Bouchard Nodes

What Are They, Causes, Signs, Symptoms, and More

Author:Georgina Tiarks

Editors:Alyssa Haag,Józia McGowan, DO,Kelsey LaFayette, DNP, RN, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy Johnson, LMSW

What are Bouchard nodes?

Bouchard nodes are nodules of the proximal interphalangeal joint (i.e., the middle joint of the finger), also known as the PIP joint, typically indicative of hand osteoarthritis. They may be described as swollen, bony bumps on the middle finger joint causing rigidity and immobility of the finger. These prominences may become painful over time and lead to long-term deformity. 

Hand with nodules on the proximal interphalangeal joints.

What is the difference between Bouchard nodes and Heberden nodes?

Bouchard and Heberden nodes describe bony enlargement of finger joints due to osteoarthritis; however, Heberden nodes affect the distal interphalangeal joints (i.e., the farthest finger joint), also known as the DIP joint, rather than the proximal interphalangeal joint as seen in Bouchard nodes. Bouchard nodes are less common than Heberden nodes and may indicate more severe osteoarthritis. Heberden and Bouchard nodes can affect a single or multiple digits of one or both hands. 

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What causes Bouchard nodes?

Bouchard nodes are usually a result of osteoarthritis in the interphalangeal joints. While the exact cause of osteoarthritis is still unknown, the etiology of Bouchard nodes is more well understood. Osteoarthritis is due to general wear and tear that causes excessive damage to the cartilage. As cartilage degrades, the bone begins to rub on adjacent bone, which causes osteophytes (i.e., bone spurs) on the proximal interphalangeal joint, thereby causing Bouchard nodes.

Several risk factors for developing Bouchard nodes have been identified, including excessive, repetitive stress on the joints, increasing age over 65, and being assigned female at birth. 

What are the signs and symptoms of Bouchard nodes?

The signs and symptoms of Bouchard nodes include enlargement of the PIP joint, most often at the dorsolateral aspect. This may occur at one or multiple finger joints in either or both hands. These bony prominences may be painful or painless. Bouchard nodes can progressively grow over time, resulting in limited motion and associated grip weakness. 

How are Bouchard nodes diagnosed?

A health care provider may diagnose Bouchard nodes after performing a thorough physical examination. In addition, imaging, such as a plain film X-ray, may show osteophytes, narrow PIP joint space, and thickening of the subchondral bone (i.e., deep bone tissue). Lab work, such as a synovial fluid (i.e., liquid between joints) analysis, may help to also differentiate Bouchard nodes from gout tophi (i.e., hard deposits of uric acid) or rheumatoid arthritis (i.e., an autoimmune disorder) nodules. Synovial fluid analysis is obtained by inserting a needle into the joint space. The fluid is then drawn into a syringe and analyzed. Precisely, healthcare providers assess the fluid for elevated white blood cells (i.e., inflammatory cells), uric acid crystals, calcium crystals, or the presence of blood. Lab tests on the individual's blood may also be used for autoimmune markers (e.g., rheumatoid factor, anti-cyclic citrullinated peptides, antinuclear antibody) or inflammatory markers (e.g., C-reactive protein, erythrocyte sedimentation rate).

How are Bouchard nodes treated?

Treatment options for Bouchard nodes are primarily focused on managing symptoms, as there is currently no cure or treatment to reverse Bouchard nodes. Supportive therapy options such as heat or ice therapy, rest, steroid injections, and non-steroidal anti-inflammatory drugs (NSAIDs) may help to relieve associated discomfort or pain. Physical therapy may also help to prevent deformity or immobility.

What are the most important facts to know about Bouchard nodes?

Bouchard nodes are bony enlargements that develop due to osteoarthritis. Osteoarthritis causes cartilage degeneration and osteophyte development. The osteophytes result in bony prominences at the finger joints. Bouchard nodes, specifically, refer to the enlargement at the proximal interphalangeal joint (PIP joint), while Heberden nodes refer to the enlargement at the distal interphalangeal joints (DIP joints). These nodules may be painful, cause immobility, and occasionally lead to deformity. Treatment is mainly focused on reducing symptoms and progression of the disorder. A physical examination, history, and imaging modalities, such as plain film X-rays, may be used to diagnose Bouchard nodes.

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Joints of the wrist and hand

Resources for research and reference

Alexander, C. J. (1999). Heberden’s and Bouchard’s nodes. Annals of the Rheumatic Diseases, 58(11), 675–678.

Suneja, M., Szot, J. F., LeBlond, R. F., & Brown, D. D. (2020). The Spine, Pelvis, and Extremities. In DeGowin’s Diagnostic Examination (11th ed.). McGraw Hill.

Yazdany, J., Manno, R., Hellmann, D. B., & Imboden Jr., J. B. (2021). Degenerative Joint Disease (Osteoarthritis). In M. A. Papadakis, S. J. McPhee, & M. W. Rabow (Eds.), Current Medical Diagnosis & Treatment 2021. McGraw-Hill Education.