(See also Overview and Evaluation of Hand Disorders.)
Osteoarthritis affecting the hand may include asymptomatic enlargement of nodules at the proximal interphalangeal joint (Bouchard nodes) or distal interphalangeal joint (Heberden nodes) or angulation at these joints. Pain and stiffness of these joints and the base of the thumb are also common. The wrist usually is spared (unless there was preexisting trauma), and there is usually minimal or no metacarpophalangeal joint involvement unless the patient also has a metabolic disorder (eg, hemochromatosis).
Differentiation of hand changes in osteoarthritis from those in rheumatoid arthritis is discussed in Evaluation of the Patient With Joint Symptoms. Gout can cause acutely inflamed Heberden nodes, most frequently described in post menopausal women receiving diuretic therapy.
This photo shows Heberden nodes, hard-tissue (bony) prominences of distal interphalangeal joints seen in patients with osteoarthritis.
Heberden nodes are hard-tissue (bony) prominences of distal interphalangeal joints, seen best in this image on the 2nd and 3rd digits of both hands.
Bouchard nodes are hard-tissue (bony) prominences of proximal interphalangeal joints, which in this photo are seen best on the digits of the right hand and the 1st and 2nd digits of the left hand.
Treatment
Treatment of osteoarthritis of the hand is symptomatic with analgesics, appropriate rest, splinting, and occasionally corticosteroid injection as needed.
Surgical procedures can help relieve pain and correct deformity for severe changes at the base of the thumb and, less commonly, for advanced degeneration of the interphalangeal joints.
