Heberden or Bouchard Nodules: Development, Causes, Risk Factors, Symptoms and Treatment

They are a sign of osteoarthritis and are caused by the formation of osteophytes (calcified spurs) of the articular cartilage in response to repeated trauma to the joint.

Heberden’s or Bouchard’s nodules are hard or bony swellings that can develop in the distal interphalangeal joints (DIPs), the joints closest to the ends of the fingers and toes.

Heberden’s nodules occur as bony swelling that forms on the hands in patients with osteoarthritis. They can be easily identified as they appear in the interphalangeal joints closest to the fingertips.

They are considered unsightly and unusual manifestations, but do not pose any infectious risk, as they are simply extra bone growths that are part of the degenerative disease.

Heberden’s nodules usually develop in middle age, beginning with chronic inflammation of the affected joints or with the sudden and painful onset of redness, numbness, and loss of manual dexterity.

This initial swelling and pain eventually goes away, and the patient is left with permanent bone growth that often skews the fingertip sideways. Surgery is often considered the last resort for treating osteoarthritis.

Bouchard’s nodules may also be present; These are similar bony growths in the proximal interphalangeal (PIP) joints (middle finger joints) and are also associated with osteoarthritis.

Heberden’s nodules are more common in women than in men, and there appears to be a genetic component involved in predisposition to the disease. They are named after William Heberden (1710-1801).

The osteoarthritis of the hands is particularly common in people over 50 years and is more common among women.

It can be a cruel disease as people who are highly dependent on their hands, such as musicians, seem to be particularly prone to the condition due to the demands they place on their bodies and it can bring a professional musician’s career to a premature close. .

Development of Heberden’s or Bouchard’s nodules

Although your joints suffer minor damage through normal life and exercise, the body generally heals naturally; But sometimes the body fails to make a complete repair, resulting in a loss of cartilage and the development of bone growths and inflammation.

Osteoarthritis can affect any joint in the body, for example, knees, hips, and hands. Bouchard and Heberden osteoarthritis occurs in the hands, which can cause the formation of glands, that is, bony lumps (osteophytes).

When they occur in the middle joint, they are called Bouchard’s nodules, and when they occur in the final seeker’s joint they are called Heberden’s nodules. Similar nodes can form at the base of the thumb at the carpometacarpal joint.

Research suggests a link between the presence of Heberden’s nodes and the presence of radiographic changes from osteoarthritis in the fingers.

In other words, the chances of an X-ray showing signs of osteoarthritis (for example, joint space narrowing) are higher in a finger that has a Heberden node than in a finger that does not.

With that, suffice it to say that Heberden’s nodes are a classic sign of osteoarthritis of the hand. As the cartilage breaks down, it becomes rough, so the bones cannot slide smoothly over each other in the joint.

When the cartilage finally wears down enough, the bones come together when the joint is flexed, and this leads to bone loss. The body then reacts to bone loss by growing new bone.

But with the broken joint, the new bone growth is added as a node next to the original bone, and this results in the bone development of Heberden’s node.

Osteoarthritis is a painful condition of the joints that causes them to become stiff and restricts their ability to move freely.

The condition is generally associated with general wear and tear or injury, especially as we age, but its precise causes are not yet fully understood.

Causes

Heberden’s nodes have a direct correlation with osteoarthritis, a degenerative bone disease that typically affects the spine, knees, hips, or fingers.

In this condition, the joints usually padded by spongy cartilage on the surface of the bone wear out due to constant use. Osteoarthrosis is a disease that occurs with aging, and years of wear and tear on the joints can lead to this condition.

Furthermore, an injury to a particular joint can lead to the premature development of osteoarthritis in that joint.

This degenerative joint condition can cause the bones in the hand to swell and develop a general curvature of the finger joints as the cartilage wears away.

This process removes the finger joints from their protection, allowing bone-to-bone contact. When this occurs, it destroys the existing bone and causes significant pain as the bones begin to rub.

New bone formation occurs as a result of this increased stress on the finger joints, which grow together with the existing bone-forming nodes.

When fully formed, the nodes are present, and patients often have rigid restrictive motion, a sign of advanced osteoarthritis.

Symptoms of Heberden’s nodules

The presence of Heberden’s nodes means that severe osteoarthritis is present. When viewed up close, the finger may appear twisted or crooked due to the formation of the node. The tiny bony outgrowths can extend from the knuckle closest to the nail.

