Bouchard and Heberden's nodes - what are they and why do they appear?

Diagnosis by X-ray.
Deforming arthrosis of the hands has certain symptoms, and among them the most characteristic are Heberden's and Bouchard's nodes, which are bone growths on the joints. In this case, Heberden’s nodes are growths on the distal phalanges, Bouchard’s nodes are proximal ones.

What are Heberden's and Bouchard's nodes

Bouchard's and Heberden's nodes are identical in structure, but differ in location. The first are located on the joints of the extreme phalanges of the fingers, the second on the middle phalanges.

Damage to the joints of the thumbs is called rhizarthrosis.

They represent deforming nodular arthrosis of the hands, in which the amount of synovial fluid in small cartilages decreases and the elasticity of the joints is lost. Due to the friction of the articular surfaces against each other, injuries occur, followed by aseptic inflammation and the release of a pathological fluid substance. The latter bursts the joint capsule and deforms it. This is how a knot is formed.

Bouchard's nodes

Arthrosis of the proximal joints of the hand occurs in 50% of patients with Heberden's nodes, but can also develop as an independent disease. Bouchard's nodes usually occur only on the lateral portions of the joint. The pain in them is not very pronounced, but they deform the joint. Such a finger becomes like a spindle due to the thickening in the middle. Due to deformation, the range of motion in the joint becomes limited.

An x-ray with arthrosis of the joints of the hand shows a narrowing of the joint spaces, unevenness of the cartilaginous layer, a decrease in the bone density of adjacent areas of bone tissue, and bone growths on the sides. It is because the joint space narrows that shortening of the fingers occurs, which often frightens patients.

Causes of the disease

So far, doctors have not identified any clear reasons for the development of pathology. However, studies have been conducted on this topic, which have shown that the appearance of Heberden's nodes can be caused by a hereditary factor. Pathology in some cases manifests itself both in the next generation and after several. Thus, the features of the anatomical development of articular joints can be transmitted through genes.

The mechanism of pathological changes in the form of deforming arthrosis can be triggered due to:

1. Hormonal imbalance;
2. Age-related changes;
3. Diabetes mellitus;
4. Transmission of viral diseases;
5. Excess body weight;
6. Increased activity of enzyme substances synthesized in lysosomes;
7. Congenital articular and bone anomalies;
8. Thyroid pathologies;
9. Injuries to bones and finger joints.

Female representatives over 50 years of age are most susceptible to the appearance of knots on the fingers. This is due to age-related hormonal changes.

Another reason for the appearance of knots can be hard work and constant hypothermia of the hands. Bouchard's and Heberden's nodes appear in workers who work with rotary hammers, drills, hammers, those engaged in difficult non-mechanized work, and in women who often wash in ice holes and cold water. Athletes who play tennis, volleyball and basketball are also at risk.

What other research are we doing?

For dislocations, severe bruises, displacement and crushing of bones, radiography of the wrist joint in two projections . The images are taken so that the lower third of the forearm bones, the wrist bones, and the proximal metacarpal bones (the long bones that extend from the wrist in rays) are also visible.

The wrist joint is made up of many fragile bones. The risk of injury increases in old age, with a lack of physical activity, osteoporosis (because with this disease the bones become more fragile and less strong).

Sometimes only radiography of 1 or more fingers is performed in two projections . Depends on what exactly you damaged.

Also, in some cases, we perform x-rays of the scaphoid bone of the hand in three projections . It is one of the largest among its “neighbors” and is quite often susceptible to fractures.

X-ray of the scapula

A fracture of the scapula usually occurs due to direct impact, a direct blow. X-ray of the scapula allows you to detect not only injury, but also detect pathological inflammation, benign and malignant tumors.

Clinical picture and stages of development

Symptoms of Bouchard's and Heberden's nodes vary depending on the stage of development of the pathology. There are three different stages of the disease.

Signs of the first stage:

• Periodic pain that appears when working or moving your fingers;
• Swelling in the phalangeal areas.

During the second stage, the following symptoms appear:

• The pain becomes more stable and becomes aching;
• The skin over the phalanges turns red and swells;
• The muscles in the fingers begin to atrophy;
• Movements in the hand and fingers are limited and all of them are accompanied by crunching;
• Nodular growths begin to appear on the phalanges (they remain even when swelling and redness disappear).

The final third stage is characterized as follows:

1. Swelling and redness of the skin over the phalanges does not go away;
2. The deformation of the joints becomes very noticeable;
3. It becomes almost impossible to bend your fingers or hand;
4. All parts of the hand are curved;
5. The affected hand becomes thinner.

At the last stage, the pain becomes very severe. It’s as if my hands are twisting and few ointments help relieve the symptoms.

