Bone spur treatments
Bone spurs are of three basic types. One is the kind that arises near a joint affected by osteoarthritis (degenerative joint disease.)
The body tries to repair this damage. But the repairs result in growth of new bone along the sides of the existing bone (bone spurs). These "spurs" are called osteophytes. They are common features of the osteoarthritic shoulder, elbow, hip, knee and ankle. Removing these osteophytes is an important part of joint replacement surgery, but removing them without addressing the underlying arthritis is usually not effective in relieving symptoms.
The second type of bone spur is the kind that occurs when the attachment of ligaments or tendons to bone become calcified. Thus can occur on the bottom of the foot, around the Achilles tendon, and in the coroacoacromial ligament of the shoulder.
The third method occurs when trauma to a bone or joint causes damage to the bone. As the body tries to heal this damage, new bone growth can develop causing a bone spur in that location.
Hallux rigidus is the medical name for arthritis affecting the big toe. The joint at the base of the big toe is called the metatarophalangeal joint, or MTP joint. This is the junction of the long bone of the forefoot, and the small bone of the big toe. Because of the mechanics of our feet, this joint is especially prone to developing arthritis. In fact, hallux rigidus, or big toe arthritis, is the most common site of arthritis in the foot.
The most common symptom, and the most common reason to seek medical attention for this problem, is pain around the base of the big toe. This pain is accentuated with activity, especially running or jumping. Often wearing firm soled shoes that prevent motion at the base of the big toe will help relieve symptoms.
Your doctor will test the mobility of the joint, usually comparing it to the opposite foot to see how much motion is lost at the joint. X-Rays are done to determine if the joint cartilage is worn away, and to see if bone spurs have formed in this area. Determining the extent of the arthritis will help guide treatments.
The most common treatments include:
Wearing stiff-soled shoes limits motion at the base of the big toe. Inserts can be made for shoes that can help your existing footwear. Other shoe-wear modifications include shoes with a wider toe box, or rocker-bottom heels that allow foot motion without as much bending.
There are many causes for heel pain--from a sprain to fractures and arthritis--but one of the most common causes of heel pain is inflammation of the plantar fascia (plantar fasciitis), with or without associated spur bone formation. The inflammation is due to repetitive and excessive stretching of the plantar fascia.
Most people develop irritation and inflammation of the plantar fascia because of overuse of their feet by excessive running, jumping, jogging or twisting of the feet, resulting in excessive pronation (inner turning of feet). The injury may also result in small tears of the plantar fascia.
The pain is described as being dull aching or sharp and can be reproduced by flexing the toes upwards (dorsiflexion) and tensing the fascia. Symptoms tend to worsen after standing and walking, in the morning, after awaking or after prolonged sitting. This happens because the fascia is being stressed again after a protracted rest. As the person walks, the fascia warms up and lengthens slightly, reducing the tension and the associated pain.
The repetitive stretch of the fascia over years can also irritate the insertion site of the fascia to the heel bone and lead to the growth of a hook-shaped spur of the heel bone. A common misconception is that the heel pain is mostly due to the bone spur. The truth is that the pain is due primarily or exclusively to the inflammation of the fascia (plantar fasciitis) and not to the bone spur because significant heel pain occurs in the absence of spurs, and large bone spurs can be detected by X-rays in people with no heel pain.
The treatments recommended for plantar fasciitis include symptomatic treatment for pain, treatment directed to improve the blood flow to the sole, anti-inflammatory medications, and treatment designed to reduce the load or stress on the plantar fascia. Surgical treatment is only of last resort and is often not very successful.
Outpatient physical therapy for ultrasound treatment and muscle stimulation is helpful.
Alternate hot and cold applied locally will increase the blood flow to the foot and wash out pain chemicals that accumulate in the area. Your doctor will advise you how to do that safely. People with diabetes, peripheral neuritis, and any condition making them insensitive to temperature changes, should not try at all the alternating hot/cold treatment unless specifically approved by a physician.
Resting provides only temporary relief. A special custom splint worn at night to keep the plantar fascia on a gentle stretch so that any injuries to the plantar fascia may heal in a proper position is sometimes effective. Another modality is taping of the feet with athletic or podiatric bandages. Wearing shoes with higher than ordinary heels, firm heel pads, arch supports, or special orthototic support shoes are other things that work. Special exercises that stretch the Achilles tendon, lengthen this tendon, and reduce the stress on the plantar fascia also are advised. Sometimes a patient needs to replace jogging or running and other foot dependent exercises with non foot straining sports such as swimming. Losing weight reduces the load on the affected heel.
