Heberden's Nodes

What are Heberden’s nodes?

Heberden’s nodes are small, pea-sized bony growths that occur on the joint closest to the tip of the finger, also called the distal interphalangeal joint. Heberden’s nodes are a symptom of osteoarthritis (OA) of the hand.

Heberden’s nodes are named after the doctor who described them, William Heberden, Sr., MD.

What are Bouchard’s nodes?

Bouchard nodes are a similar symptom. They occur on the middle joints of the fingers.

What is osteoarthritis?

Arthritis is loss of cartilage (the smooth, gliding surface at the ends of bones). The joint loses this smooth cartilage and leaves rough bony ends to rub together. This leads to inflammation of the lining of the joint (the capsule) and subsequent pain. Osteoarthritis is a degenerative joint disease, meaning the breakdown of cartilage and inflammation happens over time. It typically affects older adults.

When osteoarthritis affects your hands, your finger joints can become stiff and painful — the rough bone doesn't glide as smoothly as the cartilage does.

How common are Heberden’s nodes?

Osteoarthritis of the hands is quite common. About half of women and 1 in 4 men will have osteoarthritis of the hands by age 85. Heberden’s nodes are a common symptom of osteoarthritis of the hands.

What causes Heberden’s nodes?

A finger joint is made of two bones that fit together. They glide easily when your bones move, thanks to the smooth cartilage. But when the cartilage starts to wear out, your bones don’t fit together as easily.

As cartilage breaks down, your body responds by growing new bone at the joint. The new bone growths are called nodes or spurs. When they appear at the finger’s end joint, they are called Heberden’s nodes.

How do Heberden’s nodes affect me?

If you have Heberden’s nodes, which are a sign of advanced osteoarthritis, you may have symptoms such as:

• Pain, swelling and stiffness.
• Bumps at the ends of your fingers.
• Loss of motion.
• Enlarged, stiff fingers.

It may be difficult to perform daily tasks, like opening bottles or fastening buttons. You may feel frustrated at your limited range of motion.

How will healthcare providers diagnose Heberden’s nodes?

Your provider can diagnose osteoarthritis and Heberden’s nodes by examining your hands. They may also use an X-ray.

How are Heberden’s nodes treated?

Follow your healthcare provider’s instructions for treating osteoarthritis. Treatment aims to reduce pain and help you move again. Your healthcare provider may recommend:

Non-drug therapies:

• Rest your hand.
• Wear a splint or orthotic device (orthosis) to help support your finger joints.
• Use heat, such as paraffin wax or warm compresses on your hand. You can alternate heat therapy with cold therapy to ease pain, or use heat before activity and ice after activity.
• See a hand therapist, who can teach you exercises to keep your hand mobile while protecting your joints. Continuing to use your hand in safe ways is important. Therapists can also teach you about adaptive tools to help you to continue to use your hands for daily activities.

Drug treatments:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (Tylenol®) and counterirritants such as capsaicin or menthol are often available as pills, syrups or lotions.
• Steroid injections can also ease pain.

Will I need surgery for Heberden’s nodes?

If Heberden’s nodes and other osteoarthritis symptoms bother you, and nonsurgical options haven’t helped, talk to your healthcare provider. You may want to consider surgery.

Surgical options for people with osteoarthritis at the last joint of the finger include joint fusion, to remove worn-out cartilage and join (fuse) the bones.

How can I live best with Heberden’s nodes?

You can take steps to limit the effects of osteoarthritis all over the body. To live a healthy, active life with Heberden’s nodes:

• Eat a healthy diet: The Mediterranean diet, which is low in meat and dairy and high in fruits, vegetables, legumes, fish and unsaturated fats, can limit inflammation.
• Keep joints mobile: Try walking or low-impact exercise such as swimming and yoga to keep your joints mobile without overstressing them.
• Occupational therapy: OT, especially hand OT, can help you learn new ways to use your hands so you can continue to do the tasks of daily living.
• Pain relievers: Talk to your healthcare provider about using acetaminophen and NSAIDs to help with inflammation and pain.
• Therapy: Cognitive behavioral therapy (CBT) can help you cope with any stress and anxiety you may feel about living with osteoarthritis.

When should I call my provider about changes in my finger joints?

See your healthcare provider if you:

• Notice bumps at the end of your fingers.
• Find it difficult to do tasks that use fine motor skills.
• Have pain, stiffness or swelling in your hands.
• Notice any changes in your hands or fingers.

A note from Cleveland Clinic

Heberden’s nodes are small bony growths that appear at the finger joint closest to the tip of your finger. Bouchard’s nodes, a similar symptom, appear at the finger’s middle joint. These nodes are symptoms of osteoarthritis of the hands. Heberden’s nodes can cause pain, stiffness and limited motion in your fingers, making daily tasks difficult. Treatment can ease the symptoms. Talk to your healthcare provider if you notice any change in your hands or fingers.

• American Society for Surgery of the Hand. Osteoarthritis. Accessed 9/20/2021.
• Arthritis Foundation. Osteoarthritis of the Hands. Accessed 9/20/2021.
• Merck Manual (Consumer Version). Osteoarthritis of the Hand. Accessed 9/20/2021.