Arthrosis of the thumb

In some patients with arthrosis of the hand , namely the interphalangeal joints, degenerative changes develop in the joint formed by the trapezoid bone of the wrist and the first metacarpal bone. This joint is located at the base of the big toe. The disease manifests itself as pain and limited movement of the thumb, and a crunching sensation occurs. Over time, growths (osteophytes) appear on the articular surfaces of the bones, which lead to deformation of the hand.

Taking medications

The first stage of treatment is taking medications. First, medications are prescribed, the main purpose of which will be to relieve pain. These may be drugs from the following pharmacological groups:

• Muscle relaxants. They act by relaxing the muscles surrounding the finger joints. If the joint is limited in mobility, the muscle fibers begin to become very tense, thereby increasing pain and further constraining the joints. Muscle relaxants include: Tizanidine, Baclofen, Topeizone.
• Anti-inflammatory non-steroidal. In addition to eliminating inflammation and pain relief, such medications help reduce fever (if any) and restore motor function. These drugs work only on the symptoms of the pathology and do not affect the root cause of its appearance. Their effectiveness is achieved by blocking enzymes that support the course of inflammatory processes. Most often, patients are prescribed medications based on ibuprofen, diclofenac, paracetamol, indomethacin, ketoprofen, lornoxicam, ketorolac, nimesulide, celecoxib or meloxicam. The products can be produced in the format of ointments, suppositories, tablets and injection solutions.
• Corticosteroids. They are used in the presence of serious inflammatory and destructive processes that are accompanied by severe pain. Corticosteroids are more powerful, but they also have stronger side effects. There are short-acting and long-acting agents. The first include drugs such as Prednisolone, Hydrocortisone and Dexamethosone. The second includes Polcortolone, Diprospan and Methylprednisolone.
• Analgesics. The drugs have only an analgesic effect. They can be divided into non-narcotic (based on analgin, aspirin, etc.) and narcotic (the drugs Promedol and Tramadol).

The course of use of such drugs should not be long, usually it is no longer than 7-10 days. The time for taking medications can be increased only on the instructions of the attending physician.

After using pain medications, it’s time to take chondroprotectors. These drugs just restore areas of cartilage tissue and eliminate the visible signs and manifestations of Bouchard's and Heberden's nodes.

Hydroprotectors do not have an anti-inflammatory or analgesic effect.

These drugs gradually restore damaged synovial cartilage and minimize the risk of their re-destruction. Chondroprotectors are taken from 3 months to six months.

The active ingredients are the components that make up real cartilage:

1. Chondroitin is a structural component of tissues;
2. Glucosamine is a substrate for the synthesis of synovial fluid.

Effective two-component chondroprotectors are: Chondroitin, Protekon, Teraflex and Movex. There are also medications with only one substance in their composition. Preparations with chondroitin include Structum, Chondroxide and Mucosat, with glucosamine - Artiflex, Dona.

Folk remedies cannot have an intense effect on the phalangeal joints; they can only relieve mild pain and swelling.

The only proven and truly effective remedy is vermouth ointment. It includes the following components: deer fat (15 g), deer bone marrow (6 g), olive oil (8 g) and fresh wormwood (10 g). It is difficult to prepare such an ointment at home due to the unavailability of some components, but it is sold in some pharmacies. The composition of store-bought ointments is identical.

Diagnosis and treatment

Usually, a visual examination at a medical consultation and subsequent fluoroscopy are sufficient to make a diagnosis. The image will show a narrowed joint space and deformation of the hand bones.

In addition to X-ray examination, a general blood test and rheumatic test are prescribed. As a rule, with this disease, blood counts remain within normal limits, therefore, if an increased ROE, seromucoid, or the presence of C-reactive protein are detected, this is a reason for additional diagnostic studies.

Drug treatment

Heberden's and Bouchard's nodes are eliminated during the treatment of the underlying pathology. Therapy for nodular arthrosis of the fingers is aimed at restoring joint cartilage. Treatment of arthrosis of small joints of the hands is complex and includes the mandatory administration of chondroprotectors - long-acting substances that promote the restoration of articular cartilage. These include drugs with chondroitin and glucosamine, which slow down cartilage degeneration and improve joint mobility. Glucosamine additionally has an analgesic effect.

The doctor also prescribes vasodilators - Teonicol and Trental - to improve blood supply to the joints, and non-steroidal anti-inflammatory drugs - Diclofenac, Ibuprofen, Indomethacin in the form of tablets or injections.

For local action, ointments containing non-steroidal anti-inflammatory substances are prescribed, for example, Fastum-gel, Dolgit, Voltaren-gel and others. The medicinal substance penetrates the soft tissues and joints and alleviates the patient’s condition, relieving pain and swelling.

Severe pain symptoms may be an indication for physiotherapeutic methods. For patients with hand damage, therapeutic mud and paraffin baths are recommended. Gentle massage and special physical therapy exercises can have a good effect.

Patients with severe and prolonged inflammation are prescribed Plaquenil, an immunosuppressant, the treatment of which is usually long-term - from six months to a year.

