yogabook / pathology / heberden’s nodes

Definition of

Idiopathic osteoarthritis of the finger end joints (DIP) with formation of Heberden’s nodes (hard bony thickenings). W:M 10:1, usually with postmenopausal onset. Annual incidence among 50-59 year old women is 190 / 100,000 compared to 29 men. In addition to genetic predisposition, endocrinological factors could therefore play a role. The fingers are most frequently affected 2,3,4. Arthritis is often the initial manifestation, followed by chronic joint swelling with a later tendency to develop an extension deficit, i.e. a flexion contracture, and possibly radial deviation of the distal phalanx. After the initial arthritis, the pain usually subsides. Radiological findings are then dominated by osteophytes, sclerosis and narrowing of the joint space. The diagnosis can usually be confirmed by inspection of the nodes and X-ray. The aetiology of Heberden ’s osteoarthritis begins with a breakdown of the cartilage tissue. Aetiological involvement of sport or activities with the hands, which lead to loosening of the capsular ligament apparatus, is discussed. Injuries to the joint also play a role. The incidence clearly increases with age. Sometimes a combined Heberden-Bouchard arthrosis is present. Combinations with thumb saddle joint arthrosis (rhizarthrosis) also occur. In addition to a chronic, slowly progressive course, an intermittent course (activated osteoarthritis) is also possible, with episodes lasting months.

Cause

1. idiopathic, probably genetically predisposed

Predisposing

1. familial disposition
2. discussed: manual activities, sports

Diagnosis

1. Inspection reveals the predominance of Heberden’s nodes on the extensor side (two-humped, cartilaginous-bony growths)
2. X-ray: thinner, uneven, uneven cartilage; subchondral sclerosis
3. Initial signs of inflammation, joint effusion
4. MRI for clarification and differentiation of other joint and soft tissue events

Symptoms

1. Initial pain and signs of inflammation
2. later possibly radial deviation of the end phalanx
3. even later, possibly loss of strength and restriction of movement
4. Morning stiffness, start-up stiffness

Complications

Therapy

1. NSAIDs for short-term pain relief
2. Occupational therapy, cryotherapy, ultrasound, electrotherapy
3. PT: cautious axial traction
4. Isometric or isotonic strength training
5. In severe cases: intra-articular glucocorticoid administration, arthrodesis, radiosynoviorthesis
6. X-ray therapy (X-ray irradiation)
7. Agility training
8. Heat only outside flammable phases
9. Surgery: Silicone hinge prosthesis; long-term results are still lacking for pyrocarbon TEP. Prostheses are not indicated for heavy physical labour, in which case arthrodesis is the treatment of choice.