Treating bone spurs in the shoulder is difficult. Even with surgery.

Ross A. Hauser, MD., Danielle R. Steilen-Matias, MMS, PA-C

Treating bone spurs in the shoulder is difficult

In our clinic, we attack the problem of bone spurs in the shoulder non-surgically. How we do this is by addressing the problems of the shoulder that is causing the formation of the bone spur in the first place. Shoulder instability. This is a shoulder looseness causing unnatural, destructive hypermobility in the shoulder leading to a situation of rapid degenerative osteoarthritis.

How the bone spur got there in the first place

Unfortunately, over time, the bone spurs themselves become the problem as they continue to grow and impede function. It is at this time, surgery is often recommended to shave down the bone spurs or a shoulder replacement surgery is considered.

Like many of the conditions that we see here at our clinic, bone spurs in the shoulder are the end result of years of degenerative shoulder disease and advancing osteoarthritis.

Like many of the conditions that we see here at our clinic, bone spurs in the shoulder are the end result of years of degenerative shoulder disease and advancing osteoarthritis. An MRI with a bone spur will also show, among many things, varying size tears of the different rotator cuff tendons, shoulder labrum tearing, and other abnormalities. The patient themselves will describe, years and years of doctor visits and an array of pain killers of varying strengths and potencies, chiropractic care, acupuncture, cortisone injections, and a daily diet of over-the-counter anti-inflammatories and painkillers. They will also tell us that they do not sleep, they function most of the day with one arm if they describe themselves as “lucky enough that it is in only one shoulder.” Some will also tell us that shoulder replacement is the last option and one that they have been putting off for years because they are primary care or support providers. They tell us about the disappointment in the failure of their physical therapy sessions. They tell us that once physical therapy fails and cortisone does not help, shoulder replacement is then “given the green light.”

Treating the bone spurs or the “osteophytes” on my MRI

I have learned to function without lifting my arms over my head. 

Many people that contact our center are very educated and researched in their shoulder problems. They will have typically spent countless hours researching their shoulder problems. If they are like you, most of your online research came on days of particular discomfort or basically the bad days. They will also come on days following a doctor’s visit and a desire to better understand the doctor’s recommendations. What many do, like many with any injury, is alter the way they do things. How they sleep, how they function at work or in domestic chores to limit the amount of arm movement that will cause them pain or functional limitation.

For many people, this re-education of arm movements does help and over time, reduces pain. In some, the reduction of the movements that caused the bone spurs in the first place may result in the bone spur that stops growing. This is when physical therapy would be its most successful. Learning new movements and getting the strength to function in this new way.

Is arthroscopic surgery for bone spur removal and shoulder clean-up the way to go when physical therapy fails?

For some people, arthroscopic surgery for bone spur removal is highly successful. We usually do not see these people in our clinic. We see the ones that arthroscopic surgery for bone spur removal was not very successful and has made their situation worse. This article is for those people and to explains to people suffering from shoulder pain how this can happen. Here are some typical patient stories:

I had a cleanout surgery

I had a cleanout surgery, the main goal was to shave down the bone spurs. After the surgery, my shoulder pain was worse. I was told that my surgery was successful, the bone spurs were shaved down. My pain continued and now includes numbness all the way into my fingers. My shoulder subluxated constantly. Because of the numbness, I am bouncing back and forth between orthopedists and neurosurgeons. No one seems to have any answers for me.

The bone spurs are gone, but the shoulder pain remains

I lost a lot of range of motion, putting on my clothes, combing my hair, all big problems for me.

I lost a lot of range of motion, putting on my clothes, combing my hair, all big problems for me. My x-ray revealed that I had a lot of shoulder damage. The treatment plan was for cortisone and physical therapy. After a few months, I had no improvement. I was recommended to a shoulder specialist and not surprisingly I was told surgery should be considered because I had massive bone spurs. I agreed. Following the surgery, I had less use of my arm than before and now my shoulder routinely popped out of place. A return visit to the surgeon offered another recommendation for surgery. This time a reverse shoulder replacement.

Let’s point out again that many people obtain a great benefit from arthroscopic surgery for bone spur removal. These are not the people we see. The people we see are the ones with the stories.

I had surgery for bone spur removal. There is now nothing wrong with my shoulder except it is very painful

I had surgery and the bone spurs were removed from my shoulder. Following physical therapy, massage therapy, and a cortisone injection, I have a lot of post-surgical pain. Nothing my doctors are offering me now seems to be helping or will help. Now they are looking at me like I am crazy because my MRI is “beautiful” nothing is wrong. Nothing except my now limited range of painful motion.

