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December 1932


Author Affiliations

From the Department of Orthopedic Surgery, the Johns Hopkins Medical School.

Arch Surg. 1932;25(6):1067-1073. doi:10.1001/archsurg.1932.01160240059004

Nodes of the terminal joints of the fingers have been described as pathologic conditions per se, but have been particularly valued as diagnostic criteria for general ailments. Thus hard knobs of the terminal phalanges, Heberden's nodes, are familiar as evidences of arthritis. On the other hand, soft nodules of the fingers, uratic tophi, are accepted as indications of gout. Obviously, if soft nodules are found in this region that are arthritic rather than gouty in origin, the diagnostic sign becomes inadequate and misleading. It is with such nodules that this paper deals.

In 1802, Heberden1 called attention to the knobs on the terminal joints of the fingers and indicated his belief that "they have certainly nothing in common with gout." This announcement was followed by a deluge of papers, some of which supported Heberden's theory, while others vehemently denied it.2 These radical differences of opinion are probably responsible

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