Garrod’s pads, also called knuckle pads or dorsal Dupuytren’s nodules, are firm lumps that form over the finger joints. They respond well to radiotherapy: a 2025 case series found it effective in 89% of patients, and Dr Shaffer’s own clinical experience over many years confirms this.
Radiotherapy is effective in 89% of patients with Garrod’s pads (Garrod’s pads are also called dorsal Dupuytren’s nodules or knuckle pads). I’ve been treating Garrod’s pads with radiotherapy for many years and found it to be effective in most people.
If you have knuckle pads that are not causing any problems, then it’s fine to just leave them alone. I tend to treat Garrod’s pads with radiotherapy when they are tender, for instance, causing pain when you knock on a door, or restricting the ability to fully bend the finger.
The article below by Amanda Stark and her co-authors is the first publication reflecting something that we are doing routinely. Garrod’s pads are essentially the same biological process as Ledderhose disease, occurring on the knuckles instead of the soles of the feet.
But it’s always nice to see real-world practice reflected in the literature. Personally, I use a very slightly different scheme of treatment:
- 15Gy in 5 fractions
- Review at 3 months
- Consider a further 15Gy in 5 fractions
That way, some patients will only need one phase of treatment rather than the full two phases.
Also, it’s clear that steroid injections are generally not helpful. And surgery seems to negatively affect the joint. So radiotherapy seems like a good new standard treatment to consider.
Reference: Stark A, Sharifzadeh Y, Kahn J, et al. (June 11, 2025) Radiotherapy for Symptomatic Knuckle Pads Associated With Dupuytren’s Disease: A Report of a Case Series. Cureus 17(6): e85796. doi:10.7759/cureus.85796
Frequently Asked Questions
What are Garrod's pads?
Garrod’s pads, also called dorsal Dupuytren’s nodules or knuckle pads, are firm lumps that form over the finger joints. They are part of the same biological process as Dupuytren’s disease and Ledderhose disease, just occurring on the knuckles instead of the palm or the sole of the foot.
How effective is radiotherapy for Garrod's pads?
A 2025 case series by Stark and colleagues found radiotherapy effective in 89% of patients treated for symptomatic knuckle pads. Dr Shaffer’s own clinical experience over many years puts the figure at a similar level.
What does radiotherapy treatment for Garrod's pads involve?
One approach is 15Gy delivered in 5 fractions, followed by a review at 3 months, with a further 15Gy in 5 fractions considered if needed. Using this staged approach, some patients only need the first phase of treatment.
Do steroid injections or surgery help with Garrod's pads?
Not generally. Steroid injections are usually not helpful for Garrod’s pads, and surgery appears to negatively affect the joint, which is part of why radiotherapy is increasingly seen as a better standard treatment.
Are Garrod's pads the same as Ledderhose disease?
They’re essentially the same underlying biological process, just in a different location: Garrod’s pads affect the knuckles, while Ledderhose disease affects the sole of the foot.
