What Are Heberden’s Nodes?

Heberden’s nodes present as bumps on your finger joints. They are a sign of osteoarthritis caused by the breakdown of cartilage at joints. While no specific treatments exist, there are ways to relieve the pain.
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Osteoarthritis

Osteoarthritis
Are you experiencing pain or stiffness in your fingers? It could be a sign of osteoarthritis (OA), a degenerative joint disease that can affect the joints in your hands and elsewhere.
People with OA in their hands often develop bumps on their fingers known as Heberden’s nodes. These bumps are usually one of the most obvious signs of OA in the hands.
Heberden’s nodes are bumps that affect the part of the finger that’s nearest the tip. Another type of bump, Bouchard’s nodes, affect the joint that’s nearest the hand.

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What are Heberden’s nodes?

What are Heberden’s nodes?
Heberden’s nodes are described as “bony swellings” that form on your hands as a result of osteoarthritis.
They’re named after physician William Heberden Sr., a doctor in the 1700s. He came up with the description of these swellings.
These firm growths occur on the finger joints nearest the fingertip, also called the distal interphalangeal joints.
Similar swellings located on the lower joints, or the proximal interphalangeal joints, are called Bouchard’s nodes.

Causes: How do they form?

Causes: How do they form?
Osteoarthritis typically affects the:
lower spine
knees
hips
fingers
The joints in these areas have cartilage that cushions and protects the surface of your bones.
Osteoarthritis may often result from the wear and tear that comes with aging, but it can develop after an injury.
In the case of Heberden’s nodes, there’s a degree of uncertainty about how the disease process evolves.
Research shows that the process may involve:
ligaments
tendons
periarthritis
the joint capsule
It also indicates that there may be some changes in soft tissue, as well as bone.
The cartilage can degrade and become unable to protect your bones. Without this protection, the bones begin to rub against each other.
This process can destroy existing bone and cause significant pain, which can be an early sign of OA and the development of nodes. Over time, the pain may lessen, but the deformity progresses.
As the cartilage continues to break down, new bone grows alongside the existing bone in the form of nodes or bony spurs.
By the time the nodes appear, your fingers may have become stiff, and the pain may have lessened.
Heberden’s nodes tend to appear after severe joint damage has already occurred, so they’re often seen as a marker of advanced OA, which is referred to as nodal OA.

Signs and symptoms of Heberden’s nodes

Signs and symptoms of Heberden’s nodes
If you have Heberden’s nodes, you can often see them by examining the end joints on your fingers.
Tiny firm-hard swellings may extend from the joint closest to your fingernail. In many cases, your fingers may twist or become crooked as the nodes form.
Symptoms include:
loss of motion
pain
swelling
deformed and enlarged fingers
stiffness
weakness
Here are some other features of Heberden’s nodes:
They can affect the fingers or thumb and are most common on the index and middle fingers.
You may have more than one node on a finger.
They can appear slowly or quickly.
They’re often, but not always, painful when they begin to appear.
For older women with gout and hypertension and taking a diuretic, such as hydrochlorothiazide, gout can deposit crystals in the nodes, causing acute inflammation. It’s a painful condition that’s erythematous and may mimic an infection.
Some cases of Heberden’s nodes may be asymptomatic or only cause mild or few symptoms.
If you have Heberden’s nodes, you may have difficulty performing some tasks that require gripping or pinching, like turning the key in your car’s ignition or uncapping a soda bottle.
You may feel limited in your daily activities, and it may be hard to complete tasks for work or household chores.
This can affect your quality of life. For some people, it could even lead to the development of a mental health disorder, such as depression and anxiety.

