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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My hands got worse after Dupuytren’s surgery, what can I do?

Strategy to avoid risks of Dupuytren hand surgery   

All surgery has risks. Even the most simple and direct surgery can result in an unexpected bad reaction.  These can occur due to human error and judgment issues, or simply for reasons that are unavoidable and totally unexpected.

Complications after open hand surgery for Dupuytren contracture  (palmar fasciectomy) is variously reported to occur in 17% to 41% of cases, clearly higher than for many other types of surgery.  While the side effect and complication rate for needle aponeurotomy (palmar fasciotomy) is much lower at 2 to 4%, this must be weighed against its much faster Dupuytren recurrence rate and the need for additional palmar fasciotomy surgery sooner and more often.

It is important to understand that chances for adverse reactions after either of these two types of hand operations are at least doubled when performed as a second or third Dupuytren surgery.  Simply stated:  1. The more often palmar fasciectomy or palmar fasciotomy are performed the riskier each succeeding surgery becomes, and 2. repeat hand surgery is performed because of the high rate of recurrence of Dupuytren contracture after surgery.  With each surgery normal anatomy changes and less useable tissue remains.  Sooner or later so little tissue is left for the next surgeon to use, until no more hand surgery can be done.

Avoid or delay palmar fasciectomy surgery with Alternative Medicine

Those considering a second or third Dupuytren surgery after a needle aponeurotomy (palmar fasciotomy) or open hand surgery (palmar fasciectomy), should be interested to consider natural Dupuytren treatment as a possible way to postpone or avoid another hand surgery.

To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

Medical researchers, Loos, Messina, and Bulstrod report successful outcomes of Dupuytren treatment using massage, exercise and traction, all without surgery.  Even so, not much interest is given to their work because research funding is always focused on high profile surgery and drug therapies. Natural therapies of Alternative Medicine are not a high profit way to treat Dupuytren contracture, although the Dupuytren Contracture Institute has been providing insight and assistance since 2002 to help people deal with their hand problems.

Not all people respond well to drugs and surgery, and not everyone responds to Alternative Medicine.  And just as no one in the practice of medicine can say with certainty that any drug or surgery will be successful, no guarantee can be offered that non-drug and non-surgical natural methods will assist your recovery. Even so, the advantage of using a simple and low cost Alternative Medicine approach is that when it does successfully assist the body to recover from a health problem, the need for drugs and surgery is lowered, delayed or eliminated.   Another major advantage is the well known low risk of natural therapy compared to drugs and surgery.

For those who have never had Dupuytren surgery, the conservative option is to undergo a short therapeutic trial of care with natural remedies first – rather than last – to possibly avoid hand surgery.  For those who have had one or two Dupuytren operations, the conservative option is still open but with reduced expectation.  In these cases the body has less normal tissue to work with; results cannot be as good as when surgery was never performed.

In the experience of the Dupuytren Contracture Institute working with those who have had one hand operation, it is possible to eliminate the need for a second surgery and cause doctors to change their recommendation for the need of a second surgery.  With a brief trial of Alternative Medicine treatment it is possible to make positive tissue change and either avoid or delay the need for surgery.

Rapid recurrence of Dupuytren contracture means more hand surgery later

Many who write on Dupuytren’s forums express the cavalier notion that they are willing to submit to needle aponeurotomy every few years even though recurrence is more rapid with this type of less invasive hand surgery.  They explain that they prefer NA because recovery is so rapid or they can use their hands in a few days with no rehabilitation. They fail to calculate that this does not necessarily happen each time needle aponeurotomy is done. They do not consider the risk of an adverse reaction increases with each surgery, preventing this approach to be used indefinitely.

For those who already have had one Dupuytren’s hand surgery and want to avoid another, this article presents possible avoidance options as well as the potential complications and risks of palmar fasciectomy, also known as Dupuytren’s contracture open hand surgery.

Bad reaction after Dupuytren’s surgery, what is next?

The idea that it is possible to correct a bad surgery with another surgery must be examined very closely.  While there must be cases where this works out well for the patient, extreme caution must be used to assure a bad situation is not made worse by additional irreversible tissue changes of compounded surgery.

