Heberden’s Nodes

Introduction:

• Heberden’s nodes are pea-sized bony growths that develop on the distal interphalangeal joint, which is the joint closest to the tip of the finger. A sign of hand osteoarthritis (OA) is Heberden’s nodes.
• Heberden’s nodes are so named in honor of William Heberden, Sr., MD, the physician who first identified them in the 1700s.
• The “bony swellings” known as Heberden’s nodes appear on your hands.
• Your finger joints will have lumps from Heberden’s nodes. They are a symptom of osteoarthritis, which is brought on by the destruction of joint cartilage. There are techniques to manage the discomfort even though there are no specific therapies.
• They frequently cause discomfort and stiffness in the joints closest to the fingertips. The fingers can look off. Depending on the developmental stage they are at, they might or might not be painful. You might feel pain when they’re growing and maturing. The nodes normally do not ache once they have fully developed, though.

Heberden’s Node Symptoms

• Women experience Heberden’s nodes more frequently than men do. They are more frequent on a person’s dominant hand’s fingers.
• Heberden’s node symptoms typically appear around menopause in women and in middle-aged males. These nodes appearing is a typical indication of osteoarthritis.
• In a few years, the discomfort and inflammation normally subside. After that, a Heberden’s node—a bony, painless bump—will remain on your finger.
• Heberden’s node-afflicted finger joints may drift to one side and have a reduced range of motion and functioning. For instance, a Heberden node on the index finger may cause it to point inward rather than outward.
• Bony growths called Heberden’s nodes, which surround the finger joints, can cause abnormalities in the fingers. Some people may experience only very minimal or no associated symptoms at all when they first arise.

Signs and symptoms of Heberden’s nodes

• Examining your finger’s end joints might frequently reveal Heberden’s nodes if you have them.
• The joint nearest to your fingernail may develop very small, hard swellings. Your fingers may frequently twist or bend as the nodes develop.
• However, in certain people, symptoms may be recognized and include:
  • Loss of motion of the fingers
  • Pain
  • Swelling and inflammation around the finger joints
  • Deformed and enlarged fingers
  • Stiffness in the affected area
  • Weakness

• The previously mentioned symptoms may occasionally go unrecognized since Heberden’s nodes only show up in the most severe cases of OA. This can be due to the severity of other OA symptoms or the fact that the person has developed a habit of avoiding utilizing their finger joints.

• Heberden’s nodes also have the following characteristics.

The index and middle fingers are most frequently affected, though they can also affect the thumb.
On a finger, you could have more than one node.
They may arise gradually or suddenly.
When they first start, they are frequently painful, though not always.
Gout can deposit crystals in the nodes of older women who have hypertension, or gout, and who take a diuretic like hydrochlorothiazide. This can result in an acute inflammation. It is a painful, erythematous condition that resembles an infection.
Heberden’s nodes can sometimes go unnoticed or only cause minor symptoms.

Heberden’s nodes can make it challenging to execute some actions that call for gripping or pinching, such as turning the key in your car’s ignition or removing the top from a soda bottle.

It could be challenging for you to finish duties for work or household chores, and you might feel constrained in your everyday activities.

This could have an effect on your quality of life. It may potentially result in the emergence of a mental health condition, such as depression and anxiety.

Causes of Heberden’s Nodes

• People with hand osteoarthritis frequently develop Heberden’s nodes.
  The cartilage in your joints gradually deteriorates if you have OA. Without cartilage, the bones in the joints scrape against one another, eventually causing damage.
  Your body makes new bone to help repair the harm osteoarthritis has done to your bones. One instance of this is Heberden’s nodes.
• Two bones that come together form a finger joint. Your bones move with ease because of the smooth cartilage. Your bones don’t fit together as easily as they used to though when the cartilage begins to deteriorate.
• Your body replaces lost cartilage at the joint by developing new bone as a protective measure. Nodes or spurs are the names for the new bone growths. Heberden’s nodes are what they are known as when they develop at the finger’s end joint.
• Each joint in the body has a layer of cartilage covering it to protect the bones. As a result of OA, this layer of cartilage quickly degrades, exposing the bones in the joints to direct contact. Over time, the continual scratching of the bones could be harmful.
• When an injury occurs, the body reacts by stimulating the growth of new bone forms called nodes.
• The fingers may have Heberden’s nodes, a form of bone development, in severe OA patients.
• The fingers are frequently affected by osteoarthritis.
• The cartilage in the joints in these places cushions and shields the surface of your bones.
• Osteoarthritis can appear following an injury, though it frequently results from the wear and tear that comes with aging.
• There is some ambiguity over how the illness process develops in Heberden’s nodes.
• According to research, the procedure might involve:
  • Ligaments
  • Tendons
  • Peri arthritis
  • The joint capsule
• Additionally, it suggests that in addition to bone, soft tissue may also undergo certain alterations.
• Your cartilage may deteriorate and lose its ability to shield your bones. Without it, the bones start to scrape against one another.
• This process has the potential to damage existing bone and create excruciating pain, both of which may be early indicators of OA and the emergence of nodes. Although the pain may get better with time, the deformity worsens.
• Alongside the old bone, new bone forms nodes or bony spurs as the cartilage continues to degrade.
• Your fingers may have stiffened and the discomfort may have subsided by the time the nodes show.
• Heberden’s nodes, also known as nodal OA, are frequently regarded as a marker of advanced OA since they frequently develop after significant joint damage has already taken place.

