OrthoDx: Heberden Node

Slideshow

  • Figure 1. Picture of the patient’s left middle finger.

  • Figure 2. Anteroposterior radiograph of middle finger.

  • Figure 3. Lateral view of middle finger.

A 70-year-old woman presents with left middle finger pain that has been present for several months. She reports increased swelling over the end of her finger and pain when she is knitting. A picture of her left middle finger is shown in Figure 1. Radiographs are taken of the middle finger (Figures 2 and 3). She is wondering if a surgical option is available to help relieve the pain as ice and oral nonsteroidal anti-inflammatory agents (NSAIDs) are no longer effective.

Primary arthritis of the distal interphalangeal joint (DIP) and proximal interphalangeal joint (PIP) is a common condition in people 50 years and older presenting with pain and stiffness of the digits.1 Heberden node at the DIP and Bouchard node at...

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Primary arthritis of the distal interphalangeal joint (DIP) and proximal interphalangeal joint (PIP) is a common condition in people 50 years and older presenting with pain and stiffness of the digits.1 Heberden node at the DIP and Bouchard node at the PIP is associated with enlargement of the joints due to arthritis.

Symptoms of finger arthritis are generally mild and intermittent and less commonly severe and unrelenting. Mucous cysts are fluid-filled, pea-size cysts that commonly grow from an arthritic DIP joint. Mucous cysts are fluid-filled and soft whereas Heberden and Bouchard nodes are a generalized enlargement of the joint.1,2

Radiographic findings of finger arthritis include joint space narrowing and osteophyte formation. Treatment is almost always conservative and includes ice, oral or topical NSAIDs, and splinting. Nighttime extension splitting has been shown to reduce pain and extension lag from DIP arthritis.1 In rare cases when finger arthritis causes severe pain and disability, surgery may be an option. Arthritis affecting the DIP is often treated with fusion. Mucous cysts alone can be treated with mucoid cyst excision with osteophyte resection. Arthritis of the PIP joint can be treated surgically with osteophyte excision, fusion, or arthroplasty.1,2

The patient in this case is diagnosed with a Heberden node and severe arthritis at the DIP joint.

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.

References

1. Spies CK, Langer M, Hahn P, Müller LP, Unglaub F. The treatment of primary arthritis of the finger and thumb joint. Dtsch Arztebl Int. 2018;115(16):269-275. doi:10.3238/arztebl.2018.0269

2. Watt FE, Kennedy DL, Carlisle KE, et al. Night-time immobilization of the distal interphalangeal joint reduces pain and extension deformity in hand osteoarthritis. Rheumatology (Oxford). 2014;53(6):1142-1149. doi:10.1093/rheumatology/ket455

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