Enthesopathy – Definition, Causes, Symptoms and Treatment

Are you having a nagging pain and inflammation in your wrist or knee? Are you finding it increasingly difficult to move the region? If that is the case, you may be suffering from a condition called Enthesopathy. Read on to know what is Enthesopathy as well as its causes, symptoms, diagnosis and treatment.

Enthesopathy Definition

Enthesopathy is a disorder affecting the site where capsules, muscles and ligaments attach to the joints and bones.

Enthesopathy Pronunciation : “en′thĕ-sop′ă-thē”.

What Causes Enthesopathy?

Doctors and medical researchers have suspected a number of diseases as Enthesopathy causes. These include

Tennis Elbow

It is a painful swelling of the tendon located at the outer elbow edge. The condition is caused by the overuse of muscles in the lower arm, as happens while twisting the hand.

Crohn’s Disease

It is a chronic, advancing swelling of the ileum that leads to frequent instances of diarrhea along with other symptoms like nausea, fever, weight loss and abdominal pain.

Postman’s Heel

The disease is marked by the appearance of a bony projection on the lower surface of the heel bone.

Reiter’s Syndrome

This inflammatory disease mainly affects males and is characterized by Urethritis, Conjunctivitis and Arthritis.

Plantar Fasciitis

This medical syndrome is marked by swelling of the plantar fascia or the tissue located at the heel bone. It is marked by discomfort or a stabbing pain in the heel.

Iliotibial Band Syndrome (ITBS)

Known in short as ITBS or ITBFS, this disorder is characterized by a trauma to the thigh, usually related with actions like cycling, running, weight-lifting or hiking.

Golfer’s Elbow

This is an injury that is caused by overuse of the flexor muscle tendons that curl the wrist and shut the fingers to form a fist.

Ankylosing Spondylitis

It is a chronic kind of Spondylitis that mainly affects males and characterized by damage to the spinal mobility. This even leads to Ankylosis or bone joint rigidity in some cases.

Enthesopathy Symptoms

Some of the main symptoms of this disorder include

Calcification

In Enthesopathy calcification or hardening of tissues with lime salts is commonly seen at the site of attachment to the bone.

Inflammation

The condition is associated with the swelling of the joints at the point of attachment of ligaments or muscles to the bones.

Pain

There is usually a stabbing pain at the point where ligament or tendon joins the bone.

Immobility

The affected region usually sore and stiff and its performance get impaired. Its functionality becomes weaker and patients experience tenderness, pain and a burning sensation in the region.

Enthesopathy Diagnosis

Enthesopathy is usually diagnosed by physical observation of the symptoms and medical tests.

Physical Observation

Physical exam involves touching the area to check for tenderness at the affected site. Doctors look for tenderness or redness in the region. It is also checked if there is decreased mobility in the affected joint. Physical observation also explores any underlying condition that may have caused Enthesopathy.

Medical Tests

Diagnostic tests for Enthesopathy involve routine examinations like Erythrocyte Sedimentation Rate (ESR), Urinalysis and Uric Acid tests as well as tests like Rheumatoid factor, antinuclear antibody titers (ANA) and Fluorescent antinuclear antibodies (FANA). Complete Blood Count (CBC) is also carried out to rule out the presence of infections. A higher count of white blood cells (WBC) is regarded as a sign of presence of Enthesopathy.

In Enthesopathy X-rays are also carried out to detect variations in the bone and Enthesis. Ultrasound and MRI scans help detect inflammation or thickening in the deeper soft tissues. Joint Fluid Aspiration is also carried out to detect infectious diseases or conditions like Gout.

Enthesopathy Treatment

Initial treatment for Enthesopathy usually involves rest. Patients are advised to take rest and keep their affected area as much non-functional as possible to let the impaired tissue recover. Patients require mild physical therapy during rest period and after recovery to regain flexibility and strength in the impaired region. Physiotherapy also helps patients avoid trauma in future and helps them move their joints and bones more safely.

In Enthesopathy people suffering from repetitive stress injuries, braces can provide support to the impaired joint.

Medications

Medications are also necessary for Enthesopathy patients. Medicines normally involve anti-inflammatory drugs and analgesics. Steroidal injections are sometimes required to manage excessive swelling and patients. Treatment aims at reducing the extent of swelling at Enthesopathy site to prevent further injury to the soft tissue.

Enthesopathy Prognosis

Recovery from this disease generally depends on how successfully the disease is managed. However, like many inflammatory conditions, Enthesopathy can recur after sometime. In some people, the condition can turn chronic and needs long-term management that involves medications, rest, mild exercises and other ways to avoid pain recurrence.

The time needed by the patient to return to work depends on the damage to the affected site, severity of symptoms and response to treatment. If the patient is involved in physically demanding jobs, temporary accommodations like decreasing the workload and changing tasks is required to let the body heal properly.

