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Osteophytes in osteoarthritis: Bone spurs – Symptoms and causes

Differentiation of osteophyte types in osteoarthritis – proposal of a histological classification

. 2016 Jan;83(1):63-7.

doi: 10.1016/j.jbspin.2015.04.008.

Epub 2015 Jun 12.

Susann Junker 
, Grit Krumbholz 
, Klaus W Frommer 
, Stefan Rehart 
, Jürgen Steinmeyer 
, Markus Rickert 
, Georg Schett 
, Ulf Müller-Ladner 
, Elena Neumann 



  • 1 Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik Benekestraße 2-8, 61231 Bad Nauheim, Germany.
  • 2 Department of Orthopaedics and Orthopaedic Surgery, Markus Hospital, 60431 Frankfurt am Main, Germany.
  • 3 Department of Orthopedics, Justus-Liebig-University of Giessen, 35390 Giessen, Germany.
  • 4 Department of Orthopedics and Orthopedic Surgery, Justus-Liebig-University of Giessen, 35390 Giessen, Germany.
  • 5 Department of Internal Medicine 3, University of Erlangen-Nuremberg, 91054 Erlangen, Germany.
  • 6 Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik Benekestraße 2-8, 61231 Bad Nauheim, Germany. Electronic address: [email protected].
  • PMID:


  • DOI:


Susann Junker et al.

Joint Bone Spine.

2016 Jan.

. 2016 Jan;83(1):63-7.

doi: 10.1016/j.jbspin.2015.04.008.

Epub 2015 Jun 12.


Susann Junker 
, Grit Krumbholz 
, Klaus W Frommer 
, Stefan Rehart 
, Jürgen Steinmeyer 
, Markus Rickert 
, Georg Schett 
, Ulf Müller-Ladner 
, Elena Neumann 


  • 1 Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik Benekestraße 2-8, 61231 Bad Nauheim, Germany.
  • 2 Department of Orthopaedics and Orthopaedic Surgery, Markus Hospital, 60431 Frankfurt am Main, Germany.
  • 3 Department of Orthopedics, Justus-Liebig-University of Giessen, 35390 Giessen, Germany.
  • 4 Department of Orthopedics and Orthopedic Surgery, Justus-Liebig-University of Giessen, 35390 Giessen, Germany.
  • 5 Department of Internal Medicine 3, University of Erlangen-Nuremberg, 91054 Erlangen, Germany.
  • 6 Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff-Klinik Benekestraße 2-8, 61231 Bad Nauheim, Germany. Electronic address: [email protected].
  • PMID:


  • DOI:




Osteoarthritis is not only characterized by cartilage degradation but also involves subchondral bone remodeling and osteophyte formation. Osteophytes are fibrocartilage-capped bony outgrowths originating from the periosteum. The pathophysiology of osteophyte formation is not completely understood. Yet, different research approaches are under way. Therefore, a histological osteophyte classification to achieve comparable results in osteophyte research was established for application to basic science research questions.


The osteophytes were collected from knee joints of osteoarthritis patients (n=10, 94 osteophytes in total) after joint replacement surgery. Their size and origin in the respective joint were photo-documented. To develop an osteophyte classification, serial tissue sections were evaluated using histological (hematoxylin and eosin, Masson’s trichrome, toluidine blue) and immunohistochemical staining (collagen type II).


Based on the histological and immunohistochemical evaluation, osteophytes were categorized into four different types depending on the degree of ossification and the percentage of mesenchymal connective tissue. Size and localization of osteophytes were independent from the histological stages.


This histological classification system of osteoarthritis osteophytes provides a helpful tool for analyzing and monitoring osteophyte development and for characterizing osteophyte types within a single human joint and may therefore contribute to achieve comparable results when analyzing histological findings in osteophytes.


Basic science; Histological classification; Osteoarthritis; Osteophytes.

Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

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  • 1 Introduction
  • 2 Pathophysiology
  • 3 Presentation
  • 4 Treatment
  • 5 Differential Diagnosis
  • 6 References

Osteophytes are cartilage-capped bony proliferations (bony spurs) that most commonly develop at the margins of a synovial joint as a response to articular cartilage damage, as seen very commonly in osteoarthritis (OA).[1]

Three types of osteophytes related to the degenerative spine: (a) traction osteophytes (arrow), (b) claw osteophytes (arrow) and (c) wraparound bumper osteophytes (arrow)

Osteophytes are formed of fibrocartilage and bone, often forming at the peripheral margins of joints at the interface between cartilage and the periosteum. Osteophytes are thought to develop from chondrogenic differentiation of progenitor cells, commonly from within the periosteum. Osteophytes appear to be a cellular repair response to the altered growth factor environment following joint injury. In some cases osteophytes can contribute to the stability of the joints.[2]

a. Cartilage erosion (arrows) b: Cartilage ulceration (arrow) c: Cartilage repair (arrow) d: Marginal osteophytes (arrows)

Osteophytes are most commonly found in the following areas. Neck, shoulder, knee, lower back, fingers or big toe, foot or heel. Osteophytes cause problems for example if they: cause friction if rubbing against footwear; impinge nerves such as an existing spinal root; restrict movement as may occur in hip and knee OA.[3] See these pages for conditions where osteophytes are an issue, a sample only:

  • Hallux Rigidus
  • Anterior Ankle Impingement Syndrome
  • Uncovertebral Joints
  • Lumbar Spinal Stenosis
  • Vertebral osteophytes are a characteristic of disc degeneration. [4]
  • Cervical Osteoarthritis
  • Lumbar Spondylosis
  • Hip Osteoarthritis

Osteophytes when causing issues, for example with OA, can be managed along side management of OA, See link here Osteoarthritis.

Removal of an osteophyte is not usual, unless it’s irritating a nerve in the spine or restricting a joint’s range of movement. If surgery is warranted, a surgeon will explain the procedure’s risks and benefits.[3]

  1. Syndesmophyte: Thin, vertically oriented ossification of annular ligament (Sharpey fibers) from ankylosing spondylitis[5]
  2. Enthesophyte: located at an attachment of a ligament, fascia or tendon, not associated with a joint.[1]
  3. It is difficult to tell the difference between an osteophyte and disc herniation solely by MRI. CT is a helpful adjunct; however, often central canal and foraminal narrowing are caused by a combination of a disc herniation and osteophyte.
  1. 1.01.1 Radiopedia Osteophyte Available:https://radiopaedia.org/articles/osteophyte-2 (accessed 7.9.2022)
  2. ↑ Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell JR. Kelley’s Textbook of Rheumatology E-Book. Elsevier Health Sciences; 2012 Aug 31. Available:https://www.sciencedirect.com/topics/medicine-and-dentistry/osteophyte (accessed 7.9.2022)
  3. 3.03.1 NHS Osteophyte Available:https://www.nhs.uk/conditions/osteophyte/ (accessed 7.9.2022)
  4. ↑ Czervionke LF, Fenton DS. Imaging Painful Spine Disorders E-Book. Elsevier Health Sciences; 2011 Apr 28.Available:https://www.sciencedirect.com/topics/medicine-and-dentistry/osteophyte (accessed 8.9.2022)
  5. ↑ Blankenbaker DG, Davis KW. ExpertDDx: Musculoskeletal E-Book. Elsevier Health Sciences; 2017 Oct 13.Available: https://www.sciencedirect.com/topics/medicine-and-dentistry/osteophyte(accessed 8.9.2022)

Osteophytes of the spine – treatment, symptoms, causes, diagnosis

Many patients, having received information about the presence of osteophytes, begin to associate the presence of back pain with osteophytes in the spine . However, bony growths (osteophytes) by themselves are only a sign of degeneration in the spine, and the presence of osteophytes does not necessarily mean that they are the actual cause of back pain.

In principle, osteophytes are a radiographic marker of degenerative changes in the spine, and their appearance only means involutional changes in the spine. At the age of over 60, osteophytes (bone spurs) in the spine are quite common.


Everyday stress on the spine eventually leads to degeneration of the intervertebral discs and wear of the joints of the spine. With a combination of factors such as age, injury, poor posture, the impact on the bone structures and joints of the spine increases. As the intervertebral disc wears out, there is a greater load on the ligaments and joints, which leads to thickening of the ligaments, the accumulation of lime in the ligaments, and friction in the joints, in turn, leads to excessive growth of bone formations. This promotes the formation of osteophytes.

Tissue degenerative changes begin already at a young age, but this is usually a slow process and does not affect the neural structures until the person is in their 60s or 70s.

