Heberden and Bouchard nodes are firm, bony lumps beside the finger joints. They are a common sign of osteoarthritis in the hand. For some people the lumps are the only problem. For others, the fingers ache, stiffen and become harder to use. This guide explains how the condition is diagnosed, which symptoms may point to a different cause, what helps without surgery, and when an operation may be discussed.

What is finger osteoarthritis?

Each finger has three joints. The joint nearest the nail is the . The middle joint is the . The knuckle at the base of the finger is the metacarpophalangeal (MCP) joint.
In osteoarthritis, the smooth cartilage on the ends of the bones slowly wears thin. Small growths of bone, called , form around the edge of the joint. At the DIP joints they make . At the PIP joints they make . Nodes are taken as a sign of osteoarthritis in these small joints1. It is more usual for several groups of hand joints to be affected than just one2.
The base of the thumb is a separate joint that also often wears2. It is treated differently and has its own guide: Thumb-base arthritis. A soft, fluid-filled lump next to a Heberden node may be a mucous cyst, explained in this article on mucous cysts.

How common is it?

Very common, especially as people get older. A large study in Rotterdam looked at people aged 55 and over. On X-ray, 67 in 100 women and 55 in 100 men had osteoarthritis in at least one hand joint. DIP joints were affected in 47 in 100 people, PIP joints in 18 in 100 and MCP joints in 8 in 1002.
Nodes are most common at the DIP joint of the index finger. They are more common in women and in the dominant hand1. In a UK study of people aged 50 and over, about 16 in 100 had symptoms from nodal osteoarthritis of the finger joints3.

What are the symptoms?

The usual symptoms are finger pain when you use your hand, and short stiffness after waking that lasts no more than half an hour4. Pain and stiffness can make everyday hand tasks harder5, such as gripping, opening jars or doing up buttons.
Symptoms can flare up from time to time. A joint becomes more painful, swollen and stiff than usual. A flare like this is temporary4.
Over time, a finger may bend to one side, or the end joint may no longer straighten fully. This can affect both how the hand works and how it looks6.

How is it diagnosed?

Most often, the diagnosis is made by talking with you and examining your hand. The whole picture matters: your age, the type of pain, the nodes, how many joints are affected, and whether nodes run in your family7.
UK guidance covers people aged 45 or over whose joint pain is worse with activity. If morning stiffness is absent or lasts 30 minutes or less, osteoarthritis can be diagnosed without an X-ray4. An X-ray is used when the picture is unusual or another condition needs to be ruled out. It is then the first imaging test48.
An X-ray cannot tell how much your fingers will hurt. Changes on X-ray are only weakly linked with pain and hand function2. Treatment is guided by your symptoms, not by the X-ray4.

Could it be something else?

Not every painful, swollen finger joint is osteoarthritis. See a doctor for a closer look if you have:
  • a hot, swollen joint, or any sign of infection;
  • pain or a change in finger shape that is getting worse quickly, or symptoms after a recent injury;
  • long morning stiffness;
  • swelling in many joints, especially the knuckles at the base of the fingers;
  • psoriasis, changes in your nails, or a whole finger that is swollen like a sausage.
UK guidance lists the first three as unusual for osteoarthritis4. Criteria for rheumatoid arthritis look at how many joints are swollen and where, blood test results and how long symptoms have lasted9. Psoriasis, nail changes and a sausage-shaped finger are features of psoriatic arthritis10.
Long morning stiffness does not prove another condition. In one study, 17 in 100 people with hand osteoarthritis had morning stiffness lasting an hour or more11. It is still a reason to be checked. If inflammatory arthritis is possible, early referral to a rheumatologist matters12.
Osteoarthritis affects the knuckle (MCP) joints less often than the DIP and PIP joints2. Pain and swelling there may have another cause. If knuckle joints are affected without an earlier injury, especially in a younger person, it is worth checking for haemochromatosis. This is a condition where the body stores too much iron13. Knuckle arthritis has its own guide Knuckle joint arthritis.

Erosive hand osteoarthritis

In , X-rays show small areas of bone loss in the finger joints. About 10 in 100 people with painful hand osteoarthritis have this form. It causes more pain and more difficulty using the hand143. It is not rheumatoid arthritis15.

Will it get worse?

It varies. A review followed people with hand osteoarthritis for about 10 years. On average, pain changed little. Hand function and grip strength slowly declined, and 25 to 29 in 100 people reported worse pain16.
In a study that followed people for six years, X-ray changes progressed in about half. These changes did not match how symptoms changed17. Routine treatment currently focuses on easing pain and making the hand easier to use18.

Pain, function and appearance

Finger osteoarthritis can affect three different things: pain, how well the hand works, and how it looks. Each may bother you to a different degree, so it helps to set goals for each.
Many people care about how their fingers look. In a study of 172 people, one in three rated unhappiness with how their hands looked as a big concern19. In another study, one in four people were unhappy with how their hands looked, and for one in eight it affected daily life. These people more often reported low mood20.
It is worth telling your doctor about this. Treatment without surgery can ease pain, but it does not remove the bony nodes. Studies of treatment for hand osteoarthritis mainly measure pain, function and hand strength21. Operations are done for pain, instability or loss of use of a finger, not for appearance alone.

