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Bone Spurs What You Should Know

Facts You Need To Know About Bone Spurs

Bone Spurs What You Should Know

Bone spurs, also called osteophytes, are outgrowths of bone that develop within joints over a long period of time. Bone spurs in the hand can develop as a result of injury to the finger joints or more commonly from osteoarthritis, where the protective cartilage covering the joint surfaces of the fingers breaks down and wears away over time. Bone spurs are most common in people over 60 years old, but they can occur in younger people too.

Many patients are told that they have bone spurs, or osteophytes in their back or neck. Bone spurs are simply an indication that there are increased forces on the joints of the spine. With increased forces on the intervertebral discs and facet joints in the spine, instability may occur as well. In response to this over time, the body remodels bone to decrease the stress on the joints or to increase surface area to prevent the instability.

Bone spurs, or osteophytes, are smooth, bony growths, usually near joints. They develop over time in patients with arthritis or joint damage. The feet, hands, knees and spine often develop bone spurs. A healthy lifestyle can delay symptoms like pain, stiffness and limited motion. Medications, physical therapy and surgery may help.

In many cases, bone spurs and other degenerative changes may be considered the normal process of aging. The presence of bone spurs does not necessarily mean that they are the actual cause of pain. However, there are a number of common spinal conditions associated with pain that are related to the development of bone spurs. These conditions include spondylosis, cervical or lumbar radiculopathy, and spinal stenosis.

Despite their painful-sounding name, bone spurs often have no symptoms. They’re actually smooth projections that extend from your bones, frequently where two bones meet in a joint. The formation of bone spurs, called osteophytosis, is much more common after the age of 60. But younger adults can develop bone spurs, too.

If you have osteoarthritis, a risk factor for bone spurs, you should know what symptoms to look for and when treatment may be necessary.

What is a Bone Spur?

Bone spurs, also called osteophytes, are bony outgrowths that can form on the spine and around or within joints. When bones, ligaments, or tendons in the spine are damaged or irritated the body can respond by trying to repair the affected area. It does this by catalyzing bone growth through either ossification (if the stimuli affects a bone) or calcification (if the stimuli affects a tendon or ligament).

Bone damage or irritation can be caused by osteoarthritis (deterioration of the cartilage between bones which causes them to rub together), trauma, thinning or degenerative discs, ligament inflammation or tearing, and spinal stenosis, among other conditions. Bone spurs may or may not cause symptoms, this will largely depend on where they are located and the extent of their growth. If they do put pressure on a nerve in the spine you may experience pain, tingling, stiffness, numbness, and weakness in the affected area. Bone spurs are usually detected using imaging techniques such as an X-ray or an MRI.

Typically, bone spurs are only treated if they are causing symptoms. The aim of treatment is to decrease inflammation, decompress nerves, and reduce symptoms.

Osteophytes differ from enthesophytes, which are bony hook like projections that develop at the ends of ligaments (which connect bones together) or tendons (which connect muscles to bones). Enthesophytes can be caused by tendonitis, ligament tearing, inflammation of the attachment point of tendons or ligaments, or degenerative arthritis. Osteophytes also differ from syndesmophyte which result from the calcification or hardening inside the ligaments running parallel to the spine. This can result in “bamboo spine” which means the adjacent vertebrae are fused together forming one cohesive unit.

Non-marginal syndesmophytes refer to ligament hardening beyond the edges of the vertebral margin while marginal syndesmophytes develop along the edges of the vertebrae.

Bone spurs can also occur in other areas of the body such as the: Feet, Shoulders/ Rotator cuff, Knees, Heels, Ankles, Elbows, Wrists, Hands, Hip, and Shins.

Types of Bone Spurs

When bone spurs form on the spine, it’s usually because your body is trying to heal from another issue, such as degenerative bone disease. While not all spinal osteophytes will cause problems, when they do cause symptoms, the pain can become severe. A bone spur can form anywhere along the spine, though they are most common in the neck and lower back.

Types of Bone Spurs by Region of the Spine

Regions of the Spine

  • Cervical Bone Spurs: Bone spurs in the neck can develop on any of the seven cervical vertebrae from the top to the base of your neck.
  • Thoracic Bone Spurs: Bone spurs in the upper and mid-back can develop in any of the twelve vertebrae from the base of your neck to your mid-back.
  • Lumbar Bone Spurs: Bone spurs in the lower back can occur on any of the vertebrae from the thoracic region to the sacrum.

Types of Bone Spur by Portion of the Spine Affected

  • Disc Osteophyte Complex (DOC): this term is used to describe an ambiguous pathology, when it is unclear based in an MR imaging whether a patient is suffering from endplate osteophytes, a protruding disc, thickened ligaments, or multiple conditions.
  • Bridging osteophytes: The formation of a bony bridge between two vertebrae with bone spurs.
  • Anterior osteophytes: Bone spurs that develop at the front of the spine.
  • Posterior osteophytes: Bone spurs that develop at the back of the spine.
  • Endplate osteophytes: Bone spurs that develop at the top or bottom edges of the vertebrae where they interact with the disc.
  • Multilevel endplate osteophytes: Bone spurs that develop at both the top and bottom endplates, thereby affecting more than one vertebra or vertebral disc.
  • Foraminal disc osteophyte complex: Bone spurs that develop in the foramen – the hollow archways on both sides of two adjacent vertebra, through which the spinal nerve roots run.
  • Facet Joint Osteophytes: Bone spurs that develop surrounding the facet joints, which help connect two adjacent vertebrae together. There are two facet joints between each vertebrae which provide motion, spinal stability, and prevent certain harmful motions.