Factors that can accelerate the degenerative process and growth of osteophytes in the spine include:

  • Congenital features
  • Food
  • Lifestyle including poor posture or poor ergonomics
  • Injuries, especially sports or traffic accidents.

The most common cause of osteophytes is arthrosis of the facet joints, which often contributes to back pain in patients over 55 years of age. Osteoarthritis of the facet joints can lead to lower back pain and stiffness in the morning, the pain syndrome decreases with physical activity, and intensifies again in the evening.

The most common cause of cervical and lumbar osteoarthritis is a genetic predisposition. Patients may notice the onset of symptoms of osteoarthritis between the ages of 40 and 50. Men are more likely to develop symptoms at an earlier age, but women with osteophytes may have more symptoms.


The most common symptoms are back pain or neck pain due to inflammation in the joints and muscle spasm as a reaction to inflammation. Typical symptoms include:

  • Dull pain in the neck or lower back when standing or walking
  • Neck pain radiating to the shoulder, sometimes headaches
  • Low back pain and radiation to the back of the thigh

Symptoms due to osteophytes are aggravated by physical exertion and relieved by rest. In addition, symptoms may improve after leaning forward and bending at the waist. When nerves are compressed by osteophytes , the following symptoms may appear:

  • Pain in one or both arms or legs
  • Numbness or tingling in one or both arms or legs
  • Progressive weakness in one or both arms or legs

In very rare cases, bowel and bladder dysfunction may occur. But such symptoms can be associated not only with osteophytes, but also with diseases such as diabetes mellitus, circulatory disorders in the extremities, spinal cord tumors, spinal fractures, spinal infections. In addition, many symptoms in osteophytes are similar to those in rheumatological diseases (rheumatoid arthritis, SLE), and are also similar to the symptoms of compression of a herniated disc of the nerve roots. Due to the fact that the symptoms of osteophytes are similar to other medical conditions, a full examination is necessary to determine the exact diagnosis.


Diagnosis begins with a clinical examination. The doctor should first conduct a detailed examination, a neurological examination to evaluate the functioning of the nerve roots and identify signs of compression of the roots or spinal cord. Based on the examination, the history of the disease, the patient’s complaints, the doctor prescribes the necessary examination plan, including the following research methods:

ENMG allows you to determine the conduction disturbance along the nerve fiber and determine both the degree of damage and the level of damage to the nerve fibers. Radiography is often prescribed primarily for the diagnosis of osteophytes and allows visualization of osteophytes in the spine . In addition, radiography can detect other changes in the bone tissues of the vertebrae.

Computed tomography (CT) or MRI can provide more information about changes in the structures of the spine, both bone and soft tissue, and detect the presence of compression of the nerve roots or spinal cord.

Neuroimaging data allow the doctor to choose an adequate treatment strategy, both conservative and, if necessary, surgical, depending on the presence of signs of compression of nerve structures in correlation with clinical data.


There is a wide range of treatment options for symptomatic osteophytes .

Most patients with mild to moderate nerve compression and osteophyte irritation can be managed conservatively.

Medications such as anti-inflammatory drugs or muscle relaxers for several weeks.

Rest for a short period of time, which reduces inflammation in the joints.

exercise therapy. After a decrease in pain symptoms, physical exercises are connected with a gradual increase in the amount of load.

Manual therapy and massage can increase the mobility of motor segments, relieve muscle spasm.

Epidural steroid injections may be useful in inflammation of the facet joints, reducing inflammation, swelling, and thus improving symptoms.

Physiotherapy. Currently, there are physiotherapeutic methods of treatment (for example, HILT – therapy or SWT) that allow you to achieve good treatment results.

In cases where conservative treatment is not effective or there is severe compression of the roots or spinal cord, it is necessary to decide on surgical treatment.

The task of surgical methods of treatment is to decompress the nerve structures. Removal of osteophytes allows you to get rid of symptoms in most cases. But sometimes it happens that neurological symptoms may persist in the postoperative period, and in such cases there is a long period of compression of the nerve structures and irreversible changes in the nerve fibers. Or: But in some cases, neurological symptoms may persist in the postoperative period, and then the most likely is a long period of compression of the nerve structures and irreversible changes in the nerve fibers. ).

