The Causes and Effects of Heberden’s Nodes

A long list of health issues starts in midlife, depending on overall wellness, genetics, and other factors. Bony bumps on the end joints of the fingers, Heberden’s nodes, are one such condition. Although they are more common in women, men can develop them as well.

What They Are

Heberden’s nodes are bony growths that appear on the distal interphalangeal (DIP) joints, the joint closest to the fingernail. Erosion of the joint’s cartilage allows the bones to rub against each other. New bone forms and nodules or nodes develop on the joints. The fingers become gnarled and enlarged.

Causes

Heberden’s nodes are one of the first symptoms of osteoarthritis. The cartilage that covers the ends of the bones wears away due to wear-and-tear or an injury to the joint. Once the cartilage is gone, there is no longer any cushioning in the joints. This leads to friction and the formation of osteophytes or bone spurs around the joints. Heberden’s nodes follow. Some research shows that the ligaments may also play a role in the early stages of nodal development.

Symptoms

A Herbeden’s node is about the size of a pea. One finger may have a single node or multiple. Some people feel warmth or swelling at the joint before the node develops, a sign of inflammation caused by friction-induced rupture and a leak in the membrane lining the joint cavity. Heberden’s nodes are sometimes, but not always, painful. Once the node has developed, the pain usually subsides or goes away altogether. Stiffness or numbness occurs in the fingers, causing a limited range of motion. The nodes may also interfere with nail growth, changing the surface shape.

Age at Onset

Increasing age is a factor in the development of Heberden’s nodes. It is rare for Heberden’s nodes to form before the age of 40 unless the person has osteoarthritis caused by a joint injury. Women most often develop Heberden’s nodes after the onset of menopause, while they begin to appear in men during middle age. Doctors diagnose about half of the individuals with Heberden’s nodes before 65.

Hand Dominance

A 2011 study found that Heberden’s nodes most frequently affected the index finger. Researchers also noted that the nodes were more common in the subjects’ dominant hands and more prevalent in women. They determined that the presence of nodes is an indication of underlying small joint osteoarthritis. About 60% of people with osteoarthritis of the knees have Heberden nodes.

Heberden’s Nodes Versus Bouchard’s Nodes

Bony growths, or exostoses, at the proximal interphalangeal joint — the joint in the middle of the finger — are Bouchard’s nodes. Like Heberden’s nodes, these bony growths are a sign of osteoarthritis. While less common than Heberden’s nodes, Bouchard’s nodes usually occur in individuals with more severe cases of arthritis.

Genetic Predisposition

A 2006 study shows there may be a genetic predisposition for Heberden’s nodes. About 10% of people develop hereditary arthritis in the distal interphalangeal or DIP joint. If family medical history includes instances of Heberden’s nodes, a person is more likely to develop them. For females, the condition has a dominant inheritance pattern and for males, the inheritance pattern is recessive.

Diagnosis

Physicians use ultrasound scanning and magnetic resonance imaging (MRI) to confirm a Heberden’s node diagnosis. If a person has the condition, there will be evidence of soft tissue bulging between the dorsal tendons and collateral ligaments. Some doctors use X-rays to determine whether or not the individual has Bouchard’s nodes, however, this method is less reliable for diagnosing Heberden’s nodes.

Treatment

Physicians recommend treating Heberden node pain with heat or ice packs, physical therapy, and non-steroidal anti-inflammatory pain medications. They may suggest splinting the affected fingers to restrict movement. Low-level laser therapy is a possible non-invasive option for not only reducing pain and swelling but for increasing joint mobility, as well. However, the medium- and long-term effects of laser therapy are unknown and require further study. Surgery is a last resort, usually if less-invasive treatments were unsuccessful.

Prognosis and Prevention

While the pain from Heberden’s nodes decreases, the bony protrusions are permanent. However, lifestyle changes can stop or delay the progression of the disease. Splints and braces add support, especially while the individual is performing repetitive motions throughout the day. Doctors say regular exercise, such as tai chi or yoga, eating a non-inflammatory diet, and maintaining a healthy weight are steps toward preventing Heberden’s nodes and osteoarthritis.