What Causes Bone Spurs?

Bone spurs are usually caused by local inflammation, such as from degenerative arthritis (osteoarthritis) or tendinitis. This inflammation stimulates the cells that form bone to deposit bone in this area, eventually leading to a bony prominence or spur. For example, inflammation of the ligament that surrounds a degenerating disc between the vertebrae (the bony building blocks of the spine) is a very common cause of bone spurs of the spine. Inflammation of the Achilles tendon can lead to the formation of a bone spur at the back of the heel bone (calcaneus bone). Inflammation of the tissue on the bottom of the foot, plantar fasciitis, can lead to a bone spur at the underside of the heel bone.

These bone spurs are sometimes referred to as heel spurs. A bone spur is medically referred to as an osteophyte. Rarely, bone spurs may occur as a result of congenital conditions. An osteochondroma is one type of these congenital spurs.

Symptoms

Most of the time, bone spurs are small and cause no painful symptoms. You may notice them if they form around your finger joints, because they may make your fingers look a little knotted. Only about 40 percent of people 60 and older will experience bone spur symptoms painful enough to require medical attention.

When bone spurs, also called osteophytes, form in the knee, you may find it painful to straighten your leg. Bone spurs can also form in the shoulder, which can irritate your rotator cuff and cause pain and swelling there. In the hip, bone spurs can also be painful and limit movement.

One of the most common sites for bone spur growth is the spine. If spurs form on the inside of a vertebra, they can press against the spinal cord or its nerve roots. This can cause not only pain, but also numbness in your back, arms, and legs.

If you have pain or stiffness in a joint that does not get better within a day or two, see your doctor. It could be bone spurs or any number of conditions. Early diagnosis and treatment of bone spurs can limit the damage they cause. If you notice pain and swelling in a joint that doesn’t subside with ice and rest, talk to your doctor about the possibility of osteophytosis.

Diagnosis

Outlined below are some of the diagnostic tools that your physician may use to gain insight into your condition and determine the best treatment plan for your condition.

  • Medical history: Conducting a detailed medical history helps the doctor better understand the possible causes of your back and neck pain which can help outline the most appropriate treatment.
  • Physical exam: During the physical exam, your physician will try to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted.
  • X-rays are usually the first step in diagnostic testing methods. X-rays show bones and the space between bones. They are of limited value, however, since they do not show muscles and ligaments.
  • MRI (magnetic resonance imaging) uses a magnetic field and radio waves to generate highly detailed pictures of the inside of your body. Since X-rays only show bones, MRIs are needed to visualize soft tissues like discs in the spine. This type of imaging is very safe and usually pain-free.
  • CT scan/myelogram: A CT scan is similar to an MRI in that it provides diagnostic information about the internal structures of the spine. A myelogram is used to diagnose a bulging disc, tumor, or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into the low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems lie.
  • Electrodiagnostics: Electrical testing of the nerves and spinal cord may be performed as part of a diagnostic workup. These tests, called electromyography (EMG) or somato sensory evoked potentials (SSEP), assist your doctor in understanding how your nerves or spinal cord are affected by your condition.
  • Bone scan: Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also used for finding lesions for biopsy or excision.
  • Discography is used to determine the internal structure of a disc. It is performed by using a local anesthetic and injecting a dye into the disc under X-ray guidance. An X-ray and CT scan are performed to view the disc composition to determine if its structure is normal or abnormal. In addition to the disc appearance, your doctor will note any pain associated with this injection. The benefit of a discogram is that it enables the physician to confirm the disc level that is causing your pain. This ensures that surgery will be more successful and reduces the risk of operating on the wrong disc.
  • Injections: Pain-relieving injections can relieve back pain and give the physician important information about your problem, as well as provide a bridge therapy.

Treatment Options

Bone spurs do not disappear on their own, so you may want to change your routine and try some home treatments to ease your pain.

Weight loss. One treatment would be to lose weight. Because bone spurs form from pressure on the bones, losing weight helps reduce that force. Exercise, portion control, and healthy eating can all affect your feet.

Proper footwear. Tight-fitting or even lose-fitting shoes can contribute to the unnecessary duress your foot endures. Invest in some well-fitting shoes with extra padding if needed. If you find it is still too painful to walk, try using a walking boot to take the pressure off the area. These boots are especially useful if you decide to get surgery; they can be worn before and after the procedure.

Pain relief. Taking an over-the-counter pain reliever will also help by reducing the swelling around the site. Heat and ice also help with swelling. Using a heating or cooling pack for 15 minutes throughout the day can ease stiffness and inflammation. If you still are experiencing pain, see your doctor about a cortisone injection.

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