Treatment of Elbow Spurs
Conservative treatment should be the first-line approach for elbow spurs, with surgical intervention reserved for cases that fail to respond to non-operative management. 1
Conservative Management Options
First-Line Treatments
- Rest and activity modification: Avoid activities that exacerbate symptoms
- Ice application: 15-20 minutes several times daily to reduce inflammation
- NSAIDs: First-line pharmacological treatment
- Ibuprofen 1.2g daily (can be increased to 2.4g daily if needed)
- Can be combined with acetaminophen (up to 4g daily) for inadequate relief 1
- Physical therapy: Progressive rehabilitation program
- Initial phase (0-4 weeks): Pain control and protected range of motion
- Intermediate phase (4-8 weeks): Progressive strengthening exercises
- Advanced phase (8-12 weeks): Sport-specific or occupation-specific training 1
Second-Line Treatments
- Corticosteroid injections: Limited to 2-3 injections with 4-6 weeks between injections 1
- High-voltage galvanic stimulation: May promote healing process 2
- Counterforce bracing: Reduces overload forces on the affected area 2
Surgical Management
Surgical intervention is indicated when:
- Pain persists despite 3-6 months of well-managed conservative treatment
- Functional limitations significantly impact quality of life
- Progressive joint degeneration is evident on follow-up imaging 1
Surgical Options
- Endoscopic extrabursal excision: Minimally invasive technique that allows for complete spur removal with less morbidity compared to open procedures 3
- Open excision: Traditional approach involving direct visualization and removal of the spur, often performed along with bursectomy if indicated 4
Surgical Outcomes
- In a case series of 11 patients (12 elbows) who underwent olecranon traction spur resection:
- Mean Quick-DASH score: 3 (range 0-23)
- Mean Mayo Elbow Performance Score: 96 (range 80-100)
- High patient satisfaction (mean VAS satisfaction score: 9.6)
- Low pain levels (mean VAS pain score: 0.8)
- Preserved elbow motion (average 3° to 138°) 4
Rehabilitation After Surgery
- Progressive rehabilitation program similar to conservative management
- Focus on:
- Pain control
- Gradual restoration of range of motion
- Progressive strengthening
- Return to sport-specific or occupation-specific activities 1
Follow-up and Return to Activity
- Regular follow-up at 2,6, and 12 weeks to assess healing and function
- Consider MRI for persistent symptoms to evaluate for soft tissue injuries 1
- Return to full activity permitted when:
- Complete resolution of pain during and after activity
- Full range of motion compared to uninjured side
- Strength symmetry >90% compared to uninjured side
- Successful completion of sport-specific functional tests 1
Common Pitfalls and Caveats
- Olecranon spurs are often associated with other conditions like triceps tendonitis, olecranon bursitis, and gout - these should be addressed concurrently 3
- Recurrence of spurs can occur after surgical excision (2 out of 11 patients in one study) 4
- Potential complications of surgical management include wound seroma and olecranon bursitis 4
- Radiographic findings may show olecranon spurs and amorphous calcium deposits that correspond to the insertion of the triceps tendon 5