Morbus Dupuytren Flashcards
What is the anatomical location of Knuckle pads (Garrod’s pads)?
Knuckle pads are located on the dorsal aspect of the interphalangeal joints, particularly over the proximal interphalangeal (PIP) joints.
Research confirms they exclusively occur on the dorsal side, which is a key diagnostic feature distinguishing them from volar pathologies like Dupuytren’s contracture.
Do Knuckle pads typically restrict joint movement or cause extension contracture in the hand?
No, Knuckle pads generally do not restrict joint movement or cause extension contracture.
Clinical studies confirm they are usually asymptomatic and predominantly present cosmetic rather than functional concerns.
What histological feature defines Knuckle pads?
Knuckle pads are defined by fibroblastic proliferation, specifically active fibroblasts and myofibroblasts producing collagen-rich extracellular matrix. This histological hallmark is similar to Dupuytren’s nodules.
What is the pathological relationship between Knuckle pads and Dupuytren’s disease?
Knuckle pads frequently coexist with Dupuytren’s disease, particularly in patients with bilateral Dupuytren’s involvement. Research confirms this association, suggesting shared genetic or pathological mechanisms.
What is the standard management strategy for a patient presenting with Knuckle pads?
The standard management is conservative, involving observation and reassurance. Surgical excision is generally avoided due to high recurrence rates and limited symptomatic benefit.
A 45-year-old patient presents with painless, firm nodules over the dorsal PIP joints and a flexion contracture of the ring finger. What condition might be associated with these dorsal nodules?
The dorsal nodules are likely Knuckle pads, and the associated condition is Dupuytren’s disease causing the ring finger flexion contracture.
How does the histology of Knuckle pads differ from that of a callus in a patient with thickened skin over the PIP joints?
Knuckle pads exhibit fibroblastic proliferation with myofibroblasts and reduced elastic filaments, while a callus shows hyperkeratosis with a thickened stratum corneum.
Why is it critical to differentiate dorsal versus volar hand lesions in a patient with suspected Knuckle pads?
Differentiating dorsal from volar lesions aids in accurate diagnosis; Knuckle pads are exclusively dorsal, unlike Dupuytren’s contracture, which is volar.
What are the potential complications of surgically excising Knuckle pads in a patient requesting cosmetic improvement?
Surgical excision risks recurrence and keloidal scarring.
Long-term follow-up studies indicate these complications often outweigh cosmetic benefits.
In a patient with symptomatic Knuckle pads causing mild discomfort, what non-surgical interventions might be considered, and why?
Non-surgical options include emollient creams, intralesional steroids, or keratolytics. Clinical research supports these interventions for symptom relief while avoiding the high recurrence rates and scarring associated with surgical excision.
