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.

Start  Dupuytren’s contracture treatment  

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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How to Reverse Dupuytren’s Contracture

How to reverse Dupuytren’s contracture

Can Dupuytren’s contracture be reversed, really?  

Reverse Dupuytren's contracture to stop growth and development, by supporting ability to heal better.First, before answering this question, it is important to explain what it means to reverse Dupuytren’s contracture (DC).

Medical literature explains the usual progression of DC in detail.  It describes how growth of the palm lump, or finger cord, can stop and slow down as it develops.  Further, these changes can go so far that the Dupuytren’s contracture even self-heals in its early stages.  This can take place over a span of many months, or even years.  This variable development of DC occurs only because the body can affect the fibrous DC tissue.  That being the case, these minor and brief changes can go as far as being able to self-heal or reverse Dupuytren’s contracture.

It is reasonable to look upon this stopping, slowing and reversing of Dupuytren’s contracture as an incomplete or failed healing.  The body always tries to be well.  Accordingly, the body is programmed to heal itself to the best of its ability. It is how we survive. Sometimes the healing works, and sometimes it does not.  For this reason, the best and easiest way to reverse Dupuytren’s contracture is to help the body heal itself.  Using the DCI treatment strategy increases the odds for the body to do a better job of healing and repair. Think of it as a way of taking advantage of a natural process that needs a little help.

Body is smarter than science

There is a lot that science does not know.  Science still does not completely understand how the body does the thousands of common daily activities, like:

  • Making a red blood cell
  • Digesting food
  • Regulating blood pressure
  • Thinking a thought
  • Mending a broken bone

Specifically, medical science freely admits it knows little about DC.  It is not necessary for science to understand how the body self-heals DC.  The DCI encourages how the body reverses Dupuytren’s contracture, even if the process is a mystery.

Help the body reverse Dupuytren’s contracture, naturally

The DCI therapy method is simple and direct.  Supplying certain vitamins, minerals and enzymes floods the problem tissue with what it needs to heal most effectively.   A few dietary changes and external therapies support healing further. The idea is to assist the body to repair a little better than it is currently, and in this way reverse Dupuytren’s contracture.

DC is a tough and stubborn problem. A general going into war will use as many different weapons from different directions, as possible. DCI does something similar.  It is not a small effort to reverse Dupuytren’s contracture.  It requires intense and aggressive treatment effort, from different directions, to support successful healing.

Once you see how to stop Dupuytren’s contracture, it is not complicated, and makes sense.  Brief outline of DCI treatment method:

  1. Dietary avoidance – Strictly avoid those foods that give you digestive trouble. Keep your digestive tract happy. In this way, there is improved absorption of necessary nutrients for better healing.
    A.  Any specific food sensitivity.  Examples:
    1) Onions                                             2) Spicy, hot foods
    3) Pizza                                                4) Sea food
    5) Pickles                                             6) Nuts, etc.
    B.  General or broad food sensitivity.  Examples:
    1)  Gluten                                            2)  Carbohydrates
    3)  MSG                                              4)  Dairy
    5)  Caffeine                                         6)  Sulfites
    7)  Amines, etc.
  2. DCI treatment plans – more information about DCI treatment plans
    A. Vitamins, minerals and enzymes important to reversing Dupuytren’s contracture – used internally
    1) The key to using these DCI plans is to take them correctly in combination on a
    gradually increasing dosage schedule
    B. DMSO trio – used externally
    C. Ultrasound therapy – used externally
  3. DCI hand stretching exercises

Apply all these therapies at the same time.  Follow the specific instructions provided with each plan.

Effectiveness of DCI therapy plans to reverse Dupuytren’s contracture

DCI has been around since 2004.  It works with men and women to help them at least slow, and sometimes reverse, their Dupuytren’s contracture.  Reports we receive indicate 8-10 people see moderate to marked success over their DC, for every one report of failure.   Those who closely follow the DCI instructions they are given, and allow enough time for the tissue to respond, get better results. Please refer to Start Dupuytren treatment.

Not all DC gets worse

Not all cases of DC look, act, develop, or end up the same.  There are always minor differences between cases. All the experts agree on that.  One of these differences is whether there is improvement, or reversal, of the palm lump, especially during the early stages. This improvement or reversal can be minor or great.  The reversal can also be brief, followed by a return of the Dupuytren’s contracture palm lump.  On the other hand, permanent when the palm lump reversal never returns.

Some experts say DC is permanent and constant, and never reverses itself.  Other experts report that DC will sometimes improve.  But then again, there are always differences of opinion, even among the experts.

Primarily, someone’s view about reversing Dupuytren’s contracture depends on his or her experience.  Those who talk only occasionally to a few DC cases might not hear much about self-correction.  DCI talks to people from around the world, and hears hundreds of stories about reversal.  For example, DCI records show 5-10% of people with DC report one or two brief periods of reversal or improvement of the palm lump in the early stages. This is a small percent, but significant when the reversals become permanent.  This is where DCI would like to see all people.

