Bouchard's Nodes

Bouchard's nodes is a finger deformity that mostly affects people suffering from osteoarthritis. This finger deformity is characterized by the formation of cartilaginous or bony enlargements at the proximal interphalangeal joint. It was Charles-Joseph Bouchard, a French pathologist who was the first to describe this deformity in the nineteenth century.

Heberden's nodes is another similar kind of finger deformity that may be seen in people affected by degenerative joint diseases. The difference lies in the location of bony enlargements. Heberden's nodes form at the distal interphalangeal joint, which is the joint that is closest to the fingernail. In this article, we will find out more on what causes such bony enlargements and how these can be treated.

As mentioned earlier, the formation of these bony outgrowths is attributed to a degenerative joint disease called osteoarthritis. Osteoarthritis is associated with the degeneration of cartilage. The cartilage, which is a tough connective tissue that covers the ends of the bones, acts like a protective covering and prevents the bones from rubbing against each other.

Degeneration of the cartilage usually occurs as a result of aging. When this protective cartilage starts wearing out, the bones may get damaged due to friction or stress. The body may respond to the damage by creating an extra bone tissue on the edges of the bone. The calcification of articular cartilage or the bone tissue leads to the formation of such bony outgrowths.

The formation of such bony growths alters the appearance of the fingers. These may or may not be painful. Pain may, however, be experienced around the affected interphalangeal joint if the bony enlargement starts impinging on the surrounding tissue. Symptoms that may be experienced on account of this finger deformity would include swelling, tenderness and pain in the affected interphalangeal joint.

People with arthritic fingers may also suffer from loss of dexterity as the range of motion of the fingers may get adversely affected. While such a bony deformity in the fingers is a characteristic of osteoarthritis, at times, people diagnosed with rheumatoid arthritis may also develop such finger deformities.

Use of mild narcotic painkillers, non-steroidal anti-inflammatory drugs or cortisone injections can certainly help in alleviating the symptoms of arthritis in fingers to a great extent.

In case of a person suffering from rheumatoid arthritis, disease-modifying antirheumatic drugs may also be prescribed for slowing down the progression of the disease. If the interphalangeal joint is severely affected by osteoarthritis, and this deformity is interfering with hand function, doctors may recommend surgery for the removal of these nodes.

The aim of this surgery is to recover the range of motion of the hand. Arthroscopy is a minimally-invasive procedure that can help in the detection of bone spurs. If the diagnostic tests reveal the formation of bone spurs at the proximal interphalangeal joint, surgical procedures such as arthroplasty or arthrodesis may be used for treating this deformity.

Arthrodesis refers to a procedure wherein the ends of the bones of the joint may be surgically fused together into one bone. Though the pain that results from friction between the bone ends would be eliminated, there is one major drawback. Fusion of the joint may sometimes, affect the range of motion.

One may find it hard to grip objects if fusion causes stiffness or affects the range of motion of the proximal interphalangeal joint. This is the reason why arthrodesis is seen as a better treatment option for the distal interphalangeal joint.

On the other hand, arthroplasty refers to the replacement of a degenerated joint through surgery. Under this procedure, the affected joint is replaced with an artificial joint. Artificial or prosthetic joints made from silicone rubber are inserted into the shaft of the bone so as to increase the range of motion of the finger.

Swanson implant and the Sutter implant are the most commonly used silicone joint implants that are inserted into the joint. Though this procedure also facilitates an improved hand function, the artificial joint would not last for too long in case of people leading a very active lifestyle. These prosthetic joints, may however, last for several years in case of elderly people. Elderly people suffering from rheumatoid arthritis are considered to be the most suitable candidates for this surgical procedure.

Surgery, drug therapy and lifestyle-related changes can certainly help in the treatment of this finger deformity. As is the case with any medical condition, a timely diagnosis and treatment can certainly prevent the joint from losing its range of motion. The earlier this condition is treated, the better would be the chances of recovering the range of motion of the affected finger or the hand.