Houston Methodist. Leading Medicine

Hand FAQ


Last week I had X-rays taken of my right hand to see if I have arthritis developing. My orthopedic surgeon is waiting for the radiologist to "score" the X-rays and "grade" the joints. What does that mean?


Osteoarthritis of the joints of the hand has both a nonerosive and an erosive stage with inflammation, destruction, and remodeling observed. This understanding has led to the development of scoring methods to help describe the process. Physicians rely on grading joint damage using one (or more) of the scoring systems currently available when making the diagnosis of osteoarthritis. Various ways to assign a level of severity have been developed. Three of the most common scoring systems rely on X-rays to grade osteoarthritis. These are the Kellgren and Lawrence method, the Kallmann method, and the Verbruggen method. The Kellgren and Lawrence grading system has four levels (one through four). Grade 1 is the normal joint. Up to one osteophyte (bone spur) can be seen around that joint and still be considered "normal". Grade two is assigned to the joint that has two osteophytes in separate places on the same joint. There are some slight changes in the bone under the joint but no deformities and no changes in the joint space. Grade three shows a definite narrowing of the joint space, moderate osteophytes, and the start of joint deformity at the ends of the bones. In a joint labeled grade four, there are large osteophytes, loss of joint space, bone sclerosis (hardening), deformity, and the formation of cysts. The Kallmann system differs from the Kellgren and Lawrence scoring in that the changes observed (spurs, joint space, cysts, deformity, sclerosis) are given a score of zero (none or absent)or one (present). Some of the defining characteristics (e.g., joint space narrowing, osteophytes) can also be given a score of two for moderate changes and three (large or severe). The third system (the Verbruggen assessment) was developed to help record smaller changes that take place quickly. Each of these systems has a slightly different way of assessing hand osteoarthritis. The tests give points that can be considered the "score". The final score determines the "grade" that helps define whether your arthritic changes are mild, moderate, or severe. Using all three systems together provides a way to assess specifics about changes in the individual lesions as well as the progression in phases of osteoarthritis. None of the systems are enough as stand-alone methods. The Verbruggen scoring method is less time consuming and might be the most reliable but further studies are needed to confirm this. Robert A. Kaufmann, MD, et al. Osteoarthritis of the Distal Interphalangeal Joint. In The Journal of Hand Surgery. December 2010. Vol. 35A. No. 12. Pp. 2117-2125.

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