Answer:
Bouchard's and Heberden's nodes are manifestations of osteoarthritis at the PIP (Bouchard's) and DIP (Heberden's) joints. Primary osteoarthritis of the interphalangeal joints tend to occur in women over fifty. In the case of the DIP, it may occur in a single-digit, especially if there is an antecedent history of intra-articular fracture. In the PIP, involvement of only a single joint is rare, and there is commonly associated DIP involvement. These nodes develop gradually as bony swelling and osteophyte formation enlarges and deforms the joint. With progression, the joint becomes mildly painful, weak, stiff, and unstable. As the enlarging osteophytes stretch the collateral ligaments, the joint will sublux palmarly and deviate to one side. Radiographic findings may be normal in the initial stages and osteophytes may only be seen on oblique views. As the disease progresses, more prominent osteophytes, loss of articular cartilage, and joint deformity with loss of joint space will be seen. Synovial-fluid-containing mucous cysts may appear especially in an acute exacerbation of DIP involvement. These often spontaneously regress, however, if they cause pain then these cysts can be aspirated with injection of corticosteroid. In the initial stages of osteoarthritis, antiinflammatory medication and splinting is used. However, surgical treatment may be required if the pain becomes disabling. Osteophytes and mucous cysts may be debrided and excised. In more severe degenerative cases, arthrodesis or arthoplasty may be performed, however, arthrodesis is usually preferred, especially for the DIP. Arthoplasty is not recommended in any DIP joint or in the index and middle fingers because it often does not withstand the normal stresses placed on these joints.