Contact Enthesitis Symptoms and Treatments Enthesitis is irritability of soft tissues muscles, tendons or ligaments where it enter into the bones. It is caused by joint disease and is the main sign of spondyloarthritis. It is also linked to diffuse idiopathic skeletal hyperostosis DISHan ailment in which a few of the spinal structures shore up. It is a typical clinical aspect of spondyloarthropathy and is located generally in the knee or heel.
This has traditionally been viewed as a focal abnormality, even though the inflammatory reaction intrinsic to enthesitis may be quite extensive.
This highlights the fact that stress concentration at an insertion site involves not only the enthesis itself, but neighbouring tissues as well.
The archetypal enthesis organ is that of the Achilles tendon where intermittent contact between tendon and bone immediately proximal to the enthesis leads to the formation of fibrocartilages on the deep surface of the tendon and on the opposing calcaneal tuberosity, but similar functional modifications are widespread throughout the skeleton.
Many entheses have bursae and fat near the insertion site and both of these serve to promote frictionless movement. Collectively, the fibrocartilages, bursa, fat pad and the enthesis itself constitute the enthesis organ. However, it also includes both the immediately adjacent trabecular bone networks and in some cases deep fascia.
The SEC concept emphasizes the interdependence between synovial membrane and entheses within enthesis organs. It draws attention to the fact that one component the enthesis is prone to microdamage and the other the synovium to inflammation.
If an enthesis is damaged, any ensuing inflammatory reaction is likely to occur in the synovium. Stress concentration at the enthesis itself is dissipated at many sites by fibrous connections between one tendon or ligament and another, close to the insertion site.
At a microscopic level, enthesis fibrocartilage is of paramount importance in ensuring that fibre bending of the tendon or ligament is not focused at the hard tissue interface. Normal enthesis organs are avascular in their fibrocartilaginous regions, but tissue microdamage to entheses is common and appears to be associated with tissue repair responses and vessel ingrowth.
This makes the enthesis organ a site where adjuvant molecules derived from bacteria may be preferentially deposited. This microdamage and propensity for bacterial molecule deposition in the context of genetic factors such as HLA-B27 appears to lead to the characteristic inflammatory changes of AS.
Understanding the enthesis organ concept helps to explain synovitis and osteitis in spondy-loarthropathy.
In this chapter, we review the extent and types of enthesis organs and show how a patho-anatomic appreciation of these structures leads to a new platform for understanding the pathogenesis of SpA.Enthesis ultrasound: validation of enthesis fibrocartilage Priority PaPer evaluation how, at the fibrocartilage level, it is the origin of the enthesophytes, erosions or bone irregu-.
With the exception of bone irregularities (54%) and enthesophytes (55%), the interobserver prevalence of the 9 elementary lesions was low, with reliability ranging from poor (thickened enthesis kappa, ; 95% CI, ) to good (enthesophytes kappa, ; 95% CI, ).
The patients meeting the inclusion criteria underwent clinical evaluation and the data involving demographic characteristics, laboratory tests and physical examinations, clinical and functional activities, radiograms, and enthesis examinations were recorded.
A commonly syndrome encountered in primary care, sports medicine and orthopedic practice is the degeneration, with or without tears, of tendon enthesis at the origin of the common flexor tendons of the forearm termed the medial epicondylitis.
METHODS: A transversal blind and controlled two-dimensional (2D) and three-dimensional (3D) ultrasound (US) study of Achilles enthesis bursa in early SpA was undertaken.
Clinical outcome measures were collected. They define an ‘enthesis organ’ as a collection of related tissues at and near the enthesis, which serve a common function of stress dissipation. The enthesis organ concept is widely applicable, but is most clearly understood by considering the attachment of the Achilles tendon to the calcaneus (Fig.