yogabook / pathology / bouchard’s nodes

Definition of

Idiopathic osteoarthritis of the metacarpophalangeal joints(PIP) with the formation of Bouchard nodes (hard bony thickenings), usually with a postmenopausal onset. It affects several PIPs in isolation and begins with pain on movement, which is dependent on exertion. There is initial pain, followed later by restricted movement and, as a late symptom, pain at night or at rest. The pain can range from dull to stabbing. Weather sensitivity is also observed. Inflammatory phases reduce mobility. Later, the typical Bouchard nodes appear and axial misalignments often develop. In contrast to Heberden ’s osteoarthritis, Bouchard’s osteoarthritis usually begins non-inflammatory. Up to 1/5 of older people are affected.

Cause

1. idiopathic, probably genetically predisposed

Predisposing

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

Diagnosis

1. X-ray: joint space narrowing
2. later axial misalignments, even later osteophytes

Symptoms

1. Early symptoms: Morning stiffness, starting stiffness; pain after exertion
2. Middle stage: pain on exertion and after exertion, increasing pain towards the evening; first restrictions in mobility; inflammatory phases; formation of Bouchard’s nodes
3. Late stage: severe pain, even at rest; sometimes chronic inflammation; increasing deformities, axial deviations and restricted mobility, consecutive muscle atrophy
4. Joint instability
5. Bouchard knot

Complications

Therapy

1. NSAIDs for pain and inflammation
2. Intra-articular cortisone injections
3. Neurectomy (cutting of the pain fibres)
4. If necessary TEP, arthrodesis
5. X-ray irradiation if necessary
6. Grip strength and mobility training
7. Prostheses (silastic, Swanson spacer, hinged joints, anatomical surface replacement prostheses, pyrocarbon), if applicable, but these show postoperative complications in 27.5% and subsequent implant loosening in 12.5%.