Symptoms and Significance of Heberden's Nodes

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Heberden's nodes are bony swellings of the joint closest to the fingertip, also known as the DIP joint or distal interphalangeal joint. This joint lies 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.

A pair of elderly hands close up
Camille Tokerud Photography Inc. / Getty Images

Heberden's Node Symptoms

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

The pain and signs of inflammation generally subside within a few years, 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).

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 most often located on the index finger.

Causes

Research published in 2012 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.

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

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

A study published in 2011 indicated 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.

Treatment

Due to the lack of a specific therapeutic strategy for Heberden's nodes, the treatment usually follows the recommendation for hand osteoarthritis.

A study showed that five to seven treatments with low level laser therapy (LLLT) could reduce the pain and ring size and enhance the range of motion in patients with Bouchard's and Heberden's OA.

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. 

A physical therapist or occupational therapist may use hand therapy, which might help minimize the pain and/or teach a person how to 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 surgery on the finger would be to replace or fuse the affected joint. 

A 2020 study found that wearing orthoses at night by women with hand osteoarthritis reduced pain as well as improved their hand functioning. 

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.

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.

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  1. National Institute on Aging. Osteoarthritis. Updated May 1, 2017.

  2. Rees F, Doherty S, Hui M, et al. Distribution of finger nodes and their association with underlying radiographic features of osteoarthritis. Arthritis Care Res (Hoboken). 2012;64(4):533-8. doi:10.1002/acr.21586

  3. Michou L. Genetics of digital osteoarthritisJoint Bone Spine. 2011;78(4):347-351. doi:10.1016/j.jbspin.2010.09.012

  4. Baltzer AW, Ostapczuk MS, Stosch D. Positive effects of low level laser therapy (LLLT) on Bouchard's and Heberden's osteoarthritisLasers Surg Med. 2016;48(5):498-504. doi:10.1002/lsm.22480

  5. Arthritis Foundation. Osteoarthritis of the hands.

  6. American Society for Surgery of Hand. Osteoarthritis.

  7. Silva PG, de Carvalho Silva F, da Rocha Corrêa Fernandes A, Natour J. Effectiveness of nighttime orthoses in controlling pain for women with hand osteoarthritis: A randomized controlled trial. Am J Occup Ther. 2020;74(3):7403205080p1-7403205080p10. doi:10.5014/ajot.2020.033621