than the rest of the finger, due to cold weather)

These nodes on the back of the fingers were first described in the 1980’s. They are NOT Garrod’s pads, although they are often found in the same place, on joints in the finger. Dorsal nodules are found mainly on the PIP joint (the joint in the finger closest to the hand) of the index finger, with the little finger affected less often, the others even less, and the thumb does not tend to be affected. One study showed these lumps in about 20% of Dupuytren’s patients. Like all Dupuytren’s nodules they may be painful or cause contracture.

If they cause a contracture on the tendon on the back of the hand, first the finger will feel tight when making a fist, then making fist will become harder over time. As dorsal nodules progress they can make it painful and sometimes impossible to form a fist at all, whereas nodules on the front of the hand make the finger bend towards the palm. Garrod’s pads don’t tend to cause any problems.