Garrod’s Pads Treatment and Dupuytren’s Contracture

Garrod’s Pads Treatment 

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Garrod’s pads and Dupuytren’s contracture treatment

Garrod's pads are often associated with Dupuytren's contracture. Garrod's knuckle pads are a fibromatosis of the hand. They are also called Dupuytren nodules, and safely treated with natural alternative medicine and no side effects. Since 2002, Dupuytren’s Contracture Institute has worked with over 800 people whose primary complaint was Garrod’s pads. In addition, DCI notes that Garrod’s knuckle pads occur in combination with Dupuytren’s contracture in 20-30% of people who come to DCI for help.  Combined, these two groups total of over 2,000 people with Garrod’s pads who have used DCI treatment. They totally eliminated or significantly reduced their knuckle deformity, or at least eliminated all pain and limitation it causes.

Based on the reports of natural treatment progress from people DCI works with, the results are very good to excellent.  DCI receives 8-10 reports of moderate to marked improvement of palm lumps and cords for each failure reported, when using the DCI large treatment plan. Improvement of dense and painful knuckle pads is even better. In fact, we often tell people that Garrod’s pads typically improve before they notice a change in their DC.

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Usually, people who use a large DCI treatment plan report that their Garrod’s pads respond faster than their Dupuytren’s contracture.

The typical Garrod’s knuckle pad responds to the large DCI treatment plan by becoming smaller, softer, less painful, less dark, as well as the fingers feeling less stiff and painful, in a few weeks. Rarely do we work with someone whose Garrod’s nodules show some degree or type of improvement.  How long treatment takes to reach complete and final improvement depends on a variety of factors like genetic predisposition, severity, age of the individual, duration, if hand surgery was used previously, etc.

While a few got a small amount of improvement, most benefitted to a moderate to great degree. Of course, all treatment was safe and natural. Without drugs or surgery, and no side effects.

About Garrod’s knuckle pads

Typically, Garrod’s knuckle pads are well-defined and smooth lumps or thickening on the dorsal (back) of one or more finger joints.  Garrod’s nodules or pads are a form of fibromatosis (excess collagen and fibrin production), just like Dupuytren’s contracture (palmar fibromatosis), Ledderhose syndrome (plantar fibromatosis) and Peyronie’s disease (penile fibromatosis).

Our records show every person with Garrod’s pads benefitted in some way by our natural treatment methods.

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Clinical features

A history of repetitive injury to this part of the hand from work or sports activity is often present.  However, it sometimes happens that Garrod’s knuckles develop without any physical explanation.

Knuckle pads can look like calluses on the skin, where the skin thickens and loses its elasticity. The cause of Garrod’s pads is excess fibrous tissue (collagen and fibrin) in or under the skin. Because this problem is a fibromatosis of the fingers, it usually runs in families, but can also appear as a sporadic occurrence.

Garrod’s pads can appear in one or both hands, at any or all fingers, one joint or many.

They mainly affect the PIP finger joint (joint closest to the hand).  Less often they appear at a knuckle (MCP or metacarpophalangeal/first joint) or distal interphalangeal (DIP/third) joint of a finger. In severe cases, this dark, raised and rough tissue can also appear away from the knuckles, on the sides of the hand or elsewhere on the upper extremity.  Some clinicians even apply the name to other parts of the body.  Although the hands are by far most commonly affected, other areas and joints, such as the feet and knees, may be involved.

When appearing along with Dupuytren’s contracture, Garrod pads usually suggests a more aggressive form of the Dupuytren disease problem.

In the U.S and the rest of the world knuckle pads are a common occurrence.  The prevalence of knuckle pads is difficult to determine because this problem often does not cause physical symptoms.  Thus, people do not often seek medical care for them. Knuckle pads can be present in any age group, with the most common in adults 40 years of age and older, especially males who engage in heavy manual labor.

Pain associated with knuckle pads

Pain associated with Garrod’s pads is greatly variable. For some people there is no pain.  Most, and for others the pain is intense and constant.  Further, for some, pain is only when touched or when the finger moves. This suggests a connection between the Garrod’s pad and the tendon sheath of the finger.

When firm, the knuckle pads or nodules may be only tender to palpation, otherwise they do not cause pain or other symptoms.   These nodules are closely adherent to the skin in Dupuytren contracture while movement of the nodule during finger flexion/extension suggests an association with the tendon sheath.

Treatment for Garrod’s pads  

Treatment for Garrod’s pad makes sense when knuckle pads cause pair or otherwise affect the use of the hand.  Surgery can be considered after safer conservative natural DCI treatment has not been successful.  Please read about the DCI treatment protocol.

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Dupuytren contracture recurrence after hand surgery

Recurrence of Dupuytren contracture is commonDupuytren contracture recurrence is the return of excessive collagen and fibrin into the palm after hand surgery.

Dupuytren contracture recurrence means that the abnormal palm and finger tissue comes back after surgical removal. For example, after surgically removing the palm lump, it grows back again.  And, after surgically straightening the bent finger to some degree, the finger cord grows back, pulling the finger down toward the palm again. This happens because this is the nature of Dupuytren disease. Excessive and spontaneous collagen production in the palm of the hand continues because surgery cannot stop it.

Recurrence of Dupuytren contracture after surgery is common and frequent.  This return of the Dupuytren contracture tissue is exactly why some people have 2-4, or more, hand surgeries. They always think the next surgery will solve their problem.

Surgeons admit that “sometimes the Dupuytren contracture returns within a few months after surgery.  Other times, it can return many years – even decades – later.”  It has been written, if a person lives long enough after hand surgery, the Dupuytren tissue will eventually return.

