Hyperplasia

Knuckle Pad

search

Knuckle Pad, Garrod's Pads, Knuckle Fibroma

  • See Also
  1. Palmar Fibromatosis
  2. Hand Dermatitis
  3. Nodular Tenosynovitis
  4. Subcutaneous Nodule
  5. Dermatofibroma
  • Epidemiology
  1. Peak age 30 to 60 years
  2. Gender: Slightly more common in males
  • Pathophysiology
  1. Benign fibromas affecting the knuckles on the dorsum of the hands and feet
  2. May form in reaction to repetitive Trauma or pressure at the affected knuckles
    1. Manual Labor
    2. Sports (e.g. boxing, Surfing)
    3. Musicians
    4. Chewing or sucking on knuckles
  • Symptoms
  1. Often asymptomatic, slow growing Nodules on knuckles of hands and feet
  2. Pruritus may be present
  • Signs
  1. Discrete, well-demarcated, firm, non-tender Nodules of variable size (up to centimeters in diameter)
  2. Hypopigmented Nodules in some cases
  3. Distribution (may be bilateral or unilateral, variable in number)
    1. PIP Joints (hands)
    2. Dorsal MCP and MTP Joints (hands, feet)
  • Associated Conditions
  1. Palmar Fibromatosis (Dupuytren's Disease)
  2. Peyronie's Disease
  3. Bart-Pumphrey Syndrome (Autosomal Dominant)
    1. Leukonychia
    2. Sensorineural Hearing Loss
    3. Palmoplantar keratoderma
  • Differential Diagnosis
  1. See Hand Dermatitis
  2. See Subcutaneous Nodule
  3. Dermatofibroma
  4. Nodular Tenosynovitis
  5. Gouty Tophi
  6. Rheumatoid Nodules
  7. Xanthoma
  • Management
  1. Avoid repetitive Trauma
  2. Avoid sucking or chewing on knucles
  3. Consider surgical excision of fibroma in large, bothersome or refractory cases
  • References
  1. Quip (2025) Am Fam Physician 111(6): 547-8