Hand / Fingers
Heberden's Nodes (DIP Joint OA)
Heberden 결절 (DIP 관절 골관절염)
Bony nodules from osteoarthritis of the distal interphalangeal (DIP) joint
- How common
- Common (30% of women >50)
- Typical age
- Age 50+, female predominant
What is it?
Cartilage wear at the DIP joint with marginal osteophytes forms the characteristic bony nodules.
Commonly affected: Index and middle finger DIPs most common
How it develops
- Cartilage WearDIP cartilage thins and fibrillates
- Joint Space NarrowingCartilage loss narrows the joint space
- Osteophyte FormationMarginal osteophytes develop
- Heberden NodulesDorsolateral bony prominences form nodules
Symptoms
- Bony DIP nodulesHard, bony enlargements
- Joint painWorse with activity, better with rest
- Morning stiffness <30 minBrief stiffness that resolves quickly
- Reduced ROMLimited DIP flexion
- Mucous cystClear dorsal cyst may form over DIP
How it is examined
- Bony DIP enlargementHard, fixed bony prominences palpable
- No warmth/erythemaDifferentiates from inflammatory arthritis
- DIP grind testAxial compression/rotation reproduces pain
- Normal MCP/wristProximal joints normal — differs from RA
Imaging
AP hand X-ray diagnostic — DIP joint space narrowing, osteophytes, subchondral sclerosis.
- DIP joint space narrowing
- Marginal osteophytes
- Subchondral sclerosis
- Possible subchondral cysts
Usually unnecessary; used if soft-tissue differential required.
- Cartilage defects
- Subchondral marrow edema
- Mucous cyst confirmation
Non-surgical care
- Activity modificationReduce repetitive pinching/gripping
- NSAIDs (topical/oral)Topical diclofenac preferred
- Heat/paraffin therapyRelieves stiffness and pain
- Hand exercise programMaintains ROM and strength
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, large mucous cyst
Procedures that may be discussed
- DIP arthrodesis
- Mucous cyst excision
- Osteophyte removal
Outlook
Slowly progressive; function mostly preserved. Arthrodesis gives excellent pain relief.