Causes and treatment of Bouchard’s knot

Bouchard’s Node Is the bony enlargement of the middle joint of the finger, also known as the proximal interphalangeal (PIP) joint. These are the first joints just above the joints.

Lymph nodes are a classic sign of osteoarthritis or joint degeneration in the hand. They are named after Charles-Joseph Bouchard, a French pathologist who studied arthritis patients in the 19th century.

Bouchard’s nodes are less common than Heberden’s nodes, which are bony enlargements of the distal interphalangeal (DIP) joint closest to the fingertip.

This article looks at the symptoms and causes of Bouchard lymph nodes and explains how to diagnose and treat this condition.

Bouchard Node Symptoms

Bouchard’s lymph nodes, like Heberden’s, may or may not be painful. However, they often affect how well a joint can move or its range of motion.

Over time, the accumulation of excess bone tissue can cause bones to become misaligned and become curved. The fingers can also be swollen.

As the joints stiffen, a person’s grip weakens, making it difficult to perform everyday tasks such as opening a jar, using a can opener, or even turning a car key.


Bouchard’s nodes are bony lumps on the middle joints of the fingers that can cause joint stiffness, dislocation, and weakening. They may or may not be in pain.


Osteoarthritis most commonly affects the joints of the hands, knees, hips, lower back, and neck. When this happens, the tissue that normally cushions the joint space is worn away. Over time, a person can begin to experience joint pain, stiffness, and even significant joint enlargement.

Additionally, the connective tissue (cartilage) can become rough, making it difficult for joint bones to slide past each other. When enough cartilage wears away, the bones begin to rub against each other, often causing extreme pain and inflammation.

Joint damage and inflammation can lead to excessive remodeling of bone tissue. Ossification, the part of the process responsible for bone formation, continues haphazardly and uncontrollably. This can lead to unsightly nodules. Those that affect the PIP joints are called Bouchard nodes.

Genetics may play a role in the development of Bouchard’s knots because they are common in families. Also, women are more susceptible than men.

That being said, the main cause of Bouchard’s lymph nodes is the same as any other manifestation of osteoarthritis: long-term wear and tear of joint tissue.


Bouchard’s nodes are the result of osteoarthritis, in which loss of cartilage between the PIP joints leads to excessive bone remodeling. Genetics may play a role in their development.


Bouchard’s node is considered a characteristic sign of osteoarthritis and helps differentiate it from other types of arthritis, such as gout or rheumatoid arthritis.

That being said, there are also lumps associated with rheumatoid arthritis and gout. People with rheumatoid arthritis may develop rubbery bumps called rheumatoid nodules on the thumb and knuckle joints. People with gout may develop crystalline lumps in the joint space called tophi.

Since there are no blood tests to diagnose osteoarthritis, doctors will perform other tests to rule out causes of rheumatoid arthritis and gout.

These include blood tests to check for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibodies, which are found in people with rheumatoid arthritis. If gout is suspected, a blood test can also check for elevated uric acid levels.

Joint fluid may also be obtained to check for uric acid crystals associated with gout.

A complete blood count (CBC) can be used to detect a high white blood cell count (WBC) consistent with inflammation. Because osteoarthritis is not associated with chronic inflammation, WBC is generally lower than in gout or rheumatoid arthritis, both of which are inflammatory.

Imaging tests, such as X-rays to check for loss of articular cartilage, can also help confirm the diagnosis.


X-rays can detect articular cartilage loss in people with osteoarthritis of the hand. Since there are no blood tests for osteoarthritis, the diagnosis usually involves ruling out other possible causes, including gout and rheumatoid arthritis.

How to Diagnose Rheumatoid Arthritis


Treatment of Bouchard’s lymph nodes is similar to that used for osteoarthritis of the hand without lymph nodes. This includes:

  • rest joints
  • Heat and Ice Therapy
  • Pain relievers such as Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve (naproxen) or Advil (ibuprofen)
  • topical capsaicin cream for mild aches and pains
  • Intra-articular steroid injections for severe cases

Arthrodesis can also be used during acute attacks to minimize joint movement.

Once a node is formed, it is not painful on its own, but may add to any pain that occurs with movement. By this stage, treatment may be needed to improve range of motion and prevent disability:

  • Physical therapy can help improve hand movement.
  • Occupational therapy can help improve your ability to perform certain activities of daily living.

Surgery is rarely used for Bouchard’s lymph nodes, especially for cosmetic reasons.


Bouchard lymph nodes can be treated with rest, heat or ice therapy, oral or topical pain relievers, or steroid injections (if pain is involved). Hand therapy can help improve joint mobility and prevent disability. Surgery is rarely used.


Bouchard’s nodes are bony overgrowths in the middle joints of the fingers caused by osteoarthritis. They occur when the loss of articular cartilage leads to excessive bone formation. Bouchard’s lymph nodes may or may not be painful, but they usually cause joint stiffness, weak grip, and in severe cases, crooked, bent fingers.

Diagnosis involves laboratory and imaging tests that help differentiate osteoarthritis from similar diseases such as gout and rheumatoid arthritis.

If there is pain, Bouchard lymph nodes can be treated with rest, ice or heat therapy, pain medication, or steroid injections. Hand therapy can help prevent disability and increase joint mobility.

Frequently Asked Questions

  • What are Bouchard’s nodes?

    Bouchard’s nodes are bony growths, also known as spurs, at the mid-joint. They are caused by the wear and tear of the bones caused by osteoarthritis of the hand rubbing against the bones.

  • What is the difference between Heberden’s nodes and Bouchard’s nodes?

    A Heberden node is a bony growth at the joint closest to the nail. Bouchard’s node is the bony enlargement of the middle joint, above where you wear the ring.

  • Can you get rid of Bouchard’s node?

    incomplete. You can treat associated pain with rest, pain medication, and heat and ice therapy. The lump itself will not go away unless you have surgery to remove it, but this procedure is rarely performed.