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Osteophyte

Bone Spur

Osteophytes, also known as ‘parrot beaks’ or bone spurs, are bony outgrowths covered by smooth fibrocartilage. These projections often grow from the periosteum at the junction between bone and cartilage.


Presentation

Osteophytes may remain asymptomatic for several years and symptoms, when present, depend on the location of the spur. Spurs are of clinical importance as they cause pain, and sometimes, loss of function of joints. Compression of nerves limits the mobility of joints and obstruct many tissues and organs. For example, vertebral osteophytes lead to pain in the lumbar region and abdominal pain [6]. Osteophytes of the spine is also associated with dysphagia and breathing problems [7]. Report of spine osteophytes causing vocal cord paralysis is also available [8]. Cervical osteophytes with vertical artery compression may also result in dysphonia [9].

Osteophytes located in other parts of the body may cause considerable pain and affect functions. Acromioclavicular joint osteophyte is associated with rupture of supraspinatus tendon [10]. Medial tibial condyle spur may cause knee pain, particularly in patients with osteoarthritis. Osteophytes of the neck may result in pins and needles sensation, numbness, and weakness in the arms. Rotator cuff tear results from osteophytes in the shoulder region that limit the space available for tendons and ligaments. Lumps may be seen on the fingers with the presence of osteophytes.

Pneumonia
  • We report a case in which an anterior thoracic vertebral osteophyte was responsible for chronic obstructive pneumonia due to obstruction of the right main stem bronchus.[ncbi.nlm.nih.gov]
  • Lesser Aspiration pneumonia due to difuse cervical hyperostosis Chest, 98 (1990), pp. 763-764 [11.] K. Suzuki, Y. Ishida, K.[elsevier.pt]
Nail Deformity
  • All nail deformities had resolved; 53 patients felt no discomfort and 65 were very satisfied or satisfied with the procedure and would undergo surgery again.[ncbi.nlm.nih.gov]
Back Pain
  • RESULTS: The prevalence of low back pain was significantly greater in the group of osteophyte formation with disc height narrowing than the other 2 groups.[ncbi.nlm.nih.gov]
  • Abstract A case report is presented of a patient with an anterosuperior osteophytic bone bridge of the sacroiliac joint causing lumbar back pain. After prolonged physiotherapy, the bone bridge was excised, with complete resolution of the symptoms.[ncbi.nlm.nih.gov]
  • Abstract We present an interesting case of a fractured osteophyte causing back pain that was demonstrated both on bone single photon emission computed tomography (SPECT) and computed tomography (CT).[ncbi.nlm.nih.gov]
  • Back Pain Facet Joint Syndrome Osteophytes[cure-back-pain.org]
  • Bone spurs do not directly cause back pain but influence the development of other spinal disorders such as osteoarthritis and spinal stenosis .[spine-health.com]
Phalen's Sign
  • The patient presented with a 3-year history of CTS, consisting of progressive pain and paresthesias in his right hand, positive Tinel and Phalen signs, and an electrodiagnostic study demonstrating median nerve compression at the wrist.[ncbi.nlm.nih.gov]
Anterior Knee Pain
  • The patellofemoral symptoms and functions included anterior knee pain, abilities of chair-rising and stair-climbing and quadriceps muscle power.[ncbi.nlm.nih.gov]
Dysuria
  • The patient was regularly followed up as an outpatient, and no dysuria had been noted by January 2003.[ncbi.nlm.nih.gov]
Dysarthria
  • A 74-year-old man who presented with progressive dysphagia and dysarthria was found to have right-sided tongue deviation, left palatal droop, and hypophonia.[ncbi.nlm.nih.gov]
Dysesthesia
  • Complications were rare (n 2) and included heterotopic ossification and ulnar dysesthesias. This procedure addresses the pathologic processes associated with arthritis of the elbow and was safe and effective in this series.[ncbi.nlm.nih.gov]
Stroke
  • Copyright 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]

Workup

Individuals with osteophytes present with non-specific pain and often the area of pain is not associated with the location of osteophyte. In most of the cases, diagnosis of osteophyte is incidental during the workup for some other non-correlated condition.

Physical examination may reveal discomfort and pain at the region of spur during palpation. Osteophytes that are located deep may not be revealed with external touch. Shoulder range motion testing is used to check for mobility and pain. Spur that impinge upon rotor cuff tendons often cause considerable pain.

X-rays are the ideal imaging studies for the identification of location and severity of bone spurs. But, very small spurs may not be visible in these images. Radiographic images are useful in assessing the degree of degenerative changes. In the early stages, radiographic images may show osteophytes with well-maintained space in the joint. Degenerative changes are severe in advanced forms of osteophyte formation. Narrowing of joint space, osteophytes, sclerosis and joint irregularities are some among them. Cases with impingement of nerves or muscles may be viewed with other imaging methods like MRI, CT, or EMG.