Enthesopathy Complications

People suffering from Enthesopathy may suffer from severe chronic inflammatory disorders that can lead to deformities. Such deformities may cause invalidity of the affected body region. Rarely, patients with associated Enthesopathy and Ankylosing Spondylitis may suffer from Secondary Amyloidosis.

Enthesopathy Risk Factors

There are several risk factors associated with this disorder. People with rheumatic conditions and also non-rheumatic swellings are found to be more vulnerable to this disorder. Other diseases that may lead to the development of Enthesopathy include

• Spondyloarthropathies
• Septic arthritis
• Spinal arthritis
• Ankylosing spondylitis
• Reactive arthritis
• Psoriatic arthritis
• Enteropathic arthritis

Rarely, people suffering from medical syndromes like celiac disease, Whipple disease, Arthritis (associated with acne), tendon tears and avulsion fractures are also seen to be affected by the condition.

Enthesopathy of Hip

Enthesopathy commonly affects various joints in hand and foot of the body. This includes the hip joint. Trauma or weakening of the knee bone is often regarded as the cause of Enthesopathy of hip joint.

What Is Spinal Enthesopathy?

It is a type of Enthesopathy that targets the spinal column. Generally, it affects the muscular or peripheral connective tissue attachment of the spine. It belongs to a group of conditions called Spondyloarthropathies which also involves inflammatory bowel disorders, reactive arthritis, psoriatic arthritis, undifferentiated Spondyloarthropathy and Ankylosing Spondylitis. In Spinal Enthesopathy groin pain is the main symptom.

Enthesopathy Adductor

Also known as Adductor Enthesopathy or Adductor Tendinopathy, this is a chronic tendon trauma that includes wearing down of the adductor tendon at the site where it is attached to the pubic bone. This degenerative disease is caused by excessive stress or repeated use of the adductor tendons and muscles, mainly during actions like kicking, running, side-stepping or twisting. This can lead to pain and immobility of the affected joint. The condition is more popularly known as groin pull, groin strain or simply groin injury.

Enthesopathy Differential Diagnosis

The object of Differential is to make sure that the symptoms of Enthesopathy is not the result of some other condition like

Tendinitis

Also known as Tendonitis, it is characterized by the swelling of a tendon.

Bursitis

This condition is marked by the inflammation of a bursa, or tiny fluid-filled sac located between body joints, especially at the shoulder.

Synovitis

The disease is characterized by pain and swelling in a swollen synovial membrane lining a synovial joint.

Strains

It refers to an injury to a muscle, mostly due to overuse. A strain causes pain and swelling in the injured muscle.

Sprains

It is a painful trauma to a joint resulting from a sudden racking of its ligaments.

Enthesopathy in Children

In kids and adolescents, Enthesopathy often arises in the limbs and is supposed to be associated with Spondyloarthropathies. It occurs less frequently due to other inflammatory and non-inflammatory conditions. It is essential to diagnose Enthesopathy early in children to prevent them from developing Spondyloarthropathies later in their life. Drugs and physical therapies are generally used to treat Enthesopathy in children.

Enthesopathy In Ankylosing Spondylitis

Enthesopathy of Ankylosing Spondylitis is characterized by inflammation at the site where the ligament is attached to the bone. Ankylosing Spondylitis is a chronic inflammatory disease that affects axial joints like costovertebral joints or sacroiliac joints. Enthesopathy is often found to be associated with Ankylosing Spondylitis.

Enthesopathy Tendinopathy Difference

Enthesopathy is often confused with Tendinopathy due to the similar nature of symptoms that they produce. However, both are entirely different conditions and are caused due to separate factors. Enthesopathy develops due to a degenerative process which makes the site of attachment weak due to compression. Tendinopathy, on the other hand, arises due to sudden trauma, ageing and slow degeneration.

What Is Calcaneal Enthesopathy?

Calcaneal Enthesopathy arises when there is repeated injury at the site of joining of the Achilles tendon which leads to a spur up into the tendon from the Calcaneum. The condition is generally diagnosed with the aid of an X-Ray examination. The main symptoms of Calcaneal Enthesopathy are pain and tenderness if other conditions like Tendonitis or Bursitis are associated.

Enthesopathy is mostly curable if diagnosed early and treated properly. If you or anyone in your family is having symptoms similar to this condition, you should get a medical checkup done. If Enthesopathy is revealed, it is better that you start treatment early. Early treatment will help you recover from the disease faster and enjoy life in the pink of your health.

References:

http://en.wikipedia.org/wiki/Enthesopathy

http://www.wisegeek.com/what-is-enthesopathy.htm

http://www.mdguidelines.com/enthesopathy

http://www.wrongdiagnosis.com/e/enthesopathy/intro.htm

http://www.ncbi.nlm.nih.gov/pubmed/14685509