Symptoms and Significance of Heberden's Nodes

Heberden's nodes are a clinical sign of osteoarthritis

An elderly woman with arthritic hands.
An elderly woman with arthritic hands. Camille Tokerud Photography Inc./Getty Images

Heberden's nodes are bony swellings of the joint closest to the fingertip, also known as the DIP joint or distal interphalangeal joint, which is the joint just below the fingernail.

Heberden's nodes may or may not be painful, depending on their stage in development, and once fully formed, people often view them as unattractive.

With their undesirable appearance and potentially burdensome presence, let's take a closer look into what these firm bumps signify, and how they are managed.

Development of Heberden's Nodes 

Research suggests a link between the presence of Heberden's nodes and the presence of radiographic changes of osteoarthritis in the fingers. In other words, the odds of an x-ray showing signs of OA (for example, joint space narrowing) are higher on a finger that has a Heberden's node than a finger that does not.

With that, it suffices to say that Heberden's nodes are a classic sign of hand osteoarthritis

In hand osteoarthritis, the cartilage in the finger joints is worn away. As the cartilage degrades, it becomes rough, so the bones cannot glide smoothly past each other in the joint.

When the cartilage is finally worn away enough, the bones grind upon each other when the joint is flexed, and this leads to loss of the bone. The body then reacts to losing bone by growing new bone.

But with the joint disrupted, the new bone growth is added as a node next to the original bone, and this results in the bony bump of a Heberden's node developing.

Symptoms of Heberden's Nodes

Symptoms of a developing Heberden's node usually begins around menopause for women or middle age for men. These symptoms include pain, stiffness, and a limited range of motion of one or more than one finger joint. Sometimes, a person may also notice signs of inflammation like warmth and swelling.

Over a period of a few years, though, the pain and signs of inflammation generally subside, and all that is left is a bony painless bump—called a Heberden's node (a Bouchard's node is the same thing but develops at the middle finger joint).

In addition to the limited range of motion, finger joints that have Heberden's nodes sometimes deviate (for example, an index finger with a Heberden's node may point towards the middle finger)

Treatment of Heberden's Nodes

During the painful development of Heberden's nodes, treatment entails rest and sometimes splinting, plus pain relievers, like nonsteroidal anti-inflammatories (NSAIDs), and heat or ice therapy. 

Physical or occupational therapy may also be helpful, as a person learns how to minimize pain and/or use their affected finger(s) that is restricted in its range of motion due to the Heberden's node.

Rarely, surgery may be performed, but mostly only if symptoms persist or a person is unable to use the finger. One example of a surgery on the finger would be to replace or fuse the affected joint. 

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

Significance of Heberden's Nodes

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

In addition, studies suggest that there is a genetic predisposition to developing Heberden's nodes, whereby the associated gene is dominant in women and recessive in men. This means that if your mother has Heberden's nodes, you are likely at a greater risk to get them if you develop hand osteoarthritis.

A Word From Verywell

A final tidbit is that visible signs of osteoarthritis, like Heberden's nodes, are an important element when the disease is being diagnosed.

This is in contrast to other types of arthritis, such as rheumatoid arthritis and gout, which often rely more heavily on laboratory tests.  

If you suspect a Heberden's node and/or hand osteoarthritis, please see your physician for a proper diagnosis. There are other health conditions that can mimic that of hand osteoarthritis or even a bump on the finger. Be sure to undergo a proper diagnosis, so an effective treatment plan can be made for you. 

Sources:

Bernstein RA. Arthritis of the thumb and digits: current concepts. Instr Course Lect. 2015;64:281-94.

Doherty M, Abhishek A. (2017). Clinical manifestations and diagnosis of osteoarthritis. Hunter D, ed. UpToDate. Waltham, MA: UpToDate Inc.

Dunkin MA. (n.d.). Arthritis Foundation: "What Your Hands Say About Your Health". 

Rees F et al. Distribution of finger nodes and their association with underlying radiographic features of osteoarthritis. Arthritis Care Res (Hoboken). 2012 Apr;64(4):533-8.

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