Reversal of Dupuytren’s contracture is great news for anyone with a palm lump or finger cord.  When a palm nodule or finger cord reverses, even a little, it is a small and imperfect variation of DC healing.  Reversal means a person has hope, a chance, to push it even further to complete healing.

Can you reverse Dupuytren’s contracture with hand surgery?

You might think, “Why do all this work?  I can have some kind of hand surgery, like needle aponeurotomy or a fasciectomy, to reverse my Dupuytren’s contracture.  Snip, snip, and it is gone, right?”

No. Hand surgery of any type, even the hand surgery of a Xiaflex injection, does not reverse Dupuytren’s contracture.  After DC hand surgery, the hand still has the tendency to over-produce fibrous tissue.  And it often does just that. The purpose of DC hand surgery is to do only one specific thing:  To improve finger movement as much as possible.  Not to get rid of Dupuytren’s contracture.

Dupuytren’s contracture surgery removes just enough fibrous palm tissue to allow the fingers to move better – for a while. However, some abnormal fibrous tissue remains behind after surgery.  Removal of it all is impossible. For this reason, too much fibrous tissue can still be created after  injury, or other reasons. Meaning, the palm lump and finger cord can grow back in time.  The term for this is Dupuytren’s contracture recurrence.

Dupuytren’s contracture recurrence

Reverse Dupuytren's contracture without hand surgery so their is no Dupuytren's contracture recurrenceCommonly, 2-4 years (sometimes as soon as 6 months, or as long as 10 years or more) after DC surgery, the palm lump or finger cord will return.  Because of this, half the people who contact DCI for advice have had one or more hand surgeries. These people often say the same sad thing. They thought their first Dupuytren’s contracture hand surgery would eliminate their hand problem. They thought their hand would be normal after their first surgery. The opposite happens.

When DC returns after hand surgery, the hand can become worse for three reasons:

  1. A little normal skin and muscle tissue is lost with each hand surgery.  After a few hand surgeries, those losses add up.  The hand becomes clumsy, weak, or achy.   In addition, each hand surgery damages normal and healthy nerves and blood vessels. This results in inevitable pain, numbness and circulatory issues.  Even excellent surgeries leave the hand less than perfect.
  2. Each surgery leaves behind some old DC fibrous tissue that can continue to cause problems, as it continues to grow larger. Think of pruning a bush to stimulate new growth.
  3. Each surgery can stimulate new Dupuytren’s contracture fibrous tissue that can further contract the palm and fingers.  The new DC naturally grows larger.  Think of stirring up a beehive.

This explains why so many patients with Dupuytren’s contracture have so many hand surgeries.  It is common for someone who develops DC in their 50s to have 2-5 hand surgeries by the time they are in their 70s.  The record number DCI has heard about is one person having 11 Dupuytren’s contracture hand surgeries. So, no, the idea you can reverse Dupuytren’s contracture with surgery is not true.

Conclusion

Everyone who has palm lumps, finger cords and contracted fingers wants to know how to stop Dupuytren’s contracture.  Medical science only thinks about drugs and surgery.

Why not perform hand surgery before my Dupuytren contracture gets worse, while it is still small?

Hello: I have just recently been diagnosed with Dupuytren’s contracture. I noticed a small hard bump/lump appear in the palm of my right hand, as well as one on the bottom of my right foot. I have just turned 50 and I am female. If the outcome is ‘black and white’, why not perform hand surgery to remove the bump BEFORE it grows into a long band deforming the fingers / toes?  Why wait ?

 

Greetings,

The answer is simple:  Dupuytren contracture recurrence after surgery. For more discussion of this topic see Dupuytren Surgery and Recurrence of Hand Contracture.

You are a little younger than average to develop Dupuytren’s contracture (hand) and Ledderhose disease (foot), and for this reason you are more likely to have an ongoing problem with Dupuytrens; the earlier in life it starts, the more aggressive and difficult the palm lumps and cords tend to be.  Your doctor is trying to delay your surgery for Dupuytren’s contracture to delay the time when your first recurrence starts.

Let’s say you had hand surgery the way that you propose.   If you had your first Dupuytren’s operation at age 50, it is possible to have your first recurrence start within two years.  Following your idea of early surgery to prevent progression of the problem, let’s say you had your  second hand surgery as soon as the recurrence appeared, and the next Dupuytren’s recurrence again appeared within the next two years.   Following your idea of early surgery to prevent progression of the problem, let’s say you had your  third hand surgery as soon as that next recurrence appeared,  and the next recurrence again appeared within the next two years.   Again, you would theoretically have another surgery for Dupuytren’s recurrence, with another recurrence, and so on. 

