Treatment of Bone Spurs – Symptoms, Treatment

Treatment of Bone Spurs/Bone spurs also called osteophytes, are outgrowths of bone that develop along the edges of bones, often where two or more bones meet. They can form in the back, hip, sole, or heel of the foot, spine, neck, shoulder, or knee. Most bone spurs are caused by tissue damage brought on by osteoarthritis. Many are silent, meaning they cause no symptoms and only detected by an x-ray or other test for another condition. Others cause problems and require treatment.

Bone spurs (also called osteophytes) are smooth, hard bumps of extra bone that form on the ends of bones. They often pop up in the joints the places where two bones meet.

What areas of the body are affected by bone spurs?

The most common problem areas for bone spurs are:

• Knees – Over time, bone spurs may cause pain, stiffness, and reduced range of motion (how far a joint can move).
• Hip – Spurs may cause pain and reduced range of motion.
• Spine – Bone spurs on the vertebrae can be a factor in the development of spinal stenosis, a narrowing of the spine in the lower back. This can pinch nerves, causing pain, numbness, and weakness in the legs.
• Shoulder – Motion in the shoulder may be affected by bone spurs rubbing against tendons and muscles in the shoulder’s rotator cuff. This can lead to tendinitis (an inflammation or irritation of a tendon) and a tear in the rotator cuff.
• Hands – Bone spurs can form in the finger joints. This can cause loss of motion and give the fingers a knobby appearance.
• Foot and ankle – Bone spurs may form at the back or bottom of the heel (heel spurs). They may be painful and may require shoe inserts, stretching, or, as a last resort, surgery. Bone spurs are also common in the mid-foot and great toe. Inserts and changes in shoes are the treatments before surgery is considered.

Causes Of Bone Spurs

Bone spurs typically cause back pain one of three ways:

• Joint inflammation – Bone spurs of the joints of the spine (facet joints) can cause adjacent vertebrae to grind against each other, resulting in friction and inflammation. The inflammation can lead to pain, stiffness, and other symptoms.
• Compression of a nerve root – The development of bone spurs can cause narrowing of the neural foramina, where the nerve roots exit the spinal column. With less space, the nerve roots may become compressed. Nerve root compression can cause paresthesia (tingling) if they become compressed. If the nerve root becomes inflamed, pain may occur.
• Compression of the spinal cord – Bone spurs can grow into the spinal canal, where the spinal cord travels, leaving less space for the spinal cord. Compression of the spinal cord can cause weakness, strength loss, pain and other symptoms.
• Osteophyte formation has been classically related to any sequential and consequential changes in bone formation that is due to aging, degeneration, mechanical instability, and disease (such as diffuse idiopathic skeletal hyperostosis). Often osteophytes form in osteoarthritic joints as a result of damage and wear from inflammation. Calcification and new bone formation can also occur in response to mechanical damage in joints.^[rx]
• Osteophytes tend to form when the joints have been affected by arthritis.
• Osteoarthritis damages cartilage, the tough, white, flexible tissue that lines the bones and allows the joints to move easily.
• Osteoarthritis is most common in the knees, hips, spine and small joints of the hands and base of the big toe.
• As the joints become increasingly damaged, new bone may form around the joints. These bony growths are called osteophytes.
• Osteophytes can also form in the spine as a result of ankylosing spondylitis, a type of arthritis that specifically affects the spine.
• Increased age
• Disc degeneration
• Joint degeneration
• Sports injury or another joint injury
• Poor posture
• Genetics
• Congenital skeletal abnormalities

How Does a Degenerated Disc Lead to Bone Spurs?

A degenerated disc is likely to lead to instability in the spine, and instability is likely to lead to the type of bone spurs called enthesophytes.

