A bone spur, medically termed an osteophyte, is a bony projection that develops along the edges of a bone, typically due to wear and tear or degenerative conditions like osteoarthritis. In the shoulder, these growths most often form under the acromion (the highest point of the shoulder blade) or within the acromioclavicular joint. When a bone spur develops beneath the acromion, it reduces the subacromial space, leading to shoulder impingement syndrome. This narrowing can pinch or irritate the underlying rotator cuff tendons and the fluid-filled bursa during arm movement, causing pain and restricted motion. Treatment aims to alleviate this irritation and restore comfortable function, starting with the least invasive approaches.
Identifying Bone Spurs and First Steps in Care
The presence of a shoulder bone spur is usually indicated by symptoms such as pain when lifting the arm, especially when reaching overhead or behind the back, and general shoulder stiffness. This discomfort often feels like it is coming from the front of the shoulder and may worsen at night or when lying on the affected side. Diagnosis begins with a physical examination to test the range of motion and identify positions that trigger impingement symptoms.
To confirm the diagnosis and determine the location and size of the bone spur, a doctor will typically order an X-ray, the standard imaging test for viewing bony growths. Initial management focuses on reducing inflammation and pain. Resting the shoulder and modifying activities to avoid painful overhead movements is an effective first action.
Applying cold packs to the affected area can help minimize swelling and acute pain, while heat therapy may assist with muscle relaxation. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, also manage symptoms by reducing inflammation and providing pain relief.
Professional Non-Surgical Treatments
When initial self-care measures do not provide adequate relief, the next step involves structured, professional non-surgical interventions. Physical therapy (PT) is a primary treatment focusing on strengthening the rotator cuff muscles and improving shoulder mechanics to create more space within the joint. Specific exercises strengthen stabilizing muscles, such as external rotators, helping the humeral head move correctly beneath the acromion during elevation.
A physical therapist may introduce exercises like pendulum swings to gently increase range of motion or external rotation strengthening using light resistance bands. Improving posture and thoracic spine mobility is also a component of therapy, as poor alignment can contribute to tendon impingement. The goal of PT is to adapt the joint’s function so that the tendons can move past the spur without irritation.
Another common intervention is a corticosteroid injection, which delivers potent anti-inflammatory medication directly into the subacromial space. The injection typically contains a corticosteroid combined with a local anesthetic, providing both immediate pain relief and longer-term inflammation reduction. Reducing inflammation with an injection can provide a window of opportunity for physical therapy to be more effective, allowing the patient to exercise with less pain. Physicians generally limit these injections to about two to three per year in the same location due to the potential for side effects like tendon damage.
When Surgery is Necessary
Surgery is considered the final treatment option for shoulder bone spurs, reserved for patients whose pain and functional limitations persist after conservative treatment. Doctors usually recommend a trial of non-surgical care, including physical therapy and injections, for at least three to six months before considering an operation. Persistent pain that prevents daily activities or disturbs sleep is a key indicator that conservative measures have failed.
The most common surgical procedure is an arthroscopic subacromial decompression, also known as an acromioplasty. This minimally invasive, keyhole procedure involves using a small camera (arthroscope) and specialized instruments inserted through tiny incisions. The surgeon removes the bone spur and shaves the underside of the acromion to create more space for the rotator cuff tendons to glide without being pinched.
This decompression aims to alleviate the impingement and prevent further damage to the rotator cuff. Most patients can return home the same day following the procedure. Post-operative physical therapy is mandatory to restore strength and full range of motion, with a full return to activity often ranging from three to six months.