Risk factors

Risk factors
Osteoarthritis is the most common type of arthritis. It often affects older people, but over half of those who have both OA and Heberden’s nodes receive a diagnosis before age 65.
Other risk factors include:
hereditary conditions that affect the joints
having OA in the knee or elsewhere in the body
rheumatoid arthritis, which can cause joint and cartilage changes
gout, which can affect periarticular boney erosion
having a family history of these nodes
having obesity, as this may increase the risk of OA
doing sports or jobs that involve repetitive movements

Treatment options

Treatment options
There’s no specific treatment for Heberden’s nodes.
Possible options for relieving pain may include:
topical treatments containing capsaicin or nonsteroidal anti-inflammatory drugs (NSAIDs), which are usually given during the acute pain phase, per anecdotal evidence
applying heat and cold pads to manage pain and inflammation
devices (orthoses) aimed to support specific finger joints
steroid injections, which may be difficult to give in this type of joint, according to one expert, but anesthetizing the skin, with a cold spray, for example, and using a very small needle can help the process move along more smoothly and help the person better tolerate the injection
surgery to fuse the joints, if symptoms are severe and other options have not worked
In one small study, researchers found that low-level laser therapy reduced pain and swelling and increased mobility in people with Heberden’s and Bouchard’s nodes.
However, more research is necessary to identify the best ways to deliver this procedure and examine the long-term effects.
Treatments for OA of the hand
A wide range of treatments can help you manage OA of the hand, although they’re not specifically for Heberden’s nodes.
Treatment will aim to:
slow the progression of OA
relieve pain
maintain joint function and mobility
improve your quality of life
However, it’s not yet possible to repair damage that has already occurred.
Lifestyle choices
Experts from the American College of Rheumatology and the Arthritis Foundation (ACR/AF) recommend taking an active role in your own treatment plan, which includes learning new skills and working with your healthcare provider to make decisions about treatment.
Options may include:
Occupational therapy (OT), and the subspecialty hand OT. OT helps you learn new ways of using your hands. Hand OT analyzes your hand function to determine the best methods to benefit your hand OA. Examples of these methods may include splits, specific exercise programs, and assistive devices.
Physical therapy (PT). PT helps to enhance or maintain mobility.
Cognitive behavioral therapy (CBT). CBT helps you develop coping methods for ongoing pain, sleep, and stress-related issues.
Some people with OA find that the use of elastic “arthritis gloves” with open fingertips helpful for increasing their hand mobility.
Experts recommend exercise for everyone with OA, including OA of the hand.
Staying active can help improve overall strength and flexibility, and it may help manage stress and anxiety. Specific exercises may help keep your fingers mobile.
Other home and alternative therapies include:
acupuncture
paraffin, which is a type of heat therapy
gloves that are designed to be warmed, such as those that can be warmed in a microwave
soaking hands in a solution of warm water and magnesium salts
wrapping a warm towel (warmed in the microwave or in warm water) around your hand
There’s some evidence that these therapies may help with pain and stiffness, although more research is needed to confirm their benefits.
Options to avoid
People sometimes use the following, but the ACR/AR strongly advise against using them for hand OA:
fish oil
vitamin D
bisphosphonates
glucosamine
chondroitin sulfate
Studies haven’t shown that these are beneficial, and some may cause adverse effects or interact with other drugs.
Medications
Over-the-counter medications include:
NSAIDs, such as ibuprofen, for pain and inflammation
acetaminophen, for pain
creams and ointments containing capsaicin or NSAIDs
If these do not work, your healthcare provider may prescribe:
higher dose NSAIDs
duloxetine (Cymbalta)
corticosteroid injections, if appropriate
Occasionally antidepressants may be prescribed to help relieve stress, anxiety, and depression, which can occur with many chronic conditions.
Surgery
Surgical treatment is usually a last resort after conventional treatment options have proven unsuccessful, and it’s rarely done.
Joint replacement surgery is common in knee and hip OA but not for arthritis of the fingers or thumbs, as it has a low success rate.

Seeing your doctor

Seeing your doctor
If you’re experiencing pain, swelling, and a loss of motion in your fingers, it’s a good idea to see a doctor.
They will:
ask you about your symptoms
request and assess your medical history and medications
give you a physical exam
in some cases, recommend imaging tests or lab tests
If your doctor diagnoses OA, they’ll work with you to make a treatment plan that suits you.