Bone Spurs

Bone spurs or osteophytes are fibrocartilage-capped, smooth bony growths that are usually formed close to joints. They are often an attribute of osteoarthritis, a condition which causes joints to become stiff and painful. Osteophytes can grow from any bone, but they are mainly found in weight-bearing joints such as, the spine (e.g., neck, lower back), shoulder, knee, fingers, big toe, foot and heel.

Essentially, osteophytes are a sign that there are persisting increased forces (more than what the joint can normally bear) on an affected joint. Due to the excessive forces, the joint may begin to become unstable. The body then remodels bone to decrease the stress subjected to the joints or to increase surface area to prevent instability.

Osteophytes and other degenerative changes are common in the ageing process. The presence of osteophytes does not necessarily mean that they are the direct cause of pain. Nevertheless, they are often related with common degenerative conditions.

Common Causes

Generally, degenerative joint disease, also known as osteoarthritis which becomes more common with ageing is the main cause of osteophyte formation. However, osteoarthritis may also develop in younger people if their joint has been overused or overloaded persistently for a prolonged period of time.

Other diseases that are susceptible to the formation of osteophytes include:

Gout
Ankylosing spondylitis
Psoriatic arthritis
Erosive arthritis
Diffuse idiopathic skeletal hyperostosis (DISH)

Risk Factors

Ageing: More common above 50-60 years-of-age
Sex: Females are more likely to develop osteophytes than males
Obesity: Excessive weight may increase the load a joint has to bear, especially in a weight-bearing joint
Sports injury: May develop following a sprain injury or fracture
Genetics: Rarely, due to mutations in the genes of structural collagen types found in articular cartilage could lead to certain hereditary forms of osteoarthritis

Signs and Symptoms

Osteophytes are not always symptomatic. They start to become symptomatic if they:

Restrict movement
Come in contact with other bone or soft tissue
Put pressure on surrounding nerves

As such, symptomatic patients often report stiffness and a dull ache in the affected joint that is also accompanied by decreased range-of-motion. A few examples include:

In the shoulder, osteophytes around the joint can narrow the space available for tendons and ligaments to pass through, and is associated with rotator cuff tear or tendonitis.
In the finger, osteophyte formation presents as a painless lump around the distal interphalangeal joint (Heberden’s node) or proximal interphalangeal joint (Bouchard’s node).
In the spine, depending on the size and location of the osteophyte, it may affect the spinal nerve roots leading to radicular symptoms, such as numbness, pulling and/or tingling into the upper limbs or lower limbs.

Diagnosis

A detailed medical history and extensive physical examination are performed during a visit to the chiropractor. Usually, patients suffering from degenerative diseases and/or have decreased range-of-motion during a physical examination are associated with osteophytes.

Nevertheless, as osteophytes are usually painless and their symptoms are usually due to the associated osteoarthritis, they are usually detected on radiographs as incidental findings.

With patients who present with symptoms, X-ray images of the symptomatic body part can be ordered to assess for the presence or extent of osteophytes formation. In some cases, further imaging such as, MR imaging and CT scans may be warranted.

Treatment and Management

Treatment specifically for the osteophyte is typically not required if it is painless. In fact, it is usually the associated degenerative disease that is treated and managed to reduce pain and improve function. These are usually done via conservative care which includes, rest, rehabilitation exercises, activity and/or posture modification and manual therapy. Pharmaceutical options include painkillers and NSAIDs, as well as injection therapy.

If the above care does not work, then only is surgical consult considered.

Furthermore, surgical consult may also be considered if the osteophyte presents in the finger or toe, and interferes with activities-of-daily living, or for cosmetic reasons.

Frequently Asked Questions

I was told by my doctor that I have a bone spur, but I do not have any pain. Do I need treatment?

If you are not experiencing any pain or discomfort related to the bone spur, then there is no need to treat the bone spur specifically. However, the presence of a bone spur means that there is an underlying cause such as, premature degeneration or instability of the affected joint. Consulting a healthcare professional to help identify the root cause of the bone spur will allow you to have a better understanding of your condition. With that knowledge, you can make well-informed decisions regarding your care, such as taking a more active role in caring for yourself by making necessary lifestyle modifications. This can help prevent the worsening of the condition and possibly aid in slowing down the degenerative process.

Are bone spurs hereditary?

A patient’s genetic predisposition to early degenerative changes can increase the likelihood of the formation of bone spurs. Hence, this is why a detailed medical history is very important. Be sure to inform your healthcare professional about all your medical conditions and/or related family history of degenerative diseases during the initial visit.

Will bone spurs disappear or go away by themselves?

No, bone spurs can not disappear or go away by themselves. They generally do not cause pain and are often just a response of a joint towards overloading. The body remodels the bone by making it grow to decrease the stress subjected on the joint or reduce instability. In symptomatic cases, the symptoms associated with or caused by bones spurs generally respond well to conservative care. Surgical intervention may be warranted in certain cases, but you should discuss this with your healthcare professional first to allow them to develop a treatment plan that is specific to your condition and needs.

References

NHS, 2019. Osteophyte (bone spur) [online]. Available from: https://www.nhs.uk/conditions/osteophyte/ [Accessed December 2022].
Wong, SHJ., Chiu, KY., Yan, CH., 2016. Review Article: Osteophytes. Journal of Orthopaedic Surgery [online], 24 (3), 403-10.