Olecranon Enthesophyte
Elbow Bone Spur
Jacksonville, FL
A bone spur at the tip of the elbow — often seen on X-ray and frequently blamed for posterior elbow pain. Dr. R. David Graham at JOI takes olecranon enthesophytes seriously when they are symptomatic. Conservative management first; surgical excision with triceps repair when pain is refractory and the spur is truly the cause.
- Enthesophyte = bone spur at triceps tendon insertion on olecranon
- Often painful — not always incidental
- Conservative: activity modification, PT, injection
- Surgical: open excision — takes down part of triceps, excises spur, reattaches triceps
- Distinct from olecranon tip osteophyte from extension impingement
- Often coexists with olecranon bursitis — both addressed at same surgery if needed
Olecranon enthesophytes are not always incidental. When they cause posterior elbow pain with triceps loading — pushing, pressing, terminal extension — they are the problem and can be definitively treated with surgical excision.
Understanding the Condition
Triceps Traction Spur —
Often Painful, Treatable
An olecranon enthesophyte is a bone spur that forms at the attachment of the triceps tendon to the olecranon. It is a traction spur — formed by chronic mechanical stress at the tendon-bone interface, where the triceps repeatedly pulls on the olecranon during elbow extension activities. Enthesophytes at this location are found commonly on elbow X-rays and are sometimes dismissed as incidental. In Dr. Graham's experience, they are often painful and worth treating when they are the identifiable source of posterior elbow pain.
The clinical presentation is pain at the tip of the elbow with triceps loading — particularly with pushing (pushups, bench press), resisted elbow extension, or terminal elbow extension. The spur is palpable at the olecranon tip and tender to direct pressure. It is distinct from olecranon bursitis, which produces a soft, fluctuant swelling over the same area, though the two frequently coexist.
Conservative management addresses the underlying triceps tendinosis component — activity modification, PT, and targeted injection. When this fails, surgical excision is performed: a posterior approach, takedown of the relevant portion of the triceps from the olecranon, excision of the enthesophyte, and reattachment of the triceps using suture anchors. Recovery requires protecting the triceps repair during healing.
- ✓ Activity modification — reduce triceps eccentric loading
- ✓ PT — triceps flexibility and eccentric strengthening protocol
- ✓ Injection — peritendinous, not directly into triceps tendon
- ✓ When surgery: refractory pain despite 3–6 months conservative management
- ✓ Open excision with triceps takedown and suture anchor reattachment
- ✓ Coexisting bursitis: bursectomy at same setting
Surgical Treatment
Enthesophyte Excision with Triceps Repair
Posterior Approach
Longitudinal posterior incision over the olecranon. The bursa is addressed if present. The triceps tendon insertion is exposed at the olecranon tip.
Triceps Takedown
The relevant portion of the triceps tendon is elevated from the olecranon to expose the enthesophyte beneath. Careful dissection preserves as much tendon tissue as possible for reattachment.
Enthesophyte Excision
The bone spur is excised with an osteotome or rongeur, resecting back to normal olecranon cortical bone. Fluoroscopy confirms complete excision. The remaining bony surface is prepared for tendon reattachment.
Triceps Reattachment
Suture anchors placed in the olecranon and used to reattach the triceps tendon to its anatomic footprint. The repair is tested through passive flexion — the triceps should hold securely. Repair integrity confirmed before closure.
FAQs
Frequently Asked Questions
Related Conditions
Next Steps
Posterior elbow pain and a spur
on your X-ray — let's confirm it.
Not every bone spur is the cause of pain, but when the clinical picture matches, olecranon enthesophytes respond well to treatment. Dr. Graham evaluates posterior elbow pain specifically and tailors management to what is actually causing the problem.
Jacksonville Beach, FL 32250
No imaging required.