Studies have shown that age is not the main factor determining the possibility of surgical treatment of osteophytes . However, conditions often associated with age, such as hypertension, diabetes, and heart disease, can increase the risk of surgery and slow recovery, and therefore should be taken into account when deciding on surgical treatment.

What is osteoarthritis? – Clinic “Family Doctor”.

Osteoarthritis is a disease that affects all components of the joint: capsule, synovial membrane, cartilage, subchondral bone, ligaments, periarticular muscles.

Doctors call osteoarthritis degenerative joint disease or deforming arthrosis. Patients talk about arthrosis and salt deposition. However, there is no salt here. At the heart of the development of pathology is inflammation. Therefore, in recent years, the disease is increasingly referred to as osteoarthritis, emphasizing the inflammatory nature of the disease.

Prevalence of osteoarthritis

This is the most common joint disease in the world. According to statistics, every fifth inhabitant of the Earth suffers from osteoarthritis. The number of cases increases by a quarter every year. At the age of 30-40, every tenth person has radiographic signs of osteoarthritis, at 55-60 years old – in half, at 75 years old – in 80% of people. Sometimes osteoarthritis is found in young people.

Primary and secondary

  • Primary is a disease that develops on an intact joint.

  • Secondary osteoarthritis affects a joint after an injury or one in which there are already changes due to a congenital or acquired disease, metabolic or endocrine characteristics.

Mechanism of development of deforming arthrosis

A joint is a mobile connection of bones, the surfaces of which are lined with shiny and smooth cartilage. Outside, the joint is limited by a capsule, held by ligaments. Inside the joint bag is filled with synovial fluid. The complex design ensures painless and long-term operation of the joint even under heavy load.

Osteoarthritis begins with damage to chondrocytes – cartilage cells. Normally, they synthesize proteoglycans and collagen. In case of injury or illness, this process is disrupted. Defective chondrocytes produce defective collagen and small proteoglycans that cannot stay in the cartilage layer (matrix) go into the synovial fluid.

Altered proteoglycans attract water but do not retain it. Excess moisture absorbs collagen, causing it to swell and break into fibers.

Synovial fluid loses its transparency. Articular cartilage becomes dull, rough. It gradually becomes thinner and cannot play the role of an elastic pad.

The surface of the bone, which was previously protected by cartilage, is experiencing an increased load, compacted. Along the edges of the articular surfaces, bone and cartilage remnants grow compensatory, osteophytes – bone spikes – are formed rather quickly.

The work of the joint is difficult. The situation is complicated by the activation of inflammatory and autoimmune reactions. The capsule thickens, the mobility of the joint is sharply limited. This leads to atrophy of the corresponding muscles.

So small initial changes lead to catastrophic consequences. Without adequate treatment, a person is at risk of disability.

What causes osteoarthritis

  • Age . The disease is typical for people over 50 years of age. Over the years, the synthesis of proteoglycans and the hydrophilicity of tissues decrease. Joint cartilage loses elasticity, gradually loses the ability to self-repair after microdamage. As a result, the cartilage becomes thinner, and the joint becomes sensitive even to the usual loads.

  • Belonging to the female sex. Women get sick twice as often as men. Pathology develops with estrogen deficiency – after gynecological operations or during menopause.

  • Hereditary predisposition . The likelihood of developing the disease is twice as high if the family has relatives suffering from osteoarthritis, 3. 5 times higher if they have Heberden’s and Bouchard’s nodules (thickening of the finger joints due to hard bone outgrowths characteristic of deforming arthrosis).

  • Joint injury or surgery . The integrity of the individual structures of the joint, the nutrition of the cartilage is violated. The process of development of arthrosis is started.

  • Physical overload . Sports and some occupational activities involve heavy lifting, standing for long periods, or stereotyped movements that put stress on the joints. Articular cartilage wears out, which gradually leads to arthrosis.

  • Overweight . Increases the load on the supporting joints: hip and knee. Overweight women suffer from osteoarthritis four times more often than normal women.

  • Previous diseases of the joints, as well as chronic diseases: diabetes, gout and others, disrupt metabolic processes, worsen the nutrition of cartilage. This leads to its rapid wear even with normal stress on the joints.

Which joints are affected by osteoarthritis?