For many people, are the only things holding the shoulder together are the bone spurs

What is happening here? Why didn’t the surgery work for these people? Simply the bone spurs, for many people, are the only things holding the shoulder together. When you remove the bone spurs, the shoulder has “nothing to hang on.” Below we will make a treatment recommendation of Prolotherapy injections that regenerate and strengthen the shoulder capsule soft tissue.

Treating bone spurs in the shoulder is difficult, as judged by the many surgical recommendations trying to solve the problem

Here is a brief list of surgical recommendations published by doctors at the University of California at Los Angeles (UCLA) in the journal Clinics in Sports Medicine. (1) In the first sentence of this paper, the doctors note: “The management of glenohumeral osteoarthritis is difficult in young, active individuals.”

Here are the summary learning points:

What you see in these treatments is “cutting away,” “removing,” “scraping, drilling.” You do not see repairing. This is why treating bone spurs in the shoulder is difficult with surgical treatments.

Bone Spurs and Shoulder Instability

A bone spur (more technically known as osteophyte) is an abnormal bony overgrowth that extends out from the normal bone.

The shoulder reacts in many ways to its own instability.

The muscles may then start to degenerate and the body is left with one other option for stabilization: to start to overgrow bone tissue as a permanent way to stabilize the joint. This overgrowth of bone is the “bone spur” (as it typically spurs out from the joint). If left untreated, bone spurs can become very large and very painful. They may cause pain with certain motions (i.e. a shoulder bone spur could cause pain when it pinches on tissue every time you raise your arm over your head) or significantly limit your range of motion due to pain.

Shoulder Bone Spurs Treated with Prolotherapy at Caring Medical

What are we seeing in this image?

In this x-ray, a large bone spur in the shoulder is revealed. This x-ray is of a patient who is only in their thirties. This patient has significant pain and limitations in their range of motion or ability to move their arm around. Of note in this x-ray is that the patient has a lot of cartilage in the shoulder. While Prolotherapy injections may help with pain, the presence of the bone spur may require a recommendation for arthroscopic surgery.

In this x-ray, a large bone spur in the shoulder is revealed. This x-ray is of a patient who is only in their thirties. This patient has significant pain and limitations in their range of motion or ability to move their arm around. Of note in this x-ray is that the patient has a lot of cartilage in the shoulder. While Prolotherapy injections may help with pain, the presence of the bone spur may require a recommendation to arthroscopic surgery.

Can Prolotherapy injections help?

Are these injections realistic in helping a bone spur without surgical intervention?

Recently, we had a young man come to see us at Caring Medical with shoulder pain and limited range of motion. His pain could be explained by various tendon and ligament injuries of the shoulder but the restriction of motion could not, thus an x-ray was ordered. As you can see on the x-ray (above), he has a huge bone spur on the bottom of his humeral head (essentially the “ball” that helps the shoulder rotated around the way it does). This could explain why his range of motion was so limited. The extra bony growth prevented him from fully moving his shoulder. While Prolotherapy can resolve pain in cases like this, some patients still may end up needing surgery to remove the bone spur and get back the full range of motion.

At Caring Medical, we see many patients whose only desire is to get out of pain. Had this been the case with this gentleman, Prolotherapy would be a great solitary treatment option by itself. However, at such a young age, he also desires a full range of motion to stay active for the rest of his adult life. In this case, surgery may be warranted to allow him greater motion while Prolotherapy will ease pain and treat the underlying cause: joint instability.

Prolotherapy is always a great option when it comes to chronic joint pain but if you have a significant restriction of motion in a joint, a plain and inexpensive x-ray may provide valuable information. It illustrates that “yes” sometimes surgery is needed! However, if you don’t treat the underlying cause of the bone spur (the joint instability), it will most likely come back.

If you have a bone spur in your shoulder, as evidenced by an x-ray or MRI, you have a few treatment options.

Platelet Rich Plasma Therapy (PRP) and shoulder instability

Danielle R. Steilen-Matias, MMS, PA-C narrates the video and is the practitioner giving the treatment:

Questions about our treatments?

If you have questions about your pain and how we may be able to help you, please contact us and get help and information from our Caring Medical staff.

This is a picture of Ross Hauser, MD, Danielle Steilen-Matias, PA-C, Brian Hutcheson, DC. They treat people with non-surgical regenerative medicine injections. Offices are located in Oak Park, Illinois and Fort Myers, Florida.

Brian Hutcheson, DC | Ross Hauser, MD | Danielle Steilen-Matias, PA-C

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References: 

1 Takamura KM, Chen JB, Petrigliano FA. Nonarthroplasty Options for the Athlete or Active Individual with Shoulder Osteoarthritis. Clinics in Sports Medicine. 2018 Oct 1;37(4):517-26. [Google Scholar]

This article was updated April 5, 2021

 

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