It is important to note that due to the advanced nature and restricted timing caused by Heberden’s nodes on the finger, a patient cannot complain of any symptoms as they have learned not to abuse their hands over time.

The following are expected symptoms of Heberden nodes:

  • Reduced range of motion.
  • Pain.
  • Swelling.
  • Stiffness in the location of the node.

Symptoms of a developing Heberden’s node usually begin around menopause in women or middle age in men.

These symptoms include pain, stiffness, and a limited range of motion of one or more finger joints. Sometimes a person may also notice signs of inflammation such as heat and swelling.

However, over a period of a few years, the pain and signs of inflammation disappear and all that remains is a painless bony lump called Heberden’s nodule (a Bouchard’s nodule is the same but develops in the joint of the middle finger).

In addition to the limited range of motion, the joints of the fingers that have Heberden’s nodes are sometimes deviated (for example, an index finger with a Heberden’s node may point toward the middle finger).

Heberden nodes may or may not be painful, depending on their stage of development, and once fully formed, people often find them unattractive. With its undesirable appearance and its potentially annoying presence.

Treatment

Unfortunately, Heberden’s nodes are part of osteoarthritis, which is incurable. Symptomatic treatment is the only effective treatment for this condition, involving pain relief and restoration of joint function if possible.

Treatment will likely depend on the patient’s personal medical history and current medication. The following are some of the most widely used treatment methods to help osteoarthritis patients.

During the painful development of Heberden’s nodes, treatment involves rest and sometimes splinting, in addition to pain relievers, such as non-steroidal anti-inflammatory drugs and heat or ice therapy.

The goal of treatment is:

  • Ease the pain.
  • Restore joint function.

Lifestyle changes : Exercise is considered one of the most effective treatments for osteoarthritis, as physical activity helps reduce pain and improve strength and flexibility.

Exercise will help maintain a lighter frame, which will take pressure off the joints and reduce the risk of forming nodules or worsening current nodes.

It is important to see a doctor first to assess the appropriate level of exercise for you, as osteoarthritis patients can easily fall and are prone to bone fractures.

See your doctor as well to help you learn new methods of doing daily activities due to limited movement or stiffness in your fingers. These alternative methods are aimed at controlling excess pressure and pain.

If you are overweight or obese, your doctor may also encourage a change in diet. You may be referred to a dietitian who can help you develop healthier eating patterns to help you lose weight. This will increase your ability to move.

Therapy : Occupational or physical therapy can also help increase range of motion and control pain. Losing excess weight will also reduce unnecessary stress on weight-bearing joints.

Physical therapy can also be helpful as a person learns how to minimize pain and / or uses their affected fingers which are restricted in their range of motion due to Heberden’s node.

Medications : The most common medications used in osteoarthritis patients are non-steroidal anti-inflammatory medications such as aspirin (Bufferin), it can help treat pain and inflammation.

Other examples of non-steroidal anti-inflammatory drugs include Advil (ibuprofen) and naproxen .

Many people take non-steroidal anti-inflammatory drugs without side effects.

However, it is important to note that the use of chronic non-steroidal anti-inflammatory drugs can have serious side effects, it has been associated with heart failure, kidney damage, and intestinal bleeding.

COX-2 inhibitors are another type of non-steroidal anti-inflammatory drug. They have fewer side effects but are more expensive than aspirin or ibuprofen.

Over-the-counter gels or creams can also help eliminate discomfort. Also, your doctor may give you a corticosteroid injection. This can provide long-term relief for joint pain.

Other medications may include antidepressants to help ease the sadness or feelings of hopelessness associated with osteoarthritis.

They help relieve pain and reduce inflammation that can occur in the joints with minimal side effects.

Surgery : Rarely, surgery may be done, but mostly only if symptoms persist or if a person is unable to use the finger.

When the change in lifestyle and the use of medications is not enough, the only solution is surgery. Surgery may involve:

  • Removal of excess bone.
  • Reform the joint.
  • Joint fusion in the fingers, which reduces movement but can relieve pain.

This can include joint reconstruction or removal of bone growths. An example of a surgery on the finger would be to replace or fuse the affected joint.

The good news is that once the bone node has formed, a person is generally pain free. At this stage, the node may be more of a cosmetic problem. Unfortunately, there really is no way to simply improve the appearance of the joint.

Low level laser therapy

Low-level laser therapy (LLLT) has recently been shown to be an effective and completely safe treatment.

Low-level laser therapy uses low-level lasers of specific wavelengths that interact with tissue to promote natural healing. The wavelength is generally between 600 and 1,000 nanometers and the power ranges from 5 to 500 milliwatts.

