Causes and risk factors
Knuckle pads are more commonly caused due to repeated trauma due to certain sports or occupational activity. This injury is more commonly seen in boxers, surfers, and in foot ball players. Repeated motion or activity in this results in rubbing of the proximal phalangeal joint. Although still not clear, certain genetic factors also result in this. In some cases, the cause remains unknown (idiopathic). Children who bite or suck their fingers are more prone for towards developing this condition. Even ill ill-fitting shoes contribute for towards affection of toes. Familial predilection is also seen. Knuckle pads have been associated to with certain underlying causes like palmoplantar keratoderma, Ledderhose disease, Dupuytren’sDuputyrens contracture, etc.
Clinical presentation:
There are three types of knuckle pads- Duputyrens contracture fibromatosis, plantar fibromatosis and penile fibromatosis. Though the names suggestDupuytren’s contracture is affection of the knuckle, – the skin over the proximal and inter phalangeal joint are more commonly affected. Formation of papules is the characteristic feature seen, dome shaped and skin colored papules varying from in size from 0.5- to 3 mm are seen. It causes difficulty in movement of hand. Along with this, tenderness and painful swelling is complained by the patient. In most of the cases, the patient does not suffer from any subjective complaints. Eventually, these papules can enlarge and form large nodules.
Investigations:
Diagnosis is done on the basis of the symptoms narrated by the patient and the physical examination carried out by the dermatologist. Usually no investigations are advised, . If required, a histological examination of the skin can be done.
Treatment:
There is yet no effective treatment for this. Adopting protective measures is the most important step. Use of protective gloves and change in working methods is of foremost importance. Corticosteroid injections are given in order to reduce the swelling. Temporary cast or splint can be used. Application of certain soothing agents, moisturizers, and radiation therapy are some other methods of treatment. Surgery, although rarely done can also be adopted, however, it can lead to keloid formation.
Other modes of treatment:
Certain other modes of treatment can also be helpful in coping up with the disease. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints.
