Hand / Fingers
Bouchard's Nodes (PIP Joint OA)
Bouchard 결절 (PIP 관절 골관절염)
Bony nodules from osteoarthritis of the proximal interphalangeal (PIP) joint
- How common
- Less common than Heberden
- Typical age
- Age 50+, female predominant
What is it?
PIP cartilage wear with marginal osteophytes produces joint enlargement and lateral deviation.
Commonly affected: Index and middle finger PIPs
How it develops
- PIP Cartilage LossProgressive cartilage wear
- Joint NarrowingArticular surfaces approximate
- Osteophyte GrowthDorsolateral osteophytes
- Lateral DeviationAsymmetric wear causes finger angulation
Symptoms
- Bony PIP enlargementHard enlargement of middle finger joints
- Joint painWorse with gripping/pinching
- Flexion restrictionCannot make a full fist
- Lateral deviationFinger angulation
- Reduced grip strengthDecreased grip affects ADLs
How it is examined
- Bony PIP prominenceHard, large, fixed nodules
- Lateral stability testCollateral ligament laxity with advanced OA
- Decreased flexion anglePIP flexion <90°
- Concomitant HeberdenOften accompanied by DIP nodules
Imaging
AP/lateral hand X-ray — PIP joint space narrowing, osteophytes, lateral deviation.
- PIP joint space narrowing
- Osteophytes
- Lateral deviation
- Subchondral sclerosis
Rarely required; used for cartilage/soft-tissue assessment.
- Cartilage defects
- Mild synovitis
- Possible marrow edema
Non-surgical care
- Activity modificationAvoid repetitive forceful gripping
- Topical NSAIDsTopical diclofenac gel
- Splinting (short-term)Static splint during acute flare
- Intra-articular steroidShort-term pain control
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Refractory pain, severe deformity/instability
Procedures that may be discussed
- PIP arthroplasty (silicone implant)
- PIP arthrodesis
- Osteophyte excision
Outlook
Pain manageable but deformity progresses; surgery effective for function.