Treatment

Treatment of osteophyte is dependent on the severity of symptoms. The most common symptom associated with the condition is pain, which may or may not be related to the location of the spur. Non-steroidal anti-inflammatory medications are the first line of treatment for osteophytes. They help to reduce pain and inflammation in the affected region. Local injections or oral anti-inflammatory medications are commonly used depending on the location of spur.

Physical therapy are equally effective in relieving symptoms due to osteophytes. These exercises the muscles surrounding the spur and strengthen them, improving their mobility. Stretching exercises, use of ice packs, massage and ultrasound treatment, are all used under physical therapy. Cortisone injections are sometimes used to reduce pain in the joints. For spine and hip, these injections are delivered with the help of X-ray. Mechanical methods like orthotics, or shoe inserts, are useful in relieving symptoms of spurs in the leg. Surgical measures are suggested in case of impingement of nerves, or tendons. Surgery is an option only when conservative treatment measures do not provide any relief to the symptoms.

Prognosis

Asymptomatic osteophytes may not require any specific treatment and may not cause any major issues. Conservative treatment may be enough for many bone spurs which often have a good prognosis. However, osteophytes persist even when the symptoms resolve. Osteophytes may cause severe disability when they press against the neighboring nerves. Some of the spurs show enlargement over a period of time. Surgery may not give permanent relief as the spurs may grow back.

Etiology

Remodeling of joints secondary to changes in joints, like osteoarthritis or pathological changes, are presumed to be most common causes of bone spur formation. Osteophytes may also be an adaptation to stabilize articular cartilage [2]. Presence of osteophytes is directly related to age as chances of osteoarthritis and cartilage wear off increases with time. Cartilage damage may act as a mechanical stimuli and stimulate osteophyte formation, but spur formation may also occur in healthy joints. Cartilage damage associated with narrowing of joints is highly correlated with formation of osteophytes [3]. In the knees, anterior cruciate ligament tear stimulates osteophyte formation, anterior and posterior to the point of tear. This aids in limiting the translocation of femur on tibia ensuring stability.

Local inflammation, as in tendinitis and osteoarthritis, is also related to formation of osteophytes. Thus plantar fasciitis and Achilles tendinitis also increase the chance of spur formation. Osteophytes may result from certain congenital conditions like osteochondroma, and are referred to as congenital spurs.

Epidemiology

Osteophytes are commonly seen in persons over the age of 60 years, as the incidence of osteophyte formation increases with age. In majority of cases, the condition remains asymptomatic and may be diagnosed through X-rays indicated for other reasons. In individuals above 50 years, ankle spurs are more common among women when compared to men [4]. A moderate positive correlation is noted between these spurs for women over 30 years.

Sex distribution
Age distribution

Pathophysiology

Excessive mechanical stress and the presence of structural fissures in the articular cartilage result in cartilage damage in the joints. Cartilage in this area becomes rough and worn out, which affects the movement of the joint. This may initiate the release of enzymes that expedite the disintegration of cartilage. This acts as the trigger for osteophyte formation. Osteophytes express transforming growth factor β, a factor that is involved in the initial formation and also in the later developmental stages of bone spurs [5]. Expression of growth factors and mediators play a key role in formation of osteophytes. Osteophytes contain fibroblasts, prechondrocytes, maturing chondrocytes, hypertrophic chondrocytes and osteoblasts. Type II collagen is the most prominent component in the cartilaginous zone of osteophytes.

Osteophytes play an important role in providing protection to the articular cartilage by redistributing forces in the affected region. Thus, they form an adaptive reaction to deal with the instability in the joints containing damaged cartilage.

Prevention

Preventing the underlying cause of osteophytes like inflammation is the only known way to prevent spurs. Being physically fit and active helps to reduce the symptoms due to osteophytes.

Summary

Osteophytes are bony outgrowths covered by smooth fibrocartilage often associated with osteoarthritis. These projections usually grow from the periosteum at the junction between bone and cartilage [1]. Osteophytes are one of the common features noted in the radiography of osteoarthritis. Traction spurs, found at the insertion of tendons and ligaments, and inflammatory spurs are other types of osteophytes. They are considered as an adaptive response of the joint to stabilize and provide protection to articular cartilage. Studies report that osteophytes stabilize knees affected by osteoarthritis.

Osteophytes may remain asymptomatic in many, but are of clinical importance as they may represent or predict disintegration of joint. Herberden’s nodes, spine, elbow and feet are the most common sites of osteophyte formation. Osteophytes may be associated with pain when they compress nearby structures like nerves and spinal cord. Treatment is based on the severity of symptoms.

