Bone spurs are overgrowths of bone in your skeletal joints that can project painfully into the joint, or onto nearby structures, such as nerves. They form in response to wear and tear, or trauma, to the cartilage overlying a joint. When this wear and tear occurs, the exposed bone becomes inflamed, provoking a reactive overgrowth. Bone spurs typically occur in joints that are subjected to repetitive stress, such as shoulders, knees, and intervertebral discs in the spine.
Symptoms & Causes
Bone spur symptoms can range from mild to severe. Mild symptoms may include joint achiness or stiffness. When severe, bone spurs can cause debilitating pain, frozen joints, or neurological deficits. The size and location of the bone spur can impact the severity of the symptoms. Some common areas of bone spur formation are:
- Shoulder: Bone spurs in your shoulder typically develop at the AC (acromioclavicular) joint. When this happens, a hook forms at the end of the acromion; therefore, impinging the tissues that pass underneath it. This can cause pain, loss of range of motion, and damage to the impinged tissues, which may result in tears to the rotator cuff.
- Knee & Hip: Bone spurs in your knees and hips can cause debilitating pain, diminished of range of motion, and difficulty walking, rising from a chair, and negotiating stairs.
- Foot: Bone spurs in the foot are typically called heel spurs as they are commonly found on the calcaneus, or heel bone, where the plantar fascia attaches. They are formed from natural wear and tear from walking and running. Obesity is also a risk factor in developing heel spurs secondary to the added weight and stress placed on the boney surfaces of the feet.
- Spine: Bone spurs develop on the bony segments of the spine known as the vertebrae. They can cause narrowing of the canals where your spinal cord and nerves travel. This narrowing, called spinal stenosis, can cause neck and back pain, as well as neurological symptoms in the arms and legs. Neurological symptoms include pain, numbness, tingling, weakness, and loss of coordination in the arms and legs. Changes in your gait may also occur.
Patients older than 50 years old are at greatest risk of developing bone spurs, as middle age is typically when osteoarthritic changes become symptomatic.
A diagnosis of bone spurs is typically grouped with a diagnosis of degenerative disc changes at the spine or at a specific joint. A thorough history and exam are performed by your medical doctor that typically includes:
- Range of motion test: Assessing how far you can move your spine or joint in each direction and if it elicits pain.
- Neurological assessment: A group of tests that evaluates your neurological system and may aide in pinpointing the area of the spine or joints where your symptoms are originating. This assessment includes testing:
- Strength of the limbs
- Walking and balance assessments
- Sensation to light touch and pin prick
- Palpation: Touching, pushing, and squeezing of muscles and other structures to determine the source of pain.
Depending on what your doctor finds on your exam he or she may make a diagnosis of bone spurs or osteoarthritis. If necessary, your doctor may order further testing to refine the diagnosis.
- X-ray: An image of the bones in your spine or joints. An x-ray can locate arthritic changes in the vertebrae, including the location and severity of bone spurs. Load bearing X-rays can also be used to assess abnormal bone alignment, which may contribute to your bone spur formation.
- MRI (magnetic resonance imaging): An image of the soft tissues of the spine, which cannot be seen on X-ray. Most commonly an MRI will be ordered for the physician to assess whether a bone spur seen on X-ray is causing compression or irritation of a nearby nerve. MRI can also locate tumors, damaged discs, and loose ligaments in the spine.
- Electromyography (EMG): An EMG measures the activity of the muscles at rest and during contraction, determining the communication of the nerve to the muscle. In an EMG test, needles are used in addition to electrodes. This study helps
The two major goals of treatment for symptomatic bone spurs in the spine are:
- to decrease or eliminate the symptoms
- to address the underlying cause of the bone spur formation.
Conservative, nonsurgical treatments are typically recommended first, and are extremely effective. Conservative treatments include medication, physical therapy, and corticosteroid injections. One or all may be used to treat your bone spur symptoms.
- Commonly used medications:
- Over the counter medications, such as Advil or Tylenol, may be used to treat your pain if symptoms are mild or moderate.
- Muscle relaxers, such as Flexeril or Skelaxin, are used to treat spasm often associated with bone spurs.
- Nerve membrane stabilizers, such as Neurontin or Lyrica, help reduce the irritability of nerves that are pinched by bone spurs.
- Opioids are used when pain symptoms are severe. Often, they are prescribed for short term use and are only used as a last resort if nothing else is helping with the pain
- Physical Therapy: Physical therapists can perform manual therapy and provide you with a program of stretching and exercises to help alleviate your symptoms more quickly than with just rest and medication alone. Physical Therapy may be prescribed in conjunction with other treatments such as pain medication and/or injections to help with your symptoms.
- Steroid Injections: A physician performs an image guided injection into the specific area of the joint or spine thought to be the location of your bone spur and pain. Common places steroid injections are performed are at the AC (acromioclavicular) joint of the shoulder, the suspected location of a heel spur on the calcaneus (heel), the joint space between the tibia and femur at the knee, and/ or the nerve root exiting the spinal cord. While corticosteroids do not remove or “fix” the bone spur, they do help decrease the pain and inflammation surrounding the tissues.
- Surgery: If symptoms do not improve with conservative treatment or the patient is experiencing progressing pain and neurological impairment due to bone spurs, surgical intervention is indicated. Surgical Intervention includes:
- Sub-acromial decompression: A surgery where the bone spur or hook in the acromion of the shoulder is shaved down or removed to create space, thereby reducing shoulder impingement.
- Total Joint Replacement: When osteoarthritic changes, including bone spurs, are severe enough to significantly impair a patient’s mobility and quality of life, a total joint replacement may be performed. They are commonly performed at the hip, knee, and more recently, the shoulder and ankle. Joint replacement can also be performed in the spine, but more often this involves fusion of the intervertebral joints, not replacement.
- Heel spur removal: Rarely when plantar fasciitis caused by a heel spur does not improve with conservative measures, surgery to remove the heel spur from the calcaneus is performed. This is sometimes preformed in conjunction with the release of the plantar fascia of the foot to fully alleviate symptoms.
- Laminectomy: Spinal stenosis is often caused by osteoarthritic changes in the spine, including bone spurs in the nerve root canal. During a laminectomy, a portion of the vertebrae known as the lamina is removed to allow the nerve root more room to exit the spine. Synonymous with spinal decompression surgery.
Bone spurs result from degenerative wear and tear to your joints. They can occur anywhere in the body, but they are commonly found in the shoulders, hips, knees, feet, and spine. Most cases of bone spurs can be treated with conservatively with medication, injections, and / or physical therapy. Surgery is usually not necessary, but it can be highly effective in severe cases that do not improve with other treatments.