Deciphering Arthritic Hand Deformities

Health Professional

Just by looking at your hands, you might be able to tell what type of arthritis you have.  All of the joints, bones, ligaments and tendons in the hand get affected in a variety of different ways.  Certain characteristic hand deformities are diagnostic clues.  Here is a list of common hand deformities seen and the corresponding most likely diagnosis.

  • Heberden’s Nodes:  Large bumps or nodules at the last joint in the finger, the distal interphalangeal joint.
  • Bouchard’s Nodes:  Same bumps as Heberden’s nodes but only this time at the middle joint of the finger, the proximal interphalangeal joint.
    • Likely Diagnosis: Osteoarthritis* ** Swan Neck Deformity**:  Flexion of two joints in the finger, as the middle joint hyper-extends, this creates a swan-neck-like appearance of the finger if you use your imagination. It is caused by muscle abnormalities.
    • Likely Diagnosis: Rheumatoid Arthritis
  • Boutonniere Deformity:  The proximal interphalangeal joint is flexed as if it pushed through the “botton-hole” of the extensor tendon as this tendon deteriorates.
    • Likely Diagnosis: Either Osteoarthritis or Rheumatoid Arthritis* ** Sausage Finger**:  The entire finger is literally swelled up like a big sausage.
    • Likely Diagnosis: Psoriasis* ** Ulnar Drift**:  Fingers appear to drift or deviate towards the ulnar side of the arm represent by the pinky finger.  As muscles and ligaments deteriorate with the inflammation, the drift will get more pronounced.
    • Likely Diagnosis:  Rheumatoid Arthritis* ** Mallet Finger**:  Also known as “baseball finger” because trauma or arthritis can cause the tendon of the last joint in a finger to rupture.  Then the joint stays permanently bent.

All of these deformities are seen in greater detail by X-ray examination.  Even before being detectable by naked eye, an x-ray will show slight changes in the joints and bones that serve as precursors of deformities to come.  This is why doctors will get hand x-rays as soon as someone complains of joint pain and stiffness.  Repeating the x-rays periodically will show any progression of the deformities, but by that time the deformities are usually visible just by looking at the hand.

Just look at your hand; if you see deformities then chances are you might be dealing with a specific type of arthritis depending on what you see.  The next step is to show your hands to your doctor and then you can start finding a solution.

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