Enthesopathy is a medical term which refers to a disorder in which a tendon or a ligament attaches to a bone. The attachment site on the bone is known as Entheses. This creates a structured complexity in that area. This complex functioning structure is known as Enthesis organ.

Recent research has shown that Enthesopathy is much more complicated than previously thought.

If the condition of Enthesopathy is followed by an inflammation then it is called as Enthesitis. There are many medical conditions in which Enthesopathy is likely to develop. These are Arthritis, psoriatic arthritis, spinal arthritis, ankylosing spondylitis, and enteropathic arthritis.

What are the types of Enthesopathy?

There are two types of conditions where Enthesopathy is likely to occur – Rheumatic conditions and musculoskeletal conditions.

1. Rheumatic conditions

The rheumatic condition affects mainly joints and connective tissues. The symptoms of Rheumatic Enthesopathy are red and swollen joints, inflamed connective tissues like cartilage, tendons, and synovial tissue. Also, this condition reduces the mobility of the affected area.

Based on the area affected there are many types of Rheumatic conditions. Few types of this condition are

Types of Rheumatic conditions

  • Rheumatoid Arthritis
  • Tendinitis
  • Gout
  • Ankylosis
  • Bursitis
  • Psoriatic Arthritis
  • Hemochromatosis
  • Polymyositis
  • Arthrogryposis

2. Musculoskeletal Conditions

The musculoskeletal condition affects mainly muscles, joints, and bones but the severity of this condition varies with age. The symptoms of Musculoskeletal Enthesopathy are swelling, stiff joints, recurring pain and aching.

Based on the area affected there are many types of Rheumatic conditions. Few types of this condition are –

Types of Musculoskeletal conditions

  • Broken finger/hand/jaw/leg
  • Hip cancer
  • Rib tumor
  • Scoliosis
  • Whiplash
  • Frozen Shoulder
  • Spinal Curvature
  • Synovial cancer
  • Kyphosis
  • Spinal stenosis
  • Hip dislocation

What Causes Enthesopathy?

According to researchers, there can be many reasons for Enthesopathy to occur. The few common cause which leads to the introduction of Enthesopathy are –

1. Tennis elbow

It happens when there is an overuse of muscles in the lower arm while twisting the hand. It causes painful swelling of the tendon in the outer elbow edge.

2. Postman’s heel

It is a disease which causes an appearance of projected bone on the lower surface of the bone of the heel.

3. Reiter’s syndrome

It is an inflammatory disease which mainly affects males. It can be characterised by Urethritis, Conjunctivitis, and Arthritis.

4. Crohn’s disease

It is a chronic and causes an advance swelling in the ileum. The symptoms are diarrhoea, nausea, fever, weight loss, and abdominal pain.

5. Golfer’s elbow

It is an injury mainly causes by overuse of flexor muscles tendons which curl the wrist. It also shut the fingers to form a fist.

6. Plantar Fasciitis

It is a medical condition in which plantar fascia or the tissues located in heel bone are swollen. It can cause a stabbing pain in the heel bones.

7. Iliotibial Band Syndrome

Also known as ITBS or ITBFS is a disorder which is characterised by a trauma in thighs. The causes behind this are actions like cycling, hiking, running or weight-lifting.

8. Ankylosing spondylitis

It is spondylitis but of chronic type. It mainly affects male and is characterised by damage in the mobility of the spine.

Few other causes of Enthesopathy are

  • Psoriatic Arthritis
  • Reactive Arthritis
  • Rheumatoid Arthritis
  • Osteoarthritis
  • Infections
  • Some alter medications
  • Excessive stress at workplace
  • Runner’s knee
  • Rotator cuff syndrome
  • Shin splints
  • High hamstring pull
  • Celiac disease
  • Achilles tendinitis
  • Physical injury or trauma
  • Drug abuse
  • Metabolic changes

What Are The Symptoms Of Enthesopathy?

Common places for Enthesopathy are likely to happen around knee, heel, hip, elbow, backbone, bottom of the foot, toes, and fingertips. You may feel swelling around these areas or pain and stiffness while moving.

These pains are different from arthritis pain. Because the pain felt is in the wider area around the joint rather than inside the joint.

1. Inflammation

Enthesopathy causes swelling of the joints at the point where ligaments are attached.

2. Calcification

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

3. Immobility

The person suffering from Enthesopathy may experience in loss of mobility. This is because the affected area becomes sore and tender and hence resulting in immobility.

4. Pain

Patients feel a stabbing pain in the affected bone area.

5. Soreness

The affected area becomes sore and tender which causes the immobility in the affected bone area.

6. Burning sensation at the affected bone area

The person suffering from Enthesopathy feels a burning sensation at the point where ligaments are attached to the bone.

7. Irritation at affected ligaments

Pain and burning sensation are also accompanied by the irritation in the affected area.

8. Stress

The patients are most likely to develop an irritating nature because of the stress caused by the pain and irritation.

Our ability to move is dependent on the bones, ligament, and tendons. Any problems in the musculoskeletal systems result in problems. Enthesopathy is common and harmful as it disrupts the proper movement and function of the affected bone and the area.

Diagnosis Of Enthesopathy 

Enthesopathy is usually diagnosed by observing the symptoms physically and general medical tests.

