It Is All in Your Hands

Abstract

Named after William Heberden (1710-1801), Heberden's nodes are bony, hard nodules or swellings that develop around the distal interphalangeal joints.1 The second (index) and third (middle) fingers are affected most often (Figure). They are produced by calcific spurs of the articular cartilage at the base of the terminal phalanges. They are more common in women. The onset, which is usually in middle life, can be insidious or abrupt with pain, redness, and warmth. The initial inflammatory phase eventually subsides, leaving the patient with an angulation articular deformity (skewing the fingertip sideways), limitation of motion, and loss of manual dexterity.