What is the treatment for a bone spur in the elbow?

Treatment for a Bone Spur in the Elbow

The most effective treatment approach for a bone spur in the elbow begins with conservative management, including relative rest, activity modification, NSAIDs, and physical therapy, with surgical intervention reserved for cases that fail to respond after 6-12 months of appropriate non-operative care. 1

Initial Diagnostic Approach

• Plain radiographs of the elbow are the most appropriate initial imaging study to identify bone spurs and rule out other causes of elbow pain 2, 3
• MRI elbow without IV contrast or CT elbow without IV contrast may be considered if radiographs are normal or nonspecific but clinical suspicion remains high 2

Conservative Management (First-Line)

• Relative rest to prevent ongoing irritation while avoiding complete immobilization that could lead to stiffness 1
• Activity modification to reduce activities that aggravate symptoms 1
• Cryotherapy (ice application) for 10-minute periods through a wet towel for short-term pain relief 1, 3
• NSAIDs (oral or topical) to effectively relieve pain and inflammation 1, 3
• Counterforce bracing/orthotics to help reinforce and protect the affected area during activity 1

Physical Therapy Interventions

• Eccentric strengthening exercises to promote healing and increase strength 1, 3
• Stretching exercises for the muscles around the elbow to maintain flexibility 1
• Progressive loading exercises to stimulate collagen production and guide normal alignment of tissues 1
• Deep transverse friction massage to reduce pain 1, 3

Second-Line Treatments

• Corticosteroid injections may provide more effective short-term relief than NSAIDs for acute pain but should be used with caution as they may inhibit healing and reduce tendon strength 1, 3
• Therapeutic ultrasound may decrease pain and increase collagen synthesis 1
• Extracorporeal shock wave therapy (ESWT) appears safe and potentially effective for recalcitrant cases 1

Surgical Management

• Surgical intervention should be considered if pain and functional limitations persist despite 6-12 months of well-managed conservative treatment 1
• Surgery typically involves excision of the bone spur and abnormal tissue, with possible release of scarring and fibrosis 1
• Postoperative rehabilitation is crucial for optimal outcomes, with early mobilization showing better results than prolonged immobilization 4, 5

Treatment Algorithm

1. Initial Phase (0-4 weeks): Rest, activity modification, ice application, NSAIDs, and bracing 1
2. Rehabilitation Phase (2-8 weeks): Progressive strengthening exercises, stretching, and continued bracing as needed 1
3. For Persistent Symptoms: Consider corticosteroid injection or other second-line modalities 1, 3
4. For Refractory Cases (>6-12 months): Surgical consultation and intervention 1

Common Pitfalls and Caveats

• Overreliance on corticosteroid injections may lead to tissue weakening 1
• Complete immobilization should be avoided as it leads to muscle atrophy and joint stiffness 1, 6
• Inadequate physical therapy or premature return to aggravating activities may lead to symptom recurrence 1
• Post-surgical rehabilitation requires patient commitment to maximize motion and function 6