Knuckle Pads Treatment & Management

Updated: Mar 12, 2019
  • Author: Cheryl J Barnes, MD; Chief Editor: Dirk M Elston, MD  more...
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Medical Care

Neither medical nor surgical interventions for knuckle pads are very effective. Eliminating the source of mechanical or repetitive trauma may improve the lesions. Wearing protective gloves or changing occupation may be necessary. Intralesional injections of corticosteroids or fluorouracil may reduce the size of the lesions. [3] Lesions caused by biting or sucking may require a psychiatrist to treat the underlying psychological problem. A cast or splint placed temporarily on the involved areas of the hand may aid in reducing the lesion. Application of silicone gel sheeting has had limited success. [30] Applications of keratolytics, such as salicylic acid or urea, have helped to soften and even reduce the lesions. Radiation therapy and application of solid carbon dioxide have been reported to be of some help in selected cases.


Surgical Care

Surgical intervention may be indicated if knuckle pads cause a functional problem. Recurrence after surgery is likely, especially if the trauma that caused the initial knuckle pad is not eliminated. Scar or keloid formation may result from surgical intervention. Tendon tethering, another surgical complication, occurs only if the joint space or capsule is accidentally cut with damage to the tendon in the attempt to remove the knuckle pad. [31]



Complications of knuckle pads occur if surgery is used to remove the lesion. Complications include scar or keloid formation, recurrence, or tendon tethering (see Surgical Care). Most knuckle pads are asymptomatic and require no treatment.