• An enthesis is a piece of connective tissue that attaches another soft tissue, such as a ligament, to a bone.
• As intervertebral disc material slowly wears out, nearby ligaments holding vertebra together loosen. The spine loses some stability.
• Instability puts extra stress on the ligaments, causing them to become inflamed. They may also naturally thicken to decrease excess motion and regain some stability.
• Inflammation occurs at the enthesis.
• The inflammation at the enthesis affects the vertebra’s bone growth. Vertebral bone cells are deposited where they would not be normally, causing the enthesis tissue to calcify.
• This calcification forms a bone spur.

Symptoms of Bone Spurs

Symptoms vary depending on where the spur is located:

• Pain in the affected joint
• Pain or stiffness when you try to bend or move the affected joint
• Weakness, numbness, or tingling in your arms or legs if the bone spur presses on nerves in your spine
• Muscle spasms, cramps, or weakness
• Bumps under your skin, seen mainly in the hands and fingers
• Redness, swelling, and/or warmth at the affected area
• Stiffness or other limitations that affect joint mobility
• Difficulty standing or performing weight-bearing activities
• Other symptoms may include: numbness, burning, and pins and needle sensations that may affect the shoulders, arms, hands, buttocks, legs or feet
• Pain that eases with rest and worsens with activity
• Muscle spasms
• Cramping
• Weakness
• Rub against other bone or tissue
• Restrict movement
• Squeeze nearby nerves
• Trouble controlling your bladder or bowels if the bone spur presses on certain nerves in your spine (a symptom that’s seen very rarely)
• Heel pain when standing, walking, jogging, or running. Some people describe the pain as feeling like pins sticking into the bottom of their feet.
• Knee pain when extending or bend the leg.
• Hip pain when moving the hip, and a reduction in the hip’s range of motion.
• Spine weakness or numbness in the arms or legs caused by the bone spur pinching the spinal cord or its nerve roots.
• Shoulder limited movement of the shoulder; swelling or tears in the rotator cuff.
• Finger pain when moving the finger; the finger joint may look enlarged and knobby.

Bone Spurs in the Neck (Cervical Spine)

Depending on the location of bone spurs in the neck, people may notice:

• Dull, achy pain in the neck that gets better with rest
• Radiating pain into one or both shoulders
• Pain, numbness, or tingling in one or both arms
• Weakness in the upper limbs
• Headaches that originate with a dull ache at the back or one side of the neck and travel up the back of the head
• Numbness, tingling, and weakness in both shoulders, arms, and/or hands may be signs of spinal stenosis, commonly caused by bone spurs.
• Develop slowly over time
• Are made worse with activity
• Improve with rest

Bone Spurs in the Low Back (Lumbar Spine)

When bone spurs cause spinal stenosis in the lower spine, people may report feeling:

• Dull pain in lower back when standing or walking
• Pain, numbness, or tingling into the buttocks and back of the thigh(s)
• Weakness in one or both legs
• Pain relief when bending forward and flexing at the waist, such as leaning over a shopping cart or over a cane.

Diagnosis of Bone Spurs

Medical Imaging

Diagnostic medical imaging may also be ordered:

• X-rays – of the spine can show bone spur formation and signs of spinal degeneration. X-rays can also help the physician determine if additional medical imaging, such as a CT or MRI scan, is needed.
• A computerized tomography scan (CT scan) – is the preferred test to accurately assess bony anatomy, especially in a spine that has had prior surgery. A CT scan provides multiple cross-sectional x-rays of the body. When used with contrast injected into the fluid that normally bathes the spine, the cerebrospinal fluid (located in the intrathecal space), CT scans better demonstrate nerves and soft tissue in addition to bone. A CT scan with contrast is called a CT myelogram.
• MRI scan – is the preferred test to observe soft tissues such as discs, nerve roots, ligaments, muscles, tendons and cartilage. Unlike x-rays and CT scans, MRIs do not involve radiation. MRIs take more time and tend to be more expensive than x-rays and CT scans.
• Electrodiagnostic Tests – Occasionally, electrodiagnostic tests are ordered in addition to medical imaging. These tests are used to confirm the location and gauge the severity of a nerve injury.
• The EMG and nerve conduction (EMG/NCV) tests – may help determine if symptoms are due to compression of the spinal nerve or peripheral nerve. For example, the test may show whether symptoms affecting the hand stem from problems in the cervical spine or the compression of peripheral nerves in the wrist.