Folk remedies

Nodular lesions can also be treated with some folk remedies, for example, bischofite, a substance obtained during oil extraction and refining. It comes in the form of a gel. Therapy consists of the following:

• A medical bandage is impregnated with bischofite and wrapped around each finger with Heberden and Bouchard knots. After this, the brush is wrapped in polyethylene and a cotton mitten is put on top of it;
• This compress lasts for at least two hours and is repeated every other day for two months.

Another folk recipe includes compresses with grated vegetables, for example, green potatoes or onions mixed with chalk and kefir.

Although multiple arthrosis of the hands does not affect the internal organs and is not considered a very serious pathology, the formation of Heberden’s and Bouchard’s nodes causes inconvenience to patients, deforms the appearance of the hands and leads to blocking their movements, which can greatly interfere with work, quality of life, and lead to disability. For this reason, nodular arthrosis must be diagnosed and treated at the first sign of a problem in the small joints of the hands.

Massage

Its action is aimed at increasing joint mobility, stretching adjacent ligaments and muscles. A patient with knots on his fingers can go to a chiropractor or do self-massage.

Basic massage exercises that you can do at home yourself (carried out one by one):

1. Rubbing palm surfaces;
2. Rubbing each finger from the base and up;
3. Squeezing the fingers into a fist;
4. Stretching or twisting the fingers (must be done very carefully so as not to damage the joint). These are the most universal exercises for Bouchard's knots. More complex massage activities should be carried out in consultation with a doctor.

Exercise therapy

Most people with painful joints find some kind of physical activity painful and they try to avoid it. However, for almost all orthopedic pathologies, including Bouchard’s and Heberden’s nodes, exercise therapy is mandatory.

The exercises are developed specifically for people with limited mobility and cannot cause them any harm. On the contrary, they only strengthen ligaments, muscles and restore blood flow.

For knots on the fingers, patients can do isometric and dynamic exercises. The first ones are indicated for those whose fingers move very poorly and are very painful. Examples of mini-workouts:

1. First exercise: place your palms on the table and spread your fingers. Place your fingertips on the table and, while straining your muscles, try to form your palm into a fist (the phalanges of your fingers remain in their original position and do not move). Hold the tension for a couple of seconds, then relax your hand. Rest for 5 seconds and repeat the exercise. You can do up to 10 approaches. If your fingers hurt very badly, perform as many repetitions as you can manage.
2. Second exercise: stand or sit with your arms hanging freely. Without straining your hands and arms, you can easily shake them. This relieves excess tension well and makes the blood move more actively.

You can continue the previous series with dynamic exercises or use them independently.

The following actions are performed:

• The palm is placed on the table, the fingers need to be intensively drummed on the table;
• You need to walk around the table with your fingers (finger imitating a step);
• Flexion and extension of fingers (can be done one at a time or all together).

Squeezing a not very hard expander has a good effect on the joints. More exercises for sore finger joints can be seen in the video:

Puffy-like structures on the lower surface of the wrist and hand (Fig. 6)

Ganglion

These are intimately connected with the promenian artery and begin to flow between the styloid structure of the promenian cyst and the tendons of the m. flexor carpi radialis with articulatio radiocarpalis or trapezioscaphoidum. Liquation, as well as for the dorsal ganglia, is promptly administered only when severe symptoms are evident. A lot of ganglia for the duration of treatment spontaneously emerge over time.

Clicking fingers

Clutching may also occur on the level of the metacarpophalangeal joints and is often associated with the rupture of the tendon nodes, rather than with stenosis of the synovial tendon. At the GOST PAZI Patziynti, you can roll off the discomfort at the Doloni PID RUCHE RUCH PIGHT, for an hour the classical picture of the FIXASACHIA, Puts Zginnnya, the hitch is gone to the gear of the yogo sagututy. During the hour of fastening, you can palpate the puncture on the tendon of the finger, if the tendon collapses in the proximal-distal direction with a bent or extended finger. With the help of corticosteroid injections, 70% of relapses can be followed by recovery, although in case of relapses, surgical treatment must be completed.

Lipoma

These products can be blamed on any part of the hand, most often on the thenar or hypotenary. The stench can be of a solid or soft consistency, of a common variety, and can be attached to deep-rooted tissues, leading to sores. The diagnosis is often made with the help of an MRI; if symptoms are evident, the diagnosis is confirmed.

Principles of nutrition

This is one of the most important stages in the fight against joint pathologies of various types. An incorrectly formulated diet can deprive the body of a sufficient amount of proteins and minerals, which are essential for bone and cartilage tissue. Proper nutrition also helps to reduce excess weight, which puts additional stress on the joints.

The diet of a person with nodules on the fingers and other similar pathologies should consist of high-quality natural products. It is necessary to completely throw away semi-finished products and fast food from it.

You should eat more fresh fruits, vegetables, rye bread, cereals, lean meats and bone broths.