A last resort treatment, surgery is usually done under local anesthesia and consists of a fascia release procedure in which the fascia is partially cut to release the tendons tension. Although bone spur removal may also be done at the same time, it is not the critical curing procedure.
Just above the foot, the ankle may also be affected by spur formation. The ankle consists of two joints. The upper ankle joint is composed of three bones:
the shinbone (tibia) This is called the tibial talar joint and allows the foot to bend up and down.
Right below the tibial talar joint is another joint (subtalar), where the talus connects to the heel bone (calcaneus). This joint enables the foot to rock from side to side. Three sets of fibrous tissues connect the bones and provide stability to both joints. The knobby bumps you can feel on either side of your ankle are the very ends of the lower leg bones. The bump on the outside of the ankle (lateral malleolus) is part of the fibula; the smaller bump on the inside of the ankle (medial malleolus) is part of the shinbone.
Most bone spurs in the ankle are caused by osteoarthritis. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur.
Bone spurs can also be caused by an injury to the ankle joint. In the process of trying to heal the injury to the bone cause by the trauma to the ankle, the body may overcompensate and cause calcium to build up and this turns into a bone spur.
Most bone spurs on fingers are caused by osteoarthritis. Nodules affecting the outer row of joints (distal interphalangeal joints) are called Heberdens nodes and the spurs that affect the next row in (proximal interphalageal joints) are called Bouchards nodes. Bone spurs can also be caused by an injury to a finger joint. In the process of trying to heal the injury to the bone cause by the trauma to the finger joint the body sometimes over compensates and in the process causes calcium build up which forms into a bone spur.
Most bone spurs in the elbow are caused by osteoarthritis. Bone spurs can also be caused by an injury to the elbow joint.
Bone spurs are common in the hip joints. Most bone spurs in the hip are caused by osteoarthritis. They tend to grow outward from the acetabulum (the cup-like part of the pelvis that interacts with the femur).
There are two common places for bone spurs in the shoulder. The first is in the joint itself and is caused by osteoarthritis.
The second is where tendons meet the bone. The chronic tugging of the tendon from the bone leads to bone spurs.
Treatment for bone spurs rests on a few common principles.
Pain associated from a bone spur is commonly caused by irritation of the surrounding tissue. Giving that tissue a rest from the irritation can significantly reduce the pain.
Anti-inflammatory medications are often given to help control the pain and the inflammation caused by the bone spur.
Muscle relaxants are sometimes given when the irritation causes muscle tension or spasms.
Some times cortisone injections are given in the area of the bone spur to control the pain and inflammation.
One of the more common locations for bone spurs is the spine.
Many patients are told that they have "bone spurs" in their back or neck, with the implication that the bone spurs are the cause of their back pain. However, while bone spurs are an indication that there is degeneration of the spine, these bony growths are not usually the actual cause of the back pain.
The term "bone spurs" is really a bit of a misnomer, as the term "spurs" implies that the osteophytes are "poking" some part of the spinal anatomy and causing pain. However, this is not at all true. Bone spurs are in fact smooth structures that form over a prolonged period of time, often causing back pain.
The medical term for bone spurs is osteophytes, and they represent an enlargement of the normal bony structure. Basically, osteophytes are a radiographic marker of spinal degeneration (aging) and are by and large a normal finding as we age. Over the age of 60, bone spurs are actually quite common.
It must be stressed that degeneration of the spine occurs in all persons to some degree. However, for 42% of the population, degeneration and development of bone spurs will lead to symptoms of neck and back pain, radiating arm and leg pain and weakness in the extremities during their lifetime.
The human spine is made of thirty-two separate vertebral segments that are separated by intervertebral discs made of collagen and ligaments. These discs are shock absorbers and allow a limited degree of flexibility and motion at each spinal segment. The cumulative effect allows a full range of movement around the axis of the spine, especially the neck (cervical) and lower back (lumbar spine).
Motion between each segment is limited by the tough outer disc ligaments and the joints that move (articulate) at each spinal level (the facet joint). Under each joint, just behind the disc, is a pair of nerve roots that exit the spinal canal. The exiting hole (foramina) that surrounds the nerve (disc in front, joints above and below) is relatively small and has little room for anything besides the exiting nerve.
Normal life stressors compounded by traumatic injuries to the spinal architecture cause degeneration in the discs and the joints of the spine. With age, injury, poor posture there is cumulative damage to the bone or joints of the spine:
1. As disc material slowly wears out, ligaments loosen and excess motion occurs at the joint. Degenerative changes to normal vital tissue begin in early adulthood, but usually this slow process does not present with nervous system compression until we are in our sixties or seventies. Factors that can accelerate the degenerative process and bone spur growth include:
Congenital or heredity As always, to help avoid or minimize back pain it is generally advisable to stay well conditioned (both in terms of aerobics and strength) and to maintain good posture throughout ones life.
Doctors often refer to the changes as spinal arthritis or osteoarthritis of the facet joints, and this condition is a common cause of back pain in the older patient population (over 55 or 60). This condition can cause stiffness and lower back pain that is usually worse in the morning, gets better after moving around, then gets worse again at the end of the day.
The most common root cause of cervical and lumbar arthritis is repetitive trauma to the spine from recreational or work related excessive strains. Patients may typically develop symptoms of osteoarthritis in their mid 40s to early 50s. Men are more likely to develop arthritic related symptoms earlier in life, however postmenopausal women with stiffening spines (accelerated bone spur formation) rapidly approach men in incidence and severity of osteoarthritis.
Also, enlargement of the bone can sometimes lead to narrowing of the spinal canal and result in spinal stenosis. This condition can cause nerve pinching, leading to pain down the legs that is worse when the patient stands and walks, and is better when sitting. Spinal stenosis cannot be prevented but it certainly can be cured.
Back pain or neck pain is very common as the facet joints are inflamed and the neck and back muscles become irritated. Patients usually complain of:
Dull pain in the neck or lower back when they stand or walk The symptoms of bone spurs are made worse with activity and often improve with rest. Lumbar arthritis symptoms often improve when an individual is bending forward and flexing at the waist, such as leaning over a shopping cart or over a cane.
As the nerves become compressed, patients with bone spurs complain of several symptoms including:
Pain in one or both arms or legs Symptoms described above can also be caused by medical conditions other than bone spurs, such as diabetes, poor blood circulation to the arms and legs, spinal tumors, fractures, and spinal infections. Many of the symptoms of bone spurs are similar to generalized arthritis, rheumatism, back strain and muscle fatigue, as well as acute disc ruptures with nerve compression.
Diagnostic evaluation begins with the clinical examination. Your health care provider should perform a detailed neurological and spine evaluation assessing for spinal nerve and spinal cord compression.
Common diagnostic tests include:
Electroconductive tests are commonly performed to document the degree and severity of spinal nerve injury. The EMG and nerve conduction test (EMG/NCV) tests will exclude peripheral nerve compression such as carpal tunnel syndrome.
Radiographs begin with an x-ray of the spine to determine the extent of arthritic changes and bone spur formation. With these films the physician may determine if destructive changes are present or further radiographic images are indicated.
Computerized tomography (CT scans) with myelography and/or MRI scans can provide details about change in the spinal architecture and the degree of nervous system compression. With these films the clinician will correlate clinical symptoms with radiographic findings and recommend the corrective course of action, often seeking the consultation of the spine surgeon.
Most patients with mild or moderate nerve compression and irritation from bone spurs can manage their symptoms effectively with conservative care, such as:
Medication, such as anti-inflammatory medications and muscle relaxant pain medications, for approximately 4 to 6 weeks. Spine specialist consultation is appropriate if these conservative measures to treat bone spurs fail. Early referral is appropriate if patients suffer from severe pain or there is clinical evidence of nerve compression and damage.
Surgery (such as a laminectomy) relieves the pain and neurological symptoms by removing the bone spurs and thickened ligaments causing painful nerve compression. The majority of patients who undergo surgery for bone spurs experience good results, often gaining years of relief and improved quality of life. Studies have shown that age is not a major factor in determining whether a person will benefit from spine surgery for bone spurs. Medical conditions often associated with age, such as high blood pressure, diabetes and heart disease can influence surgical risks and slow the recovery processes.
Spine surgery for bone spurs becomes necessary if nerve or spinal cord compression is either causing unremitting pain or motor loss is documented on examination. Discuss the risks and benefits of the various approaches to spine surgery with your surgical consultant.
|