Originally developed in the 1960s, it has been used to treat a wide range of conditions, and a systematic review of the treatment concluded that it can significantly reduce pain and improve health in chronic joint disorders.

However, until recently little work has been done on how effective it is in arthritic conditions of the hand.

The study by Baltzer, Ostaoczuk, and Stosch (2016) analyzed 34 patients who received between five and ten low-level laser treatments twice a week, and the effect of the treatments on joint pain, swelling, and mobility was periodically assessed. .

After five to seven treatments there were significant reductions in pain and inflammation along with an increased range of motion. In fact, the authors found that the effects were very large and persisted for eight weeks.

For anyone who suffers from the painful condition of ostearthriis of the hand, confirmation that low-level laser therapy can have a large and long-lasting effect in reducing pain and improving joint mobility will be good news.

Although other treatments such as steroid injections, braces, pain relievers and anti-inflammatories, and surgery can help, little is known about the long-term effects of these treatments.

However, not only is low-level laser therapy effective, it is also totally safe and has been used in clinical practice for other conditions for several decades.

Consult your doctor

Before starting any treatment, you need to see your doctor for a complete exam. Your doctor will review your medical history and medications and perform a physical exam.

If you are an older adult, your doctor will likely try to determine if you have another condition with similar symptoms. A combination of a medical history, physical exam, laboratory findings, and imaging techniques can help your doctor diagnose this condition.

After diagnosis, your doctor will provide you with information about the disease and will implement a specific treatment plan for you.

Importance

It is interesting to note that Heberden’s nodules are more common in women and are more commonly found on a person’s dominant hand. They are also more commonly located on the index finger.

Furthermore, studies suggest that there is a genetic predisposition to develop Heberden’s nodes, which is why the associated gene is dominant in women and recessive in men. This means that if your mother has Heberden’s nodes, she is likely to have a higher risk of contracting them if she develops osteoarthritis of the hand.

If you suspect that you have Heberden’s node and / or osteoarthritis of the hand, see your doctor for a proper diagnosis.

There are other health conditions that can mimic osteoarthritis of the hand or even a blow to the finger. Make sure you undergo a proper diagnosis so that an effective treatment plan can be made for you.

History

Named after Dr. James Heberden in the 18th century, after correctly identifying the cause, Heberden’s nodules are abnormal bony growths that occur in the affected joint.

Between the bones of a joint, cartilage forms to cushion and protect each bone from the other. Osteoarthritis occurs when this cartilage begins to break down. This collapse causes the bones to come into direct contact and rub together.

When bones rub together, the friction wears down the bone, and the body tries to heal itself by growing new bone. Sometimes this new bone grows abnormally and forms what are called “knots” that stick out to the side of the joint.

Heberden’s nodes are generally a sign of advanced osteoarthritis, as they tend to appear after considerable wear and tear has occurred.

Risk factor’s

Osteoarthritis is the most common type of arthritis. It affects more than 20 million people in the United States. It is more common among the elderly, but can sometimes occur in people in their 40s or even younger.

There is also a genetic risk, which means that if they appear in the patient’s family, the patient is more likely to contract them. Obesity also increases the risk factor for contracting them, since excess weight puts more pressure on the joints.

Women are affected by Heberden’s nodes and Bouchard’s nodes more often than men. In fact, women with osteoarthritis are 10 times more likely to develop these nodules than men.

If you participate in sports or have a physically demanding job, your risk increases as well. Other risk factors include:

  • Hereditary conditions, such as malformed joints.
  • Diseases that involve abnormal cartilage changes, such as rheumatoid arthritis and gout.

How Heberden’s nodules form

Osteoarthritis usually occurs in the spine, knees, hips, or fingers. These particular locations have cushioned cartilage in the joints that protects the surface of the bones.

Osteoarthritis can occur due to the wear and tear of the cartilage in these areas that comes with aging or as a result of injury.

In the case of Heberden’s nodes, swelling and a general twisting occur in the finger joints as the softening cartilage begins to disintegrate or wear away.

The cartilage eventually becomes rough and cannot protect your bones, which begin to rub against each other. This process destroys existing bone and often causes significant pain. As the cartilage continues to break down, the new bone grows together with the existing bone in the form of knots.

By the time the nodules appear, the fingers may have become stiff and the pain may lessen. Heberden’s nodules appear after obvious and serious joint damage, which is why they are often considered a marker of advanced osteoarthritis.