Risk factors

• The most prevalent kind of arthritis is osteoarthritis. Although it frequently affects older persons, more than half of those who also have Heberden’s nodules and OA are diagnosed before the age of 65.
• Heberden’s nodes are only seen in OA patients, although it is unknown what causes these abnormal bone growths. Some of the conditions risk factors are:
  • Age
  • Family history
  • Related conditions, such as gout
  • Obesity
  • Injury to the joints
• Other risk factors include:
  • Hereditary conditions that affect the joints
  • A bodily part, such as the knee, suffering from OA
  • Rheumatoid arthritis, which may lead to cartilage and joint alterations
  • Gout, which can affect periarticular bony erosion
  • Having a family history of these nodes
  • Obesity may make people more likely to develop OA
  • Playing sports or doing a profession that requires repetitive motions

Treatment of Heberden’s Nodes

• Heberden’s nodes don’t have a standard course of care. Many of the same treatments that are advised for those with hand arthritis are also applicable to those who have them.
• Low-level laser therapy (LLLT) was observed to improve pain and edema after five to seven sessions in a 2016 study of persons with OA, Bouchard’s nodes, and Heberden’s nodes. Additionally, some individuals had improved finger mobility.
• Heberden’s nodes can cause pain as they develop. Rest, splinting, over-the-counter (OTC) NSAIDs like Advil (ibuprofen) or Aleve (naproxen), topical medications like lidocaine and diclofenac gel, and heat or ice therapy can all be beneficial during this time.
• Wearing hand supports known as orthoses at night was also reported to help lower pain and improve hand function in a 2020 research on women with hand OA.
• You might also wish to work with an occupational or physical therapist. They can educate you on how to utilize the fingers impacted by the nodes and use hand therapy to lessen your pain.
• To treat osteoarthritis, adhere to your doctor’s advice. Pain relief and helping you move again are the goals of treatment. Your doctor might advise you to:
• Non-drug therapies:

Put your hand down.
To support your finger joints, put on a splint or orthotic device (orthosis).

Use heat on your hand, such as paraffin wax or warm compresses. To relieve pain, you can alternate between applying heat and applying cold therapy, or you can apply heat before exercising and ice after.
Consult a hand therapist who can show you routines to maintain hand mobility while safeguarding your joints. It’s crucial to keep using your hand safely. In order to continue using your hands for regular tasks, therapists can also teach you about adapting tools.

• Drug treatments:

Anti-inflammatory medications known as nonsteroidal anti-inflammatory medicines (NSAIDs), acetaminophen (Tylenol®), and pain relievers like capsaicin or menthol are frequently sold as pills, syrups, or lotions.
Injections of steroids can also reduce pain.

• Do I Need Surgery?
  • Only if a person’s symptoms do not improve or if they are completely unable to use their finger is surgery for Heberden’s nodes performed. The joint can occasionally be replaced surgically. A surgeon can also remove the inflammatory joint components and reassemble the joint. We refer to this as joint fusion.
  • The good news is that the pain goes away once the bone node has developed. Range of motion, grip power, and general functionality, however, may be constrained.

How to Manage Your Lifestyle

• You can do a number of things to lessen Heberden’s node pain and avoid handicaps, such as:
• If you can, rest your hand.
• Heat and cold therapy alternated.
• Put on a splint to support the joints in your fingers.
• Follow your physical therapist’s or occupational therapist’s advice when it comes to performing gentle finger and hand stretches and strengthening exercises.
• Adopt a better diet and stay away from processed cereals, sweets, red meat, bad fats, and salt.

FAQs

References:

1 Professional, C. C. M. (n.d.). Heberden’s Nodes. Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/21829-heberdens-nodes#:~:text=Heberden’s%20nodes%20are%20small%2C%20pea,Heberden%2C%20Sr.%2C%20MD.

2 Eustice, C. (2023, August 21). Heberden’s Nodes: Everything You Need to Know. Verywell Health. https://www.verywellhealth.com/what-are-heberdens-nodes-2552023#toc-how-heberdens-nodes-are-treated

3 Kandola, A. (2023, April 5). What are Heberden’s nodes? https://www.medicalnewstoday.com/articles/322363

4 Wu, B. (2023, June 13). What Are Heberden’s Nodes? Healthline. https://www.healthline.com/health/osteoarthritis/heberdens-nodes