Surgical Management of Symptomatic Olecranon Traction Spurs

Abstract

Background:There is a paucity of information pertaining to the pathoanatomy and treatment of symptomatic olecranon traction spurs.Purpose:To describe the pathoanatomy of olecranon traction spur formation, a technique for spur resection, and a series of patients who failed conservative care and underwent operative treatment.Study Design:Case series; Level of evidence, 4.Methods:Eleven patients (12 elbows) with a mean age of 42 years (range, 27-62 years) underwent excision of a painful olecranon traction spur after failing conservative care. Charts and imaging studies were reviewed. All patients returned for evaluation and new elbow radiographs at an average of 34 months (range, 10-78 months). Outcome measures included the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire; the Mayo Elbow Performance Score (MEPS); visual analog scales (VAS) for pain and patient satisfaction; elbow motion; elbow strength; and elbow stability.Results:The traction spur was found in the superficial fibers of the distal triceps tendon in all cases. The mean QuickDASH score was 3 (range, 0-23), the mean MEPS score was 96 (range, 80-100), the mean VAS pain score was 0.8 (range, 0-3), and the mean VAS satisfaction score was 9.6 (range, 7-10). Average elbow motion measured 3° to 138° (preoperative average, 5°-139°). All patients exhibited normal elbow flexion and extension strength, and all elbows were deemed stable. Early postoperative complications involved a wound seroma in 1 case and olecranon bursitis in 1 case: both problems resolved without additional surgery. Two patients eventually developed a recurrent traction spur, 1 of whom underwent successful repeat spur excision 48 months after the index operation.Conclusion:Short- to mid-term patient and examiner-determined outcomes after olecranon traction spur resection were acceptable in our experience. Early postoperative complications and recurrent enthesophyte formation were uncommon.Clinical Relevance:This study provides the treating physician with an improved understanding of the pathoanatomy of olecranon traction spur formation, a technique for spur resection, and information to review with patients regarding the outcome of surgical management.

The olecranon spur

“…24 Olecranon spurs form within the superficial portion of the central triceps tendon insertion and protrude posteriorly, sometimes with a slight upward curve. 2,14 The spurs can become quite large, and 1 study found that they occupy 30% to 50% of the triceps insertion in patients with triceps tendonitis. 14 This contrasts with olecranon osteophytes, which are located on the posterolateral or posteromedial articular border on the tip of the olecranon (Fig.…”

“…14,15,21 They are also seen in patients with a history of elbow trauma, manual laborers, or people involved in recreational activities requiring repeated forceful elbow extension. 2,3,8,12 In addition, spurs are an age-related phenomenon and can represent an incidental finding. 5 There are no data specifically on the histology of olecranon spurs; however, spur formation at other anatomic sites has been studied.…”

“…5 These findings also lend credence to the theory that enthesophytes are traction spurs forming in response to repetitive mechanical loading and microtrauma 2,5 and also support clinical observations that spurs are seen in patients involved in occupations or activities requiring repeated forceful elbow extension or those with triceps tendonitis, olecranon bursitis, or a history of trauma. 2,3,8,12,14,21 Olecranon spurs and osteophytes appear to develop over a similar time scale of months to years, not days to weeks. 11 However, the accepted mechanism for osteophyte formation differs significantly from the outlined hypothesis of spur formation.…”

“…2 Posterior elbow pain can usually be elicited with resisted elbow extension, particularly from a beginning point of end arc flexion toward terminal extension over a range of about 130 to 100 . When the spur is fractured at presentation, pain can be experienced in all arcs of motion and especially with resisted elbow extension, presumably due to the pull of the triceps acting on a nonunion interface of the bony spur.…”

“…15 The current literature continues to be sparse, containing only a few case reports and just 1 report of surgical treatment with limited follow-up data. 2,3,15,21 Otherwise, spurs are only mentioned when other topics, such as triceps tendonitis or olecranon bursitis, are discussed. 6,14 A significant amount of literature has been published on the diagnosis and management of olecranon osteophytes, 4,[9][10][11]13,16,17,20,22,25 and some of these manuscripts use the terms ''spur'' and ''osteophyte'' interchangeably.…”