Osteophytes are described as a step up of bony prominence at the end of the normal bone contour, or at the margin of the joint, with or without acoustic shadow. These are commonly seen at the DIPJs, PIPJs, MCPs and MTPJs and in the larger joints such as shoulders, hips and knees. They can be painful and can become swollen.

 Case Example

 A male in their 60s presented with a 6/12 h/o swollen and painful hands and feet. This was associated with significant early morning stiffness requiring the use of anti-inflammatories and paracetamol. Examination revealed tender and swollen DIPJS and PIPJs as well as a swollen and puffy ankle. Blood tests including rheumatoid factor and CCP were negative. X rays showed evidence of degenerative disease especially at the DIP and PIPJs.

Ultrasound findings

 Ultrasound of his hands including small joints showed evidence of osteophytes at the DIPJ and PIPJs (Figure 1 and 2). Some grey scale synovitis was seen (Figure 2). 

Interpretation

Based on his history, examination findings and typical ultrasound features he was treated as a nodal osteoarthritis. Analgesia was optimised and referral for hand therapy made. He was advised that local steroid injections would be possible for ongoing pain symptoms not responding to simple analgesia.

References-

1. Wakefield et al. Musculo-skeletal ultrasound including definitions for ultrasonographic pathology. J Rheum 2005:32:2485-7.