Note 42 — Chapter XXII · CLINICAL DIAGNOSIS (continued)

As Sir W. Hale White has pointed out, “pads” not uncommonly develop on the dorsal aspects of the mid-phalangeal joints. They range in size from a split pea to a hazel nut. Histologically they are the outcome of an excessive overgrowth of fibrous tissue beneath the corium. They in no way involve the joints, but, according to Hale White, they have been confused with osteoarthritis. Their frequent association with Dupuytren’s contracture might conceivably lead to their confusion with gout also, inasmuch as that deformity is so widely attributed to a “gouty” habit.