Osteophyte (bone spur)

An osteophyte is a hard bony projection that grows at the rim of a joint or at the edge of a vertebra. The word is alarming when it turns up in an X-ray report, but on its own it is not a diagnosis: osteophytes are found in most people beyond middle age, and in most of them they cause nothing at all. They only become a problem when they rub against neighbouring tissue or press on a nerve.

Where a bone spur comes from

Bone is living tissue that keeps adapting to the load it carries. When the cartilage in a joint thins and the rim starts taking pressure it was never designed for, bone answers in the only way it can: by laying down new bone around the edge. The result is a sort of widened shelf — the joint trying to spread the load over a larger area and to steady itself.

Hence the essential point: an osteophyte is not a disease but the trace of one. Behind it there is almost always osteoarthritis, and less often an old joint injury, years of repetitive overload, an inflammatory joint disease, or age-related changes in the discs of the spine. That is why any conversation about treatment begins not with the spur but with whatever produced it.

One more consequence: the size of an osteophyte and the strength of the symptoms are only loosely related. An impressive spur may cause no trouble for decades, while a small one that happens to sit next to a nerve root can be a serious nuisance.

Where they form and what they feel like

The commonest complaint is pain and stiffness in the joint, worse with use. Beyond that everything depends on the site:

• the spine. Bony overgrowth narrows the openings through which the nerve roots leave, and the spinal canal itself. Hence neck or lower back pain radiating into an arm or a leg, pins and needles, numbness, and weakness in a hand or foot. When the canal narrows in the lower back, a characteristic pattern appears: after a few hundred metres of walking the legs grow heavy and numb, and sitting down or leaning forwards relieves it;
• the hands. Firm nodes grow at the edges of the finger joints; at first they may ache, then they usually stop, but they stay and alter the shape of the finger. The base of the thumb suffers separately, and since that joint provides grip strength, turning a key, opening a jar or wringing out a cloth becomes difficult;
• the knee and hip. Rim overgrowth restricts the extremes of movement: it is hard to straighten the knee fully, put socks on or get into a car;
• the shoulder. A spur under the arch of the shoulder blade rubs on the tendon, and the arm starts to hurt when raised above shoulder height and at night on that side;
• the foot and heel. A spur on the heel bone is a very common finding on films, while on the top of the foot a spur can rub against a shoe until the skin thickens and becomes inflamed.

How they are found and what they can be confused with

Osteophytes show on an ordinary X-ray, and as a rule they turn up incidentally on a film taken for something else. A CT scan shows them in more detail and is used before surgery. An MRI scan defines bone less well but answers the key question when there are nerve symptoms: whether a root or the cord is compressed, and at what level. Where there is numbness or weakness, that is the scan to arrange. Nerve conduction studies are sometimes added to work out where the problem arises.

The commonest mistake is to blame the pain on the spur seen on the film and stop there. These look similar but are treated differently:

• heel pain, which almost always comes from inflammation of the plantar fascia rather than from the spur: spurs are found in a great many people with no pain at all, and removing one does not take the pain away;
• a disc prolapse, the other common source of nerve root pain, which changes the whole treatment plan;
• nodules on the fingers in gout and rheumatoid arthritis: gouty deposits and rheumatoid nodules look and feel much like bony ones but need entirely different treatment;
• inflamed tendons and bursae, a frequent cause of pain in the shoulder and over the outer hip;
• entrapment syndromes, where the nerve is squeezed at the wrist or elbow rather than in the spine.

When urgent help is needed

Most symptoms can be discussed calmly at a routine appointment, but there are exceptions. Seek help immediately, including calling an ambulance (112 is the single emergency number across much of Europe), if there is:

• numbness around the genitals, back passage and inner thighs, retention of urine, or loss of control of bladder or bowels together with weakness in the legs — this is compression of the cauda equina nerve roots and it is counted in hours;
• rapidly progressing weakness in the arms or legs, unsteady walking, an electric shock sensation down the spine on bending the head, or hands that have suddenly become clumsy — this is how compression of the cord in the neck presents;
• severe back pain with a high temperature, or in someone with a known cancer or marked weight loss — here the search is for infection or a tumour, not an osteophyte.