Treatment without surgery

Guidelines agree on the importance of information about the condition and exercise. Depending on your needs, joint protection, aids for daily tasks, splints and medicines are also used2223184. Treatment is chosen with you, based on what bothers you most22.

Hand therapy and exercise

A can teach you exercises and joint protection. They assess your hand, show you exercises for movement and strength, explain how to spare your joints, and fit a splint if needed.
Exercise may give a small benefit, but the certainty of the evidence is low. In a review of studies, exercise reduced pain by about half a point on a 0 to 10 scale and eased finger stiffness a little. The benefit faded after the programme ended. Side effects were few and mild5. Pain may increase a little when you start. It is worth exercising regularly, with a programme suited to your needs and your pain4.
In a trial of 80 women, a home exercise programme improved chosen daily tasks. Sixteen women in the exercise group improved clearly, compared with two in the group given information only24.

Joint protection and daily-living aids

Joint protection means doing daily tasks in ways that put less strain on painful fingers. A study included 257 people. At 6 months, 33 in 100 of those taught joint protection had improved, compared with 21 in 100 of those who were not25.
Simple aids for gripping and opening can help too. In a trial, people given aids and splints managed daily tasks better and were more satisfied, and 92 in 100 used them26. A recent review found, with moderate certainty, that aids improve hand function over the longer term27.

Finger splints

A is a small support for a painful joint. The evidence for splints comes from small studies without random allocation62829.
In a study of 26 people, each person wore a splint on one DIP joint every night for 3 months. Pain in that joint fell more than in another, unsplinted joint of the same person. The difference was statistically significant at 6 months, and the joint straightened better6. In two other small studies, pain eased over weeks to months of splint use2829.
French guidelines recommend splints for hand osteoarthritis18. American guidelines conditionally recommend splints for hand joints other than the thumb base23. UK guidance does not advise them routinely. They may be considered when a joint is unstable or abnormally loaded and exercise alone is not effective or suitable. The splint should also be likely to improve movement and function4.

Heat

Heat, such as paraffin wax baths, mud packs or heated gloves, eases pain for some people30. In a trial of 200 people, electrically heated mittens did not clearly improve hand function compared with unheated mittens. Pain eased a little more, though the authors noted this may have been overestimated31.

Medicines

European guidelines recommend an anti-inflammatory gel, rubbed onto the skin over painful joints, as the first medicine to try. This is a type of 22. In a trial of 385 people, diclofenac gel eased pain more than a gel without the medicine32.
Anti-inflammatory tablets work about as well as the gel but cause more side effects21. They are used for a limited time22. Your doctor will weigh the risks to your stomach, kidneys, liver and heart, and offer a medicine to protect your stomach while you take them4. Paracetamol has not shown a clear benefit214.
The effect of medicines is modest. In a large analysis of drug trials, the medicines studied showed no advantage over placebo when finger osteoarthritis was looked at on its own33.
When finger joints are swollen and inflamed, two medicines have been studied: steroid tablets (prednisolone) for a few weeks, and methotrexate. In two randomised trials they reduced pain3435. In another trial, a lower dose of methotrexate did no better than placebo36. These are not routine treatments, and a rheumatologist makes the decision. Hydroxychloroquine, colchicine and biological medicines that block tumour necrosis factor (TNF), one of the body's inflammation signals, showed no advantage over placebo for pain373839.

Steroid injections

A into one very painful finger joint may ease pain. In a trial of 60 people, steroid with local anaesthetic reduced pain on movement and joint swelling for 12 weeks more than local anaesthetic alone. It did not show an advantage over local anaesthetic alone for pain at rest40. At 48 weeks, pain did not differ between the groups41.
European guidelines do not advise injections routinely but allow them for painful finger joints22. UK guidance on osteoarthritis in any joint says steroid injections give only short-term relief, for 2 to 10 weeks4. It does not advise hyaluronic acid injections4.

When is surgery discussed?

An operation may be discussed when pain, instability or stiffness of a finger still gets in the way of daily life despite treatment without surgery. A review found no trials comparing surgery with continued treatment without surgery21. So the choice depends on how much the finger bothers you, what you need your hand for and what you hope to gain.

When to seek help

See your general practitioner (GP) if:
  • pain or stiffness in your fingers makes daily tasks hard despite the measures above;
  • you notice any of the signs listed under "Could it be something else?";
  • a soft lump near a finger joint leaks fluid or the skin over it becomes red.
Your GP can refer you to a hand surgeon, a rheumatologist or a hand therapist.
Get help the same day if a joint is hot and swollen, even without a fever. This can be a sign of joint infection474.

Summary

Heberden and Bouchard nodes are a common sign of finger osteoarthritis. The diagnosis is usually made by examining the hand, and an X-ray cannot tell how much it will hurt. Treatment starts with information and exercise chosen with a hand therapist; depending on your needs, joint protection, daily-living aids, a splint, an anti-inflammatory gel or an injection may help. Swelling in many joints, long morning stiffness, psoriasis or a hot joint need a doctor's review. Surgery may be discussed when pain or instability still gets in the way despite treatment.