Heberden's and Bouchard's nodes

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Figure 1  .

Photograph of a left hand showing Heberden's and Bouchard's nodes at the usual dorsomedial and dorsolateral sites on the proximal and distal interphalangeal joints, with deviation of both middle and distal phalanges.

Figure 2  .

Photograph of a postmortem specimen showing Heberden's nodes on the interphalangeal joints with deviation of the distal phalanges.

Figure 3  .

Cross section through the head of the middle phalanx of the left index finger shown in figure 2 above. Dorsal is above, radial to the right. The extensor tendon (asterisk) is visible on the dorsum between the medial and lateral extremities of the subluxing distal phalanx. Osteophytes (arrows) are present on both sides of the middle phalanx. The capsule (chevrons) is intact on both sides but attenuated laterally where it is directly adjacent to the lateral osteophyte. Haematoxylin and eosin, original magnification × 4.5. 

Figure 4  .

Cross section through the same finger as in figure 3, at the level of the base of the distal phalanx . Dorsal is above, radial to the right. A distal phalanx osteophyte (arrow) is growing from the dorsoradial angle. Haematoxylin and eosin, original magnification × 4.5. 

Figure 5  .

Coronal section through the distal interphalangeal joint of the left middle finger shown in figure 2. Distal is above, radial to the right. The distal phalanx is subluxed radially. The capsule (chevrons) is intact but thinned on the radial side and displaced by the adjacent osteophyte. An apparent defect in the capsule on the lateral side is probably artefactual. There are osteophytes (arrows) growing from both phalanges, and both contribute to the soft tissue prominence of the node. The situation is similar to that shown in the radiograph of a different patient in figure 6. Elastic van Giesen, original magnification × 4.5. 

Figure 6  .

Radiograph of the left hand of a patient with Heberden's nodes and severe radiological OA at the interphalangeal joints. The oblique projections at the distal joints show that in all cases there are osteophytes beneath the soft tissue nodes. At the proximal joints the subnodal osteophytes are large enough to show in a semi-frontal projection. In the ring finger the dominant component in the distal node is the osteophyte arising from the middle phalanx, but in the other five joints osteophytes arising from both adjacent phalanges contribute to the soft tissue prominence.

Figure 7  .

Diagram of the tendons and ligaments of the fingers showing the potential windows at the interphalangeal joints and the lack of a window at the metacarpophalangeal joint. At the distal joint the capsule only window is between the extensor tendon and the collateral ligament. At the proximal joint the window is partly occluded by the lateral band. Modified from Tubiana and Valentin.²⁸

Figure 8  .

The right hand of the same patient as in figure 1, photographed from the ulnar side, showing dorsolateral nodes in profile on the index and ring fingers, and an atypical lateral node (arrow) on the ulnar side of the ring finger.