The above example does not work for three reasons:

  1. Recurrence of Dupuytren’s contracture tends to accelerate with each surgery, so that if the first recurrence did take two years to eventually develop, the net recurrence would be a little faster or sooner; maybe 18 months.  And if you had another hand surgery after that recurrence, the next recurrence would theoretically be even faster or sooner; maybe 12 months.   Of course, all these numbers are just made up, and could be faster or slower depending on your individual characteristics, family history, life history, clinical information and luck.   Some people wait 10 years for their first recurrence of Dupuytren’s contracture, but some people wait just a year – or even less for their first recurrence to appear.  Once the surgery starts, the process of recurrence starts; it is inevitable.   
  2. Each Dupuytren’s surgery “uses up” or removes normal hand tissue.  You cannot have too many hand surgeries without soon having little normal tissue remaining.  Depending on your individual circumstances you might only be able to have one, two or three hand surgeries in your life before your surgeon would inform you that you cannot have any more.   What do you do at that point?  You allow it to get worse, and perhaps become so bad in terms of pain that amputation is your only option. 
  3. No good surgeon would perform an early Dupuytren surgery, such as you have proposed.  Hopefully you would never find a surgeon who would agree to cut early, because he/she would know that this would be a terrible decision that would lead to a terrible result.  

There are drugs that have risks that can be used, and there is surgery as an option for you to consider. I suggest that you should consider trying to avoid Dupuytren’s hand surgery completely.  Since your problem is early and small at this time you are in a good position to try to reverse this process naturally.  I suggest you do some reading to see if this makes sense to you.  You can always try it for 2-3 months of intense natural therapy while you are waiting for your Dupuytren’s to progress.  If it work, fine – look at what you have gained.  If it does not work, as sometimes happens, you can always have your hand surgery when your surgeon thinks you are ready for it.  

For further information about treating Dupuytren’s contracture naturally you can read What is the best therapy to treat Dupuytren contracture?    TRH

Which home ultrasound unit do you recommend for treating Dupuytren’s contracture?

Which home ultrasound unit do you recommend for treating Dupuytren’s contracture?

Greetings,

First, I do not recommend that a person uses any one single treatment method against a problem so difficult and stubborn as Dupuytren’s contracture.  Using just vitamin E, or just doing hand stretching, or just DMSO applications, or taking just acetyl-L-carnitine, is not going to help recovery very much, if at all. The same with ultrasound therapy.  The palm lumps and cords that develop with Dupuytrens are not going to change if you try a single therapy approach. 

Secondly, it is my experience after working with people from around the world since 2002 that complete or partial recovery from Dupuytren’s is possible when following an aggressive treatment plan consisting of a wide and diverse range of different therapy approaches, as outlined on the DCI website.  Following this kind of approach for a few months works well in a surprisingly high percent of cases.

Lastly, the ultrasound unit that was added to the DCI lineup of treatment methods in November of 2012 is the 3MHz ultrasound machine made by Bellaire Industry, model HS-3040.  It is a great little unit; it is the only portable 3MHz machine that is made with a stainless steel sound head; on top of that it is the only portable 3MHz machine that has received FDA approval as a medical device. Go here to get details about this 3MHz ultrasound machine

Some people make the mistake of trying to use the more popular and more common 1MHz size ultrasound machine but these machines do not put the therapeutic effect of the sound waves where they are needed in Dupuytren’s contracture.  It is necessary to use a 3MHz unit to assure the ultrasound effect is placed toward the surface where the problem of DC is located.  TRH

Does Neprinol replace the Nattokinase, Fibrozym and Quercetin Bromelain Complex in the treatment of Dupuytrens?

Dr Herazy,

Does Neprinol replace the Nattokinase, Fibrozym and Quercetin Bromelain Complex in the treatment of Dupuytrens?

Thanks,

Mike Scully

 

Greetings Mike,

People who follow the Dupuytren Contracture Institute treatment concept use Neprinol in one of two ways – either as a total substitute for the other enzyme products, or in addition to them (usually with the Neprinol being the primary enzyme source and the others being used as a minor role).  The choice is yours.  I have long advised people to try Neprinol both way while assessing for which method brings about best change in the hand lump.

I would consider trying just the Neprinol by itself, and see how it works for you and the palm lumps.  If that is not enough to get your fibrous tissue to change favorably, then bring back the Fibrozym or Nattokinase, or Quercetin/Bromelain if you are also using it, or all of them.  A common strategy that is used is to take about 6-8 Neprinol daily, while taking 2-3 Fibrozym and 2-3 Nattokinase daily; all of these are taken between meals, as I am sure you know.  However, you also must know that Dupuytrens treatment is not just about using systemic enzymes to reduce the lumps on the palms.   You must also use other nutrients as  and treatment strategies at the same time to support the best change possible.

You must keep experimenting to learn what makes your scar respond favorably and then continue with that.   TRH