Heberden’s Nodes: Signs, Symptoms and Causes

Introduction

Heberden's nodes are tiny, pea-sized bony growths on the distal interphalangeal joint, which is the joint next to the tip of the finger. Heberden's nodes are one of the symptoms of hand osteoarthritis (OA). These might cause pain and restricted movement in your hands. Heberden's nodes appear only in persons with osteoarthritis (OA), a degenerative bone disorder. These growths may cause pain, stiffness, and discomfort. Heberden's nodes are called after the physician first identified them, William Heberden, Sr., MD.

What Are Heberden’s Nodes?

Heberden’s nodes are small bony overgrowths formed as nodules at the site of the joint closest to the fingertip. They are generally formed in people who are suffering from osteoarthritis. Osteoarthritis is a chronic debilitating joint disease that is characterized by damaged joint tissues, in particular the articular cartilage. Over time, the joint structure is immensely compromised, leading to managing the disease with either Disease Modifying Anti-Rheumatic Drugs (DMARDs) or, in severe cases, surgical replacement of the joint.

The loss of cartilage increases the friction between the two bones during movement. When bone scraping becomes chronic, it triggers a response that involves more bone production, which can be markedly seen as overgrowth. Heberden’s nodes are one such bony overgrowth typically found in the fingers of people with severe osteoarthritis. These nodes are reported to be painful when in their growing stage. However, they do not cause any pain or discomfort once fully formed. This article discusses its causes, symptoms, and treatment protocol to tackle these nodes.

What Are the Symptoms of Heberden’s Nodes?

Heberden’s nodes are almost always present in people with osteoarthritis. They are generally more common in females compared to males. In women, they are formed usually around menopause, whereas in men, they occur past the age of fifty. For some reason, a person's dominant hand is the most affected. They are extremely painful in their developing stage but resemble merely painless bumps on the fingers once fully formed. The fingers often point in one direction, unlike in normal people, where they point straight.

The symptoms of Heberden’s nodes include:

1. Pain and discomfort.

2. Swelling in the joints present in fingers.

3. Stiff and rigid phalanges.

4. Reduced range of mobility in fingers.

5. Weak grip strength; inability to hold things for a long period.

6. The fingers increase in size due to excess bone growth, especially near the fingertip.

7. There may be more than one node present on one finger.

8. They are either quick to occur or only occur in severe cases of osteoarthritis.

9. The index and middle fingers are most commonly involved; the thumb may also be involved.

These nodes are often asymptomatic and show no symptoms during their developing stage.

How Are Heberden’s Nodes Diagnosed?

The family history and already existing conditions are good indications to confirm the diagnosis of these nodes. Clinical examination can also provide a good base to diagnose the presence of these nodes. Pain and inflamed finger joint symptoms are good pointers to help confirm this classic sign of osteoarthritis. For a confirmed diagnosis, the doctor may order diagnostic tests like an X-ray to check for bony spurs at the joint closest to the fingertip.

What Are Bouchard’s Nodes?

Heberden’s nodes are found at the distal end of the finger joint, which is called the distal interphalangeal (DIP) joint. A similar bony spur, called Bouchard's nodes that resembles Heberden’s nodes, may also grow on the proximal end of the finger joint.

How Are Heberden’s Nodes Treated?

The underlying cause of Heberden’s nodes is osteoarthritis. Hence, treating the nodes will most likely involve treating osteoarthritis. Osteoarthritis is not a curable disease and does not go away once acquired. The only way to control it is to manage the disease symptoms appropriately. Disease management can be carried out by carrying out varied practices.

• Taking pain-relieving drugs relieves the patient from pain and discomfort. Examples include Non-steroidal Anti-inflammatory Drugs (NSAIDs). Pain and inflammation can also be controlled by alternate heat and cold therapy on the affected joints (fingers). Administering steroid injections into the finger joints can also improve the pain. However, it is said to be a very painful procedure.

• Regular physical exercise and a tailored fitness routine in the daily regimen can do wonders for joint health. The joints can improve their mobility with specific exercises and improve their strength exponentially. Resistance training as an exercise mode has proven to produce the highest benefit for bone health. However, care must be taken to perform activities within the practitioner's physiological limits. Doing exercise under the supervision of a physical therapist or a fitness instructor is highly advised during the early stages.

• Certain assistive devices that help arthritic patients can be very helpful for people who have lost their grip strength. These devices can help people carry out daily activities without dependency. Examples include long-handled knives, slicers, choppers, automatic/electronic grinders, Velcro fasteners as a replacement for shoe laces, and button fastening aids to help one dress easily.

• Splinting the joints during their development phase has also been found to relieve pain. Low-level laser therapy (LLLT) is another alternative that has gained immense popularity among patients. Other alternative therapies that can be practiced from the comfort of one’s home include acupuncture, soaking hands in warm water, warm towels wrapped around the hands, and paraffin wax therapy.

• Wearing hand-support orthopedic devices, like orthoses, can help with the hand's functionality. It provides stability to the hand, allowing one to perform tasks with a relatively better ability than when attempted without it.

• Surgical treatment is often the last option one resorts to when all else has failed to provide a permanent solution. The surgery usually involves re-sectioning the bony overgrowths and reconstructing the operated joints to remove any bumps or uneven surfaces.

Conclusion

Although manageable, osteoarthritis can prove to take an extreme toll on one’s mental health owing to the increased dependency on performing routine tasks such as dressing up, bathing, or brushing one’s teeth. Hence, mental therapy or counseling is also advised for patients to improve their overall quality of life alongside physical therapy.