First, get a second surgical opinion but not for the reason many people think. Patients typically approach a second medical opinion only to see if it agrees with the first.  This is often just another way of allowing two doctors to make a decision for a patient. The best use of a second doctor’s opinion is to receive additional medical information and a different view point to round out the thinking of the patient.  Both medical opinions should supply information to help the patient decide the next step to take.  It is the patient who must ultimately decide the best course of action to take to return to health.  When the patient does not feel capable of making that kind of decision, it is the fault of the doctor who has not provided adequate information to the patient.  Find another doctor who will talk to you and explain things in such a way that you can make this decision!

In no way is it suggested that a layperson can know more about the practice of medicine than the doctor.  Even so, the layperson must ask questions and receive answers from at least two doctors so she is able to make an informed and intelligent decision about her care – not the doctor.  A lazy patient does not get the best care.

It is the responsibility of the patient to assure that a second surgery is the best step to take – as it might be. Too often patients rely solely on the judgment of the first doctor they encounter to make important decisions for them.  This is not wise.

If you do not like the thought of additional Dupuytren surgery, for whatever reason, you can consider attempting Alternative Medicine treatment for a month or two or more to learn if your body is capable of reversing the abnormal hand contracture.  If it helps your situation and surgery is no longer indicated, look what you have gained.  If it does not help, you can have surgery knowing you have not been hasty, you have used conservative measures appropriately, and whatever reaction occurs from a second surgery was indeed unavoidable because less aggressive measures did not help you.

Suggestions to determine if your body is capable of changing the soft tissue contractures in the palm and fingers:

1. Learn about your Dupuytren problem from a different standpoint.  You were told you needed hand surgery by the MD who gave you the diagnosis of Dupuytren contracture.  Almost all internet information about Dupuytrens promotes surgery.  Go to the home page of the Dupuytren Contracture Institute for holistic information about day-to-day treatment. The information found on this website is unique because we present the idea that not all Dupuytrens needs surgery.

2.  Determine the most aggressive Dupuytren therapy plan you are comfortable following.  For best results do all that you can to help yourself.  Consider using what is called the “Large (Best) Plan” for personal treatment.  The “Medium (Better) Plan” is the most popular of the DCI plans.  The “Small (Good) Plan” is also well designed.  These three plans are found at the top of the page at Dupuytren treatment plans.   Any plan can be modified by subtracting or adding to suit your personal Dupuytren contracture treatment philosophy.  These plans are only examples of how to approach this problem, and have helped hundreds of people over the years.

3. Stop feeling discouraged. Read the Dupuytren Hand Bump Forum.  Get educated, motivated, and reminded that everyday around the world there are people who are actually beating their Dupuytren problem following the Alternative Medicine methods of the Dupuytren Contracture Institute.

Complications of open hand Dupuytren surgery (palmar fasciectomy)

No one, not even a surgeon, can predict the side effects and complications of a particular surgery – and that is the problem.  While many patients, even a majority, receive a palmar fasciectomy without an adverse reaction and no post-surgical complication at all, there are those who are worse after surgery.  The number or percent of adverse surgical cases is not important if you are one of the unlucky patients whose outcome is poor. The only bad outcome that matters is your own.

Keith Denkler, MD, in 2010 wrote, “Surgical Complications Associated with Fasciectomy for Dupuytren’s Disease: A 20-Year Review of the English Literature.”   His final comments,
“In conclusion, results of this study underscore the importance of
treating Dupuytren’s as an incurable genetic disease understanding that
surgical excision, fasciectomy, has a high rate of major and minor
complications. Surgeons must understand that while fasciectomy for
Dupuytren’s does offer a chance at long-term ‘straight’ fingers, there is
a high cost in terms of numbers of complications that are borne by the
patient.”

Because the hand is a highly complex and densely packed machine with practically no space separating very delicate nerves, blood vessels, muscles, ligaments, tendons, and fascia, the patient must carefully select the best surgeon for the best hand operation outcome.

The Dupuytren Contracture Institute is not against hand surgery.  DCI only suggests it is a prudent step to first try Alternative Medicine to learn if their Dupuytren soft tissue problem is partially or completely reversible, thus making surgery unnecessary.  If the need for Dupuytren hand surgery remains after natural methods has been unsuccessful, find the best surgeon possible.