Heberden’s Nodes: Treatment and More

Heberden's nodes are small bony growths on the finger joints closest to the tip (the distal interphalangeal joint or DIP).

Heberden's nodes are a common sign of osteoarthritis (OA). They may or may not be painful depending on the stage of development they are in.

Treatments for Heberden's nodes include laser therapy, splints, and pain relievers. Ice, heat, and physical therapy can also be effective. Some people may opt for surgery.

Symptoms

Heberden's nodes are more common on the fingers of a person's dominant hand. They occur more often in women than in men.

The signs of developing Heberden's node usually start around menopause for women and in middle age for men. Developing these nodes is a classic sign of osteoarthritis.

People may experience pain while the nodes are developing and growing. The pain and inflammation usually get better within a few years and, once fully formed, they typically do not hurt.

Heberden's nodes may develop on one side of the finger joint only, causing the fingertip to curve sideways, instead of straight out. This can further limit range of motion and functionality.

Causes of Heberden's Nodes

Heberden's nodes often develop in people with osteoarthritis (OA) of the hands. OA is a condition in which joint cartilage gradually wears away. Without cartilage, the bones in the joints rub together and become damaged over time. 

The body creates new bone to help compensate for damage caused by osteoarthritis. Heberden's nodes are one example of this.

There is no single cause of finger OA and Heberden's nodes, however, certain risk factors increase the chances of development. These include:

• Increasing age
• Being female
• Long-term repetitive stress to finger joints (occupational or recreational)
• Prior joint injuries or surgeries
• A family history of OA and/or Heberden’s nodes
  
• Genetics
• Being overweight or obese
  

Diagnosis

A healthcare provider will usually diagnose Heberden's nodes based on:

• Symptoms
• Medical history
• A physical exam

X-rays may be ordered to look for worn cartilage or bone spurs.

How Heberden's Nodes Are Treated

There is no set treatment for Heberden's nodes. Options are similar to the treatments recommended for people with arthritis of the hands.

A 2016 study of people with Bouchard's nodes, Heberden's nodes, and osteoarthritis found that having five to seven treatments with low-level laser therapy (LLLT) reduced pain and swelling. Some people could also move the affected finger better.

Heberden's nodes can cause pain while they are forming. Some strategies that reduce pain and slow or prevent disability include:

• Resting hands whenever possible
• Splinting
• Using non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Celebrex (celecoxib)
• Using Topical creams like diclofenac sodium and lidocaine
• Alternate heat and ice therapy
• Adopting an anti-inflammatory diet (e.g., the Mediterranean diet)

A 2020 study of women with hand OA found that wearing hand supports called orthoses at night helped reduce pain and improve hand function. 

Those with Heberden's nodes may also want to work with a physical therapist or occupational therapist to reduce pain and learn strategies to cope with fingers affected by the nodes.

Will I Need Surgery?

Surgery for Heberden's nodes is only done if a person's symptoms don't get better or they cannot use their finger at all. Sometimes, surgery can replace the joint. A surgeon can also take out the inflamed parts of the joint and put the joint back together. This is called joint fusion. 

The good news is that once the bony node has formed, the pain goes away. However, range of motion, grip strength, and overall functionality can be limited.

Summary

Heberden's nodes are bony swellings of the joints in the hand that are closest to the nail. While forming, the nodes can hurt. Once fully formed, the pain typically goes away. However, a person might be bothered by their appearance or the resulting limited range of motion.

There are ways to manage node pain, like taking NSAIDs and using ice and heat therapy. Additionally, working with a physical therapist can help people better use hands affected by arthritis.

There is no way to simply fix the appearance of nodes. However, if a person has Heberden's nodes because they have hand OA, joint surgery might help fingers function better.