Osteoarthritis of the Hand

Aka: Osteoarthritis of the Hand, Hand Osteoarthritis, Heberden's Node, DIP Bony Joint Enlargement, Bouchard's Node, PIP Bony Joint Enlargement

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II. Epidemiology

  1. Hand less commonly affected in Osteoarthritis
  2. Hand most disabling of joints to be involved

III. Signs

  1. Most common site
    1. Trapeziometacarpal joint (base of thumb)
  2. Heberden's Nodes
    1. Distal interphalangeal joint (ITP) nodular swelling
  3. Bouchard's Nodes
    1. Proximal interphalangeal joint (PIP) nodular swelling
  4. Mucous cysts may develop at interphalangeal joints
  5. First Metacarpal-phalangeal joint (MCP) involvement
    1. Other MCP joints are generally spared
  6. Wrist spared
    1. Contrast with Rheumatoid Arthritis

IV. Diagnostic Criteria (American College Rheumatology)

  1. Hand pain, aching or stiffness and
  2. Two DIP or PIP joints with hard tissue enlargement and
  3. Less than 3 swollen MCP joints
  4. One of the following
    1. Two DIP joints with hard tissue enlargement or
    2. Deformity of two DIP, PIP, or MCP joints
  5. Altman (1990) Arthritis Rheum 33:1601-10 [PubMed]

V. Radiology

  1. See Hand XRay in Osteoarthritis

VI. Management

  1. See Osteoarthritis
  2. NSAIDs
  3. Intermittent Splinting
  4. Moist heat
  5. Local Corticosteroid Injection
  6. Contrast Baths
  7. Surgery for resistant cases
    1. Arthroplasty
    2. Arthrodesis

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