Bouchard osteoarthritis

Classification according to ICD-10
M15.2	Bouchard's lump (with arthropathy)
ICD-10 online (WHO version 2019)

The Bouchard-arthrosis , named after the French pathologist Charles Jacques Bouchard , is an arthritic change in the proximal interphalangeal joints ( proximal interphalangeal joints - PIP). A genetic cause is discussed. Bouchard osteoarthritis is very common and occurs in around 18% of the elderly. But it is rarer than Heberden's arthrosis , which affects the end joints of the fingers.

clinic

X-ray of finger joint arthrosis (the involvement of end joints is called Heberden's arthrosis , the involvement of middle joints as Bouchard's arthrosis). An inconspicuous picture in the red box on the left.

The local findings are comparable to those of Heberden's osteoarthritis with spindle-shaped swelling and restricted mobility. Axial deviations, pain, instability and nodule formation can also occur. Radiologically narrowing of the joint space, axial misalignments and possibly osteophytes can be found. As a rule, several middle finger joints are affected.

Differential diagnosis

In rheumatoid arthritis , the middle joints of the fingers are also often affected, but mostly together with the metatarsophalangeal joints, and the end joints are usually spared. Clinically and radiologically, the forms differ significantly. In psoriatic arthritis , too , the middle joints can be inflamed, and all three joints of a finger are often radially involved.

treatment

Treatment is rarely necessary because only a few middle finger osteoarthritis becomes painful or unstable. As a rule, the use of small splints or a tape bandage is sufficient ; a cortisone injection into the joint ( intra-articular ) can rarely be useful.

Operative therapy

Surgical intervention is very rarely necessary if the pain and instability persist. In addition to a neurectomy for denervation, there is the possibility of arthrodesis , which brings good results on the index and middle fingers and because of the stiffening in the extended position does not impede much and maintains a good gripping function, while the flexion of the ring and little fingers, which is necessary in the case of stiffening, is much more disturbing and obstructive works.

Endoprostheses

There are also various endoprostheses for the middle finger joints , which were first described in 1940. The flexible silastic joints presented by Swanson in 1969 now compete with coupled hinge joints and with anatomical surface replacement prostheses (from 1979). Newer models are cement-free in press-fit technology and consist of pyrocarbon, mostly they are semi-guided. Common to all prostheses is the problem of insufficient lateral stabilization and loosening of the prosthesis. In addition, heterotopic ossifications and implant fractures can occur to a greater extent , the range of motion does not improve significantly and many joints become stiff. However, the endoprostheses usually improve the gripping function and the pain is less. However, postoperative complications occur in up to 27.5% and premature loosening of the prosthesis occurs in up to 12.5% ​​- long-term studies are lacking, however. Overall, these endoprostheses are rarely used and are generally reserved for hand surgery specialists, especially since there are few scientific follow-up examinations, little is known about the long-term consequences, and there are no data collections in the endoprosthesis registers . In addition, there are no studies that compare the long-term results with those of arthrodesis. For 2014, the costs for a Silastic prosthesis were given as € 272 and for a semi-guided two-component resurfacing replacement as € 1239 for pure material costs, whereby the duration of the operation and the times and costs of follow-up treatment do not differ

Individual evidence

1. ↑ Baenkler H.-W .: Internal Medicine , Thieme Verlag, 2001, p. 1677, ISBN 3-13-128751-9 , here online
2. ↑ Wirth CJ, ea: Orthopedics and orthopedic surgery: 4. Elbow, Unterarm, Hand , Thieme Verlag, 2003, p. 569, ISBN 3-13-126211-7 , here online
3. ^ J. Adams, C. Ryall, A. Pandyan, C. Metcalf, M. Stokes, S. Bradley, DJ Warwick: Proximal interphalangeal joint replacement in patients with arthritis of the hand: A meta-analysis. Journal of Bone and Joint Surgery, British Edition, 2012, Volume 94-B, pages 1305-1312
4. ↑ Maartebn van Nuffel, Ilse Degreef, Sofie Willems, Luc de Semt: Proxi, al interphalangeal joint replacement: resurfacing pyrocarbon versus silicone arthroplasty . Acta Orthopædica Belgica 2014; Volume 80, Issue 2, pages 190-195

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !