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.
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.
Osteoarthritis typically affects the:
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:
- 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.
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.
- loss of motion
- deformed and enlarged fingers
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.
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
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
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.
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:
- 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
- chondroitin sulfate
Studies haven’t shown that these are beneficial, and some may cause adverse effects or interact with other drugs.
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.
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.
If you’re experiencing pain, swelling, and a loss of motion in your fingers, it’s a good idea to see a doctor.
- 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.