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2012 | 12 | 51 | 493–498
Article title

Palce poduszeczkowate – rzadkie schorzenie

Title variants
Knuckle pads – a rare finding
Languages of publication
Knuckle pads are rare harmless subcutaneous nodules that must be differentiated from
joint disease of the proximal interphalangeal or rarely of the metacarpophalangeal joints
as well as from other masses of the paraarticular tissues. We present a case of an otherwise
healthy 36-year-old woman presenting with bilateral knuckle pads located at
the dorsal aspect of the proximal interphalangeal joints. No predisposition to a specific
musculoskeletal disorder was noted. Ultrasound revealed well-delimited subcutaneous
hypoechoic masses without internal flow signals at color Doppler. Histology showed
proliferation of myofibroblasts with a decrease of elastic filaments in the deep dermis.
The clinical picture, the family history in addition to the histology allowed us to make the
diagnosis of knuckle pads. We present the ultrasound findings of knuckle pads and discuss
the differential diagnosis of a “swelling” in the dorsal region of proximal interphalangeal
joints and metacarpophalangeal joints.
Palce poduszeczkowate (knuckle pads), potocznie zwane guzkami kłykciowymi, są rzadkimi i łagodnymi zmianami podskórnymi, które należy różnicować z chorobą stawu międzypaliczkowego bliższego i, rzadziej, stawu śródręczno‑paliczkowego,a także z innymi masami/zmianami okołostawowymi. Prezentujemy przypadek 36‑letniej zdrowej kobiety, u której stwierdzono obustronne guzki zlokalizowane po stronie grzbietowej stawów międzypaliczkowych bliższych. Badanie ultrasonograficzne wykazało wyraźnie odgraniczone, hipoechogeniczne guzki zlokalizowane podskórnie, bez cech obecności nieprawidłowego
unaczynienia w badaniu kolorowym dopplerem. W badaniu histopatologicznym ujawniono proliferację miofibroblastów oraz zmniejszenie liczby włókien elastycznych w głębokich warstwach skóry właściwej. Obraz kliniczny, wywiad rodzinny oraz badania histologiczne pomogły w ustaleniu rozpoznania. W artykule przedstawiamy ultrasonograficzny obraz palców poduszeczkowatych oraz diagnostykę różnicową
pogrubienia tkanek miękkich okolicy grzbietowej stawów międzypaliczkowego bliższego i śródręczno‑paliczkowego.
Physical description
  • Department of Rheumatology and Musculoskeletal Ultrasound, Bethesda Hospital, Basel, Switzerland
  • Department of Rheumatology and Musculoskeletal Ultrasound, Bethesda Hospital, Basel, Switzerland
  • Department of Rheumatology and Musculoskeletal Ultrasound, Bethesda Hospital, Basel, Switzerland
  • 1. Nenoff P, Woitek G: Images in clinical medicine. Knuckle pads. N Engl J Med 2011; 364: 2451.
  • 2. Du ZF, Wei W, Wang YF, Chen XL, Chen CY, Liu WT et al.: A novel mutation within the 2B rod domain of keratin 9 in a Chinese pedigree with epidermolytic palmoplantar keratoderma combined with knuckle pads and camptodactyly. Eur J Dermatol 2011; 21: 675–679.
  • 3. Morginson WJ: Discrete keratodermas over the knuckle and finger articulations. AMA Arch Derm 1955; 71: 349–353.
  • 4. Guberman D, Lichtenstein DA, Vardy DA: Knuckle pads – a forgotten skin condition: report of a case and review of the literature. Cutis 1996; 57: 241–242.
  • 5. Mikkelsen OA: Knuckle pads in Dupuytren’s disease. Hand 1977; 9: 301–305.
  • 6. Dickens R, Adams BB, Mutasim DF: Sports‑related pads. Int J Dermatol 2002; 41: 291–293.
  • 7. Hueston JT, Wilson WF: Knuckle pads. Aust N Z J Surg 1973; 42: 274–277.
  • 8. Rayan GM, Ali M, Orozco J: Dorsal pads versus nodules in normal population and Dupuytren’s disease patients. J Hand Surg Am 2010; 35: 1571–1579.
  • 9. Addison A: Knuckle pads causing extensor tendon tethering. J Bone Joint Surg Br 1984; 66: 128–130.
  • 10. Iselin F, Cardenas‑Baron L, Gouget‑Audry I, Peze W: Dorsal Dupuytren’s disease. Ann Chir Main 1988; 7: 247–250.
  • 11. Lopez‑Ben R, Dehghanpisheh K, Chatham WW, Lee DH, Oakes J, Alarcón GS: Ultrasound appearance of knuckle pads. Skeletal Radiol 2006; 35: 823–827.
  • 12. Tamborrini G: Ultraschall des Bewegungsapparates. First edition.
  • 13. Diniz Mdos S, Almeida LM, Machado‑Pinto J, Alves MF, Alvares MC: Rheumatoid nodules: evaluation of the therapeutic response to intralesional fluorouracil and triamcinolone. An Bras Dermatol 2011; 86: 1236–1238.
  • 14. Nalbant S, Corominas H, Hsu B, Chen LX, Schumacher HR, Kitumnuaypong T: Ultrasonography for assessment of subcutaneous nodules. J Rheumatol 2003; 30: 1191–1195.
  • 15. Ottaviani S, Bardin T, Richette P: Usefulness of ultrasonography for gout. Joint Bone Spine 2012; 79: 441–445.
  • 16. Colin JA: Heberden’s and Bouchard’s nodes. Ann Rheum Dis 1999; 58: 675–678.
  • 17. Wittoek R, Jans L, Lambrecht V, Carron P, Verstraete K, Verbruggen G: Reliability and construct validity of ultrasonography of soft tissue and destructive changes in erosive osteoarthritis of the interphalangeal finger joints: a comparison with MRI. Ann Rheum Dis 2011; 70: 278–283.
  • 18. Wan JM, Magarelli N, Peh WC, Guglielmi G, Shek TW: Imaging of giant cell tumour of the tendon sheath. Radiol Med 2010; 115: 141–151.
  • 19. Hashefi M: Ultrasound in the diagnosis of noninflammatory musculoskeletal conditions. Semin Ultrasound CT MRI 2011; 32: 74–90.
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