• NSAIDs (nonsteroidal anti-inflammatory drugs) – If you’re in pain, painkillers you can buy from a pharmacy or shop, such as paracetamol or ibuprofen, may help. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID), which can also help reduce any swelling and inflammation. Frequently used medications include oral and topical non-steroidal anti-inflammatory drugs (NSAIDs), topical capsaicin, and duloxetine. Corticosteroids can be injected directly into the joint.
• Duloxetine – can be useful for patients that have medical contraindications to NSAID use. If both non-pharmacological and pharmacological management fails, intra-articular corticosteroid injections might provide symptom relief. Opioids should be avoided. [rx]
• Analgesics (painkillers)
• Muscle relaxant
• Steroid Injections
• Injections – Fluoroscopically guided, contrast-enhanced spinal injection procedures that target the presumptive source of spinal pain can help decrease pain and inflammation. In addition, depending on whether local anesthetic is used as part of the injection into the spine, the procedure can help an astute clinician identify or narrow down the source of a patient’s pain.
• A spinal injection – may not completely relieve a patient’s pain but may provide enough relief to allow the progression of rehabilitation. Patients should avoid receiving more than 3 injections into any one joint over a short period of time. In addition, if the first injection provides no relief, there is no evidence that further injections into the same structure will provide a better result.

If these nonsurgical treatments fail to treat pain due to bone spurs, a patient may be referred to a spinal surgeon.

Spine Surgery for Bone Spurs

Spine surgery may be recommended if the nerve or spinal cord compression is causing unremitting pain and/or loss of motor/sensory function. Surgery for bone spurs involves removing tissue to relieve pressure on the spinal cord and/or nerve roots. For example:

• Bone spur removal – During this surgery special tools are used to remove bone spurs from the vertebra(e). Since it is possible for the bone spurs to grow back, and because there may be more than just bone spurs contributing to symptoms, a surgeon may suggest another surgical procedure, such as a laminectomy or foraminotomy.
• Laminectomy – A laminectomy is designed to relieve pressure on the spinal cord caused by central spinal stenosis. During surgery, a portion of the affected vertebra called the lamina and spinous process at the back of the spine is removed. With this small piece of the spinal canal wall removed, there is more room for the spinal cord.
• Foraminotomy – A foraminotomy is designed to relieve pressure on a nerve root. Every nerve root passes through an intervertebral foramen, a bony, hollow archway between 2 adjacent vertebrae. During a foraminotomy, bone tissue around the foramen is cut away or shaved down, enlarging the foramen space. This procedure creates more space for the nerve root, relieving nerve root compression.

Prevention

Take the following steps to help control your bone spur pain

• Lose weight, if you’re overweight or obese, to relieve the burden on your joints.
• Wear shoes that offer good foot support to cushion your feet and other joints when you walk.
• Start physical therapy to learn exercises that will strengthen the muscles around the joint and stabilize it, too.
• Maintain proper posture when standing or sitting to help preserve back strength and keep your spine properly aligned.
• Use over-the-counter painkillers, such as ibuprofen, when inflammation and pain flare up because of a bone spur. Ask your doctor before taking an anti-inflammatory drug.
• Wear shoes with a wide toe box, good arch support, and enough cushion to pad each step. Get your shoes fitted by a professional so they don’t rub against your feet when you walk. Wear thick socks to prevent your shoes from rubbing.
• Eat a well-rounded diet with plenty of calcium and vitamin D to protect your bones.
• Do regular weight-bearing exercises like walking or stair-climbing to keep your bones strong.
• Try to keep the extra pounds off.

References

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