The hip and knee joints are most often affected, as they experience the greatest load. In second place is the first metatarsophalangeal joint. The third place is shared by the distal and proximal interphalangeal joints of the upper extremities (those same “bumps” appear on the fingers).

Usually arthrosis first affects one joint, then – symmetrical to it. Subsequently, the disease covers other joints. In this case, they speak of polyosteoarthritis.

The main manifestations of osteoarthritis

  • Pain . At first, it is so insignificant that a person does not pay attention to it. The intensity of pain increases gradually and only after a few years becomes pronounced, acquiring characteristic features.

Starting pain – at the beginning of the movement increases, then disappears.

Mechanical pain – with a load on the joint, disappears after rest.

The night pain is drawing, dull, exhausting. In the morning, after the start of the movement, it passes.

Referred pain may occur outside the area of ​​the diseased joint.

  • Morning stiffness . Manifested by stiffness of the diseased joint. Disappears after a few movements of the limb. Never lasts more than half an hour.

  • “Jamming” joint” . Sudden blockage of the joint, accompanied by sharp pain. Occurs when a fragment of cartilage tissue is infringed by the articular surfaces. Disappears instantly with a certain movement of the joint.

  • “Crunch” in the joint during movement . Caused by structural changes in cartilage tissue.

  • Limited joint mobility . It is observed in long-term untreated osteoarthritis. Overgrown osteophytes do not allow the joint to move freely.

  • Reddening of the skin over the joint, swelling and increased local temperature are characteristic of reactive synovitis due to inflammation of the synovial membrane.

  • Joint deformity . Occurs with significant bone growths and changes in the periarticular tissues in advanced cases of osteoarthritis.

Stages of the disease

  1. Initial. Slight changes in the synovial membrane. Joint overload is accompanied by pain.

  2. Second. The cartilage starts to break down. osteophytes appear. Pain also occurs during normal exercise.

  3. Third. Severe arthrosis. Pronounced bone deformity. Severe limitation of joint mobility. The pain bothers even at rest.


Diagnosis of osteoarthritis is not difficult for an orthopedist or rheumatologist, who is able to prescribe a full examination of the patient.

Changes in the joint are confirmed by three studies:

1. Radiography;

2. Ultrasound;

3. MRI.

Often one of them is enough.

For therapeutic and diagnostic purposes, arthroscopy is used – endoscopy of the joint using a flexible probe. The doctor can see the joint from the inside, take synovial fluid for analysis, perform a minimally invasive intervention (for example, remove a bone fragment).

In most cases, blood counts are normal, signs of inflammation may be detected: an increase in the level of leukocytes, an acceleration of ESR.

Treatment of osteoarthritis

The disease is treated for a long time, continuously. Therapy cannot restore the joint to its original appearance, but it can slow the progression of the disease, reduce pain, restore joint mobility, and improve the patient’s quality of life.

Methods of treatment

  • Lifestyle correction with limiting excessive stress on the joints.

  • Complete nutrition rich in vitamins.

  • Anti-inflammatory therapy. In the form of injections, tablets, ointments – as prescribed by a doctor.

  • Chondroprotectors for cartilage restoration.

  • Physiotherapy. Simple exercises are connected immediately after the relief of pain. More complex, swimming – in remission.

  • Physiotherapy. More often they use magnetic, laser, infrared radiation, phono- and ultraphoresis.

  • Endoprosthetics. It is carried out in advanced cases, when it is not possible to restore joint mobility by other methods.

Prevention of osteoarthritis

If you suspect the development of osteoarthritis and after complex treatment, you must follow simple rules so that the remission is long and signs of arthrosis do not appear.

  • Complete nutrition without drastic diets.

  • Physical activity. Hiking, physiotherapy exercises, classes in the pool.

  • Weight normalization. Excess weight puts too much stress on the joints. A systematic decrease in body weight reduces the load on the legs.

  • Flat feet correction. Providing a proportional load on the joints and spine to prevent their deformation.

  • Timely treatment of concomitant diseases.

If you are concerned about your joints, contact the Family Doctor clinic. The clinic has been receiving patients for more than a quarter of a century. It has its own laboratory and modern diagnostic equipment. Qualified doctors work here to help get rid of pain, clicking and crunching in the joints. Osteoarthritis responds well to treatment if it is started on time. By taking regular courses of maintenance therapy, you can lead a normal life without experiencing joint pain.