Knuckle Pad

Aka: Knuckle Pad, Garrod's Pads, Knuckle Fibroma

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II. Epidemiology

  1. Peak age 30 to 60 years
  2. Gender: Slightly more common in males

III. 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

IV. Symptoms

  1. Often asymptomatic, slow growing Nodules on knuckles of hands and feet
  2. Pruritus may be present

V. 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)

VI. 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

VII. Differential Diagnosis

  1. See Hand Dermatitis
  2. See Subcutaneous Nodule
  3. Dermatofibroma
  4. Nodular Tenosynovitis
  5. Gouty Tophi
  6. Rheumatoid Nodules
  7. Xanthoma

VIII. Management

  1. Avoid repetitive Trauma
  2. Avoid sucking or chewing on knucles
  3. Consider surgical excision of fibroma in large, bothersome or refractory cases

IX. References

  1. Quip (2025) Am Fam Physician 111(6): 547-8

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