Physical Observation

It involves the overall physical examination of the affected area. Doctors touch the affected area and look for the symptoms like red, tenderness, immobility and swelling of that area. These symptoms are observed and then noted down.

Medical Tests

It involves medical routine examinations like Erythrocyte Sedimentation Rate (ESR) test, uric acid test, and urinalysis. Other tests like Rheumatoid factor, Antinuclear Antibody Titers (ANA) and Fluorescent Antinuclear Antibodies (FANA), and Complete Blood Count (CBC).

High White Blood Cells (WBC) count indicates the presence of Enthesopathy.

X-rays are performed to detect variation in bones and Enthesis. To detect inflammation, ultrasound and MRI scans are performed.

Joint Fluid Aspiration is performed to detect infectious diseases or condition of Gout.

Enthesopathy Prognosis

Recovery from Enthesopathy depends upon the successful management of the disease. If the process of treatment of Enthesopathy is carried out very well then it is easy to recover fast from Enthesopathy.

However, Enthesopathy is likely to reoccur because of its inflammation conditions. In some condition, Enthesopathy can turn chronic, which then needs proper care and long-term treatment like medication, rest, and mild exercises.

The time for a patient to return to work can depend on the damage at the affected area, symptoms, and severity of the Enthesopathy and its treatment methods.

If a patient belongs to a work background where he has more physical work then, it is advised to take proper rest and to decrease the workload. Patients should give time for their body to heal.

Enthesopathy Complications

There is a chance that the people suffering from Enthesopathy may suffer from a chronic inflammatory disorder which can lead to deformities.

These deformities may cause invalidity of the affection area.

In a rare case, patients suffering from Enthesopathy and ankylosing spondylitis may develop symptoms of Secondary Amyloidosis.

Enthesopathy Risk Factors

There are many different types of risk factors associated with Enthesopathy. People with rheumatic and non-rheumatic conditions are prone to this disorder. Other diseases which trigger the occurrence of Enthesopathy are –

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

Other diseases like celiac disease, Whipple disease, Tendon tears, and Arthritis associated with acne are also seen to be affected by the condition.

Enthesopathy in Children

Enthesopathy often grows in the limbs in kids and adolescents. It is associated with Spondyloarthropathies. Due to inflammatory and non-inflammatory conditions, it happens less frequent.

It is necessary to diagnose Enthesopathy early in children to prevent the happening of Spondyloarthropathies later in their life.

For treating Enthesopathy in children, medications, and physical therapies are employed.

How To Treat Enthesopathy?

There are many methods to treat Enthesopathy. Let’s see the common methods of treatment of Enthesopathy –

1. Traditional method

Traditional treatment is an old method in which patients are advised to take rest and to avoid any movement of the affected area. But, if the case is severe then patients may need to wear a brace.

2. Chiropractic care method

Chiropractors perform drug-free treatment to the patients. They work to treat the underlying condition to help the patient in avoiding the side effects caused by medications. Chiropractors use actions like exercise, stretching, Active Release Technique (ART), light therapy, myofascial therapy and some nutritional recommendations.

3. Anti-inflammatory medication

It is the first medical help provided to the patients. Depending on the severity of the pain tropical or oral administrations are provided. Medications provided are ibuprofen, naproxen, acetaminophen, etc. These drugs are likely to reduce the swelling and relieve pain.

4. Corticosteroid injections

When the anti-inflammatory drugs fail to show any result then Corticosteroid injections are recommended. It also reduces the swelling and pain in the bones but at a faster rate than the medications mentioned above.

5. Anti-TNF agents

These drugs are given when the patients are suffering from more severe pain and inflammation. Humira, Enbrel, and Remicade are the preferred choices for the anti-TNF agents.

6. Radiotherapy

It is a therapy for those patients who suffer from enthesopathy at the heel.

7. Other Treatments

Apart from the above-mentioned treatments, there are few other treatments. These are Physical treatment, occupational treatment, ultrasound, electrical stimulation, application of ice wrapped in cloth, and heel insertion for those suffering from plantar fasciitis.

Enthesopathy of Hips

Enthesopathy of hips is an Arthritis disorder in which the tendons or ligaments are attached in the hip bones socket. It affects the proper functioning of the hip bones and it is accompanied by severe pain in mobility.

The person suffering from it experiences pain while walking or even moving. Calcification or ossification is seen in enthesopathy of hips. Usually, the symptoms are recognised by performing X-ray of the hips.

A Severe case of Enthesopathy of hips like greater ‘trochanteric bursa pain’ can be treated successfully by ‘Platelet-rich plasma’ if the other treatments were failed.

Spinal Enthesopathy

Spinal enthesopathy is mostly discovered in men over 40 years of age. ‘Ankylosing spondylitis’ is a medical term for spinal enthesopathy. In this condition, the ligaments inserted in the spine are damaged because of the chronic inflammation.

In this bones try to compensate through calcification or ossification. Spinal enthesopathy is treated with non-steroidal and non-rheumatic medication.

Sometimes a non-inflammatory enthesopathy is seen appears at spine known as spine vertebral hyperostosis. In this condition, patients are likely to feel pain and rigidity at neck