Less urgently, but without leaving it indefinitely, see a doctor about persistent joint pain and stiffness, about numbness or weakness in a limb, and if a joint becomes swollen, red and hot.

What helps when a spur is causing trouble

There is nothing that dissolves or reabsorbs an osteophyte; no such treatment exists. But relieving the pain and restoring movement is usually achievable, because what is treated is the underlying joint disease, and the troublesome area is unloaded.

• Exercise. Strong muscles around the joint take on part of the load, and stretching gives back the last few millimetres of movement. For neck and lower back pain a programme strengthening the back and abdominal muscles works better than rest.
• Weight loss where there is excess: it unloads the knees, hips and lower back.
• Footwear and insoles. A cushioned sole, a roomy upper where a spur rubs, and a heel pad for heel pain.
• Reworking habitual movements: avoiding positions in which the joint reaches its end point, alternating effort with rest, and at a desk changing posture and standing up every hour.
• Heat for stiffness and cold after activity.
• A steroid injection into the joint or the bursa can settle a bad flare-up for a few weeks and make it possible to start exercising. It should not be repeated often.

Pain relief and its caveats

Medicines have a supporting role here: they ease pain during exercise and through a flare-up, but they do nothing to the spur itself.

It is sensible to begin with gels and creams containing anti-inflammatory painkillers, which work well over superficial joints, the hands and the knees, and of which little reaches the bloodstream. Paracetamol does not suit everyone and helps less than people expect; it is used in short courses without exceeding the dose on the packet.

Anti-inflammatory painkillers in tablet form, ibuprofen among them, are stronger but call for care. They are taken at the lowest effective dose for a short time, usually together with a medicine that protects the stomach lining. They are unsuitable if there is a stomach ulcer, can trigger an attack in some people with asthma, raise blood pressure and burden the kidneys, and after a heart attack or stroke, or with angina and heart failure, they are prescribed with great caution. Tell the doctor specifically if you take blood-thinning medicines or low-dose aspirin: the combination clearly increases the risk of a stomach bleed. Where the pain comes from a compressed nerve, ordinary painkillers often fail and the doctor will choose other medicines.

When surgery is discussed

Few people need an operation. It is considered when pain has resisted conservative treatment for months and limits ordinary life, and also when the spur is compressing a nerve or the spinal cord and numbness and weakness have appeared — in that case there is nothing to wait for.

What is done: where a root is compressed, the canal or the opening through which the nerve leaves is widened by taking away the bone in its path. In advanced osteoarthritis of the knee or hip there is no sense in removing a single spur — the whole joint is replaced. Removing an osteophyte on its own is justified in only a few places: under the arch of the shoulder blade for shoulder pain, along the front rim of the ankle in athletes, and on the top of the foot where a spur rubs on the shoe.

It is worth understanding that the operation relieves the compression but does not cancel the underlying joint disease, and over the years the overgrowth may return. Exercise and unloading remain necessary afterwards too.

Online consultation

People usually arrive with the X-ray already done and the word osteophytes in the report. Remote care fits particularly well here, because the point is to work out whether that finding explains your symptoms or whether the cause lies elsewhere.

What to prepare: a description of the pain — where it is, when it comes, what makes it worse and what relieves it; whether there is numbness, tingling or weakness and exactly where; how far you can walk without stopping; the reports of previous scans; a list of your medicines and other conditions.

The doctor will go through the finding with you, say whether an MRI is needed and when, help you choose exercises and ways of unloading the joint, match pain relief to your contraindications, and explain which signs mean it is time to see a spinal or orthopaedic surgeon. If symptoms of cord or cauda equina compression come up, you will be sent for emergency care straight away.

This material is for information only and does not replace medical advice.