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X-ray diagnosis of osteoarthritis of the joints of the hands
Medical expert of the article
Last reviewed: 08.07.2025
Standard X-ray of the hands is performed in a direct projection. The fingers are positioned together, the hands lie flat on the cassette in line with the axis passing through the forearms and wrists.
Initial manifestations of osteoarthritis of the joints of the hands (correspond to stages I-II of arthrosis according to Kellgren):
- slight sharpening of the edges or osteophytes with mild subchondral osteosclerosis,
- small, subchondral cysts,
- normal or slightly narrowed radiographic joint space,
- the presence of small calcifications in the soft tissues in the area of the lateral edges of the articular surfaces of the bones.
Pronounced changes in osteoarthritis of the joints of the hands (correspond to stages III-IV of arthrosis according to Kellgren):
- moderately pronounced or large osteophytes,
- deformation of the edges of the articular surfaces of bones,
- significant narrowing of the radiographic joint space,
- osteosclerosis (Heberden's nodes in the distal interphalangeal joints and Bouchard's nodes in the proximal ones),
- cysts with a sclerotic rim,
- marginal defects of the articular surfaces (in which bone protrusions on one side may wedge into the other), usually surrounded by a zone of osteosclerosis.
Dorsopalmar image of the hand
DA Kallman et al. (1989), RD Altman et al. (1995) in their methods of assessing individual radiographic changes in osteoarthritis of the joints of the hands take into account osteophytes, narrowing of the radiographic joint space and periarticular subchondral erosions for assessing the distal and proximal interphalangeal joints and the carpometacarpal joint of the first finger. Additional assessment data include periarticular subchondral sclerosis and joint displacements without subluxations.
The four-point scale for assessing the above changes does not accommodate the entire complex of anatomical changes observed and described by G. Verbruggen, EM Veys (1995). These authors distinguish 5 phases of disease progression. Unaffected joint (N), stationary phase of osteoarthrosis (S) are based on the presence of OF and/or narrowing of the radiographic joint space and/or subchondral sclerosis. Most joints at this stage remain in phase S for 2 to 3 years. Then obliteration of the joint space occurs (J-phase), which also lasts 2-3 years. This phase precedes or coexists with the appearance of subchondral cysts that disrupt the integrity of the subchondral plate (erosive or E-phase). Erosive episodes subside spontaneously, giving way to restoration of damage and remodeling (R-phase). This last phase leads to regeneration of the subchondral plate, covered with cartilaginous tissue, with the formation of large osteophytes, giving the affected joints a nodular appearance. G. Verbruggen, EM Veys (1995) believe that the method they proposed provides a rapid assessment of the progression of osteoarthrosis.