nodal osteoarthritis (of the fingers)

Introduction

Clinical syndrome of Heberden's nodes & Bouchard's nodes & often 1st carpometacarpal joint.

Epidemiology

predominantly women

Pathology

• bony proliferation in the absence of objective synovitis

Genetics

family history is often positive

Clinical manifestations

• aching, discomfort & stiffness increased with use of fingers
• Heberden's nodes
• Bouchard's nodes
• the 1st metacarpal joint at the base of the thumb is a common site, worsened by gripping & twisting movements
• MCP joints are rarely involved
• symptoms may improve with time secondary to reduced range of motion with bony enlargement
• function is generally preserved

Differential diagnosis

gout

Management

• see osteoarthritis
• local measures
  • avoid knitting
  • warm water soaks in the morning
  • nylon Spandex stretch gloves at night
• osteoarthritis of 1st metacarpal joint responds to splinting
• local corticosteroid injection into single joint symptomatic out of proportion to others
• capsaicin 0.025% applied QID

More general terms

• osteoarthritis (OA)

Additional terms

• Bouchard's node
• Heberden's node