A bone spur is a bony growth formed on a normal bone. In medical language, it is termed as an osteophyte. A bone spur is an extra bone and can cause symptoms due to pressure on adjacent tissues.
Bone spurs are also called osteochondral nodules, osteochondrophytes, and chondro-osteophytes.
Osteophyte is part of degenerative changes that occur with age.
How does Bone Spur Form?
An osteophyte is a fibrocartilage-capped bony outgrowth originating from precursor cells in the periosteum. The periosteum is a layer that lines the bone.
A bone spur is a response by the body to some sort of external stimulus. This repair response may lead to the formation of extra bone called spur.
The stimulus can be due to
- Pressure from adjacent tissue
- Rubbing or friction
- Prolonged stress.
- Aging process
An osteophyte develops when the remaining cartilage in a damaged joint attempts a repair after there is cartilage loss elsewhere in the joint.
It tends to form in the joint compartment where there has been cartilage loss.
This is an attempt by the body to stabilize the joint.
However, their formation pathway and factors involved are not completely understood.
It must be noted that osteophytes can also develop in the absence of explicit cartilage damage.
Traction on a surface could also lead to spur formation.
Sites of Bone Spur
- Elbow [at extensor surface of elbow]
Spine, hip and knee are common where osteophytes are seen.
Osteophytes can be at the margin of the joint where they are called marginal osteophytes. These can develop at the periphery or margin of any joint.
The other types are called central osteophytes because of their deep location in joint. These are mostly seen in the hip and knee.]
What are the Risk Factors for Osteophyte Formation
- Increasing age
- Joint injury
- Poor posture
- Congenital skeletal abnormalities
Osteophytes are often signs of joint degeneration.
They are seen in different types of arthritis both inflammatory and degenerative.
The osteophyte itself is not painful. However, depending on the location and size, it may cause it may affect other structures, resulting in pain. In addition, the presence of osteophytes may merely indicate an underlying condition which leads to the symptoms.
For example, osteophytes in the spine are present in almost all the people but they do not specifically cause of back pain but other associated changes are.
Similarly, a bone spur in the heel does not cause pain in plantar fasciitis but the symptoms are often attributed to it, though wrongly when osteophyte is present.
In another example, while osteophytes is a telltale sign of knee osteoarthritis, the pain in the knee is usually due to other changes which are associated with the degenerative condition. But in some cases, osteophytes of the knee might cause pain as well.
Osteophytes may impinge on or stretch the adjacent structures and cause pain too.
For example, nerve impingement at the neuroforamen could cause radicular pain, numbness, burning, and paresthesiae [pins and needles] in the limb supplied by the affected spinal nerve.
If the motor root is affected, there could be muscle spasm or weakness of that part.
Thus all bone spurs are not symptomatic. Many people carry spurs along without ever knowing them. The spur would cause symptom only when it presses on adjacent tissues.
It also must be highlighted that spurs are mostly found on radio imaging. They are not a diagnosis but mostly a radiological sign which is part of a bigger process.
A bone spur is usually visible on an X-ray. Most of them are however investigated only when they cause symptoms or they might be an incidental finding on an x-ray done for some other reason.
Treatment of Bone Spur
Again the treatment is aimed at the condition which has caused the spur and not the osteophyte itself.
The treatment should be restricted only to those which are symptomatic.
As most of the bone spurs or osteophytes are asymptomatic, most of them do not require the treatment.
Ideal treatment should address the cause that led to bone spurs, treat the symptoms caused by bone spurs and if needed [rarely] removal of bone spurs.
In some rare cases, the spur [for example olecranon spur] itself is a problem. In such cases, the treatment is directed at the spur only.
Following measures are generally applied in the treatment of bone spurs or osteophytes. The treatment needs to be individualized and all the measures may not be applicable in one patient.
- Weight loss (especially when osteoarthritis or plantar fasciitis is the cause)
- Stretching exercises of the affected area
- Ultrasound or deep tissue massage
- Rest and Ice compression
- Nonsteroidal anti-inflammatory drugs
- Orthotic braces/padding/footwear modification
- Corticosteroid injection
- Surgical removal