No Dupuytren contracture recurrence with natural treatment

Good news!  Based on reports from customers using the DCI large treatment plan, 8-10 people have moderate to marked reduction of palm lumps and finger cords, for every one who reports no change.  Since 2002, no one has ever reported a recurrence or worsening or side effect after improving their DC with the DCI treatment method.

The purpose of using natural Alternative Medicine treatment is to get that DC tissue healing, thus avoiding the need for any hand surgery. If you can get better on your own, there is no need to worry about Dupuytren contracture recurrence.

The DCI treatment system has saved countless people from needing hand surgery. Their fingers and palms improved enough with the DCI method that they, and their doctors, did not think surgery was still necessary.

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An old and common surgical problem  

The greatest French surgeon of the 19th century was Guillaume Dupuytren.  Even so, he also had patients whose palm lumps and finger contractures returned after hand surgery. He experimented with a variety of tactics and methods to minimize the return, but none were totally successful. Some things never change.

So, if Dupuytren contracture continues to be a problem during 300 years of surgery, what does that mean?  That they were all bad surgeons?  No, of course not.  Actually, even fantastic surgeons must deal with recurrence of Dupuytren contracture.  Fundamentally, the real problem is that Dupuytren disease is a nasty problem.  After surgery the patient still has Dupuytren disease.  And, of course, this means the patient still has the tendency to produce too much collagen and fibrin – even after surgical removal of the palm lump and finger cord.

Here is the nasty truth about Dupuytren contracture:  There is no way to get rid of it by cutting it out or dissolving it with Xiaflex (collagenase enzyme). It just keeps coming back.

Hand surgery to remove the palm lump and finger cord is like hitting a skunk with a stick to get it out of your garage. Forcing the skunk out just creates more trouble, and you get more of what you are trying to get rid of.

DCI thinks it is smarter and safer to get the skunk to leave quietly, naturally, so it does not cause any more stink.

People tell us about their Dupuytren contracture recurrence  

At DCI, we talk to many people about their Dupuytren problems. As you might suspect, the subject of Dupuytren contracture recurrence is a popular topic. Based on these conversations, we learn the average persons’ Dupuytren recurrence returns 2-3 years after surgery. It is not uncommon for recurrence to start in less than a year; some just a few months after hand surgery.  At the other extreme, other people say their DC took 5-10 years or more to return.

In addition, we discuss the actual condition of the hand when the DC returns. Do not assume that after returning, the Dupuytren problem will be the same as before surgery. Perhaps it might feel good for a few months, or even or year or so.  Eventually, the hand contracture will return. How good or bad the hand becomes depends ultimately on many different factors that are beyond the control of the doctor:

  1. Amount of normal and abnormal superficial and deep tissue that must be removed.
  2. Size of the palm lump and finger removed.
  3. How deeply the palm lump and finger cord has grown into the surrounding normal tissue.
  4. Where the palm lump and finger cord are located in relation to important blood vessels, muscles and nerves.
  5. If skin grafts are necessary to close the incisions, and if they heal well or get infected.

What happens after hand surgery?

After hand surgery, the patient still has Dupuytren disease.  Surgery only removes the thick contracted tissue; the disease remains.  Therefore, the patient’s hand can still produce an excessive amount of collagen and fibrin in that same area of the hand.  When it does, it is called Dupuytren contracture recurrence.

Removal of a large percent of tissue from the palm of the hand has consequences. It often results in a worse situation than before the hand surgery, for several reasons:

  1. Continued scar formation causes the palm to become even thicker and less flexible.
  2. Pain due to scar development after the removal of normal and abnormal tissue during surgery. It can be mild to severe, and occasional to constant.
  3. Numbness and tingling of the fingers and hand due to that same scar development.
  4. Permanence of some degree of finger joint stiffness. Seldom are fingers completely straightened after surgery.  And over time they stay flexed even more than before.
  5. Loss of muscle and valuable connective tissue with each surgery, causes weakness and awkwardness of finger and hand movement.

What is the possibility of recurrence

First of all, there is no way to accurately predict anything about Dupuytren recurrence after surgery. No one can say when recurrence will happen; how severe it might be; or what symptoms might develop.

However, a few statistical indicators suggest recurrence of Dupuytren contracture could happen sooner if one or more of the following is true:

  1. Finger joint flexion fixed at 30 degrees or more.
  2. One or more immediate family members also have DC.
  3. One or more ancestors are from northern Europe or Scandinavia.
  4. Younger than 60 years of age at onset of DC.
  5. Palm lump and finger cord are developing rapidly.
  6. History of diabetes or liver disease.

Final comment

In 1964 Weckesser stated, “In general, the longer the follow-up period [after Dupuytren’s disease surgery], the lower the percentage of good results.” This means that shortly after surgery the hand can feel and look pretty good.  However, as weeks and months pass, it is very common for the hand to tighten up again.  The results and benefits that looked so promising at first, fade and worsen. This return of the contracture ultimately causes more pain, numbness, weakness and other related problems.

Surgery for Dupuytren’s contracture only provides a temporary break from the contractures and other related complaints. The recurrence of Dupuytren contracture might not be too bad if the time of relief was long enough.  But this is not the case.

People usually say that the short period of relief they got from hand surgery is not worth what they went through.  They felt the risk of surgery, the pain, hours of rehab, cost, complications and side effects related to the surgery and subsequent complications related to Dupuytren contracture recurrence did not justify what they got out of it.

It is reasonable to first be conservative. Try a simple natural approach to help your body heal the DC tissue, and so naturally remove the Dupuytren tissue.  Better to work hard to avoid needing hand surgery if possible.  You can always have surgery later if it is still necessary.

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