Patient Information

Osteophytes or bone spurs are small outgrowths of bones from the edges of bones. Although very common in joints, it can be formed in any bone. They may also form at the region of attachment of ligaments, tendons or muscles to bones. Neck, lower back, shoulder, knee, foot and heel are the most common regions of occurrence of spurs. Stress and rubbing of bone for a long duration are the most common causes of bone spurs. Osteoarthritis and inflammation cause stress to bones and joints. With age, the cartilage cover on the edges of bones wear off causing the bones to rub against each other. This triggers the formation of new bone in the region resulting in osteophytes. This is considered as body’s method to stabilize the affected joint. Previous trauma and increasing age are two major risk factors in the development of bone spurs. Incidence of bone spurs increases with age and osteophytes are very common among individuals over 40 years.

Pain is most common symptom of osteophytes. Pain may be related to or totally different from the location of spur. When bone spurs press against the surrounding nerve or muscle, they cause pain and affect the motion of the joint. This is commonly seen in the hips, knees, shoulders, hands and feet. When spurs rub against the tendons or ligaments, it may result in tear. Spinal osteophytes may cause pain and loss of functioning and mobility. Numbness, tingling or weakness in arms or legs are seen when nerves are pinched due to the presence of spurs. Pressing of muscles may result in loss of balance, weakness and pain.

A thorough physical examination is needed to review the condition and to check for any other medical problems. This will also help to assess the severity of the problem and the mobility of the affected joint. Imaging studies like X-ray is suggested to evaluate bone spurs. X-ray imaging helps to assess the location and extent of degeneration of joint. Tear of ligament and tendons are assessed using MRI or a CT scan. These methods help to observe compression of nerve and spinal cord due to the presence of spurs.

Treatment of osteophytes is based on the severity of symptoms. Non-steroidal anti-inflammatory medications are commonly used to reduce pain and to relieve the inflammation in the affected joint. Symptoms can also be controlled through physical therapy. This includes, cold packs, exercises, ultrasound treatments and massages. These methods help to improve the movement of the affected joint and to reduce pain. Cortisone injections are used to relieve pain in certain cases. Surgery is opted only if the condition is not responding to any of the conservative treatment methods. Surgery may not give permanent relief as spurs may grow back even after the treatment. Maintaining an active life is the best way to reduce the symptoms due to the presence of bone spurs.

Bone spurs that are asymptomatic may not require any specific treatment. Symptoms, when present, may be mild or disabling, depending on the location. In most of the cases, conservative treatment measures provide good relief. But in many cases, the spurs may persist even when the symptoms are resolved.

References

Article

  1. Menkes CJ, Lane NE. Are osteophytes good or bad?. Osteoarthritis Cartilage. 2004; 12: S53–S54. 
  2. Alonge TO, Oni OO. An investigation of the frequency of co-existence of osteophytes and circumscribed full thickness articular surface defects in the knee joint. Afr J Med Med Sci. 2000; 29: 151–153.
  3. Boegard T, Rudling O, Petersson IF, Jonsson K. Correlation between radiographically diagnosed osteophytes and magnetic resonance detected cartilage defects in the patellofemoral joint. Ann Rheum Dis. 1998; 57: 395–400. 
  4. Toumi H, Davies R, Mazor M, et al. Changes in prevalence of calcaneal spurs in men & women: a random population from a trauma clinic. BMC Musculoskeletal Disorders. 2014; 15:87.
  5. Uchino M, Izumi T, Tominaga T, et al. Growth factor expression in the osteophytes of the human femoral head in osteoarthritis. Clin Orthop Relat Res. 2000;377:119–125.
  6. Lamer TJ. Lumbar spine pain originating from vertebral osteophytes. Reg Anesth Pain Med. 1999; 24: 347–351. 
  7. Aronowitz P, Cobarrubias F. Images in clinical medicine. Anterior cervical osteophytes causing airway compromise. N Engl J Med. 2003 25; 349: 2540.
  8. Brandenberg G, Leibrock LG. Dysphagia and dysphonia secondary to anterior cervical osteophytes. Neurosurgery. 1986; 18: 90–93.
  9. Giroux JC. Vertebral artery compression by cervical osteophytes. Adv Otorhinolaryngol. 1982; 28: 111–117.
  10. Petersson CJ, Gentz CF. Ruptures of the supraspinatus tendon. The significance of distally pointing acromioclavicular osteophytes. Clin Orthop Relat Res. 1983;174:143–148.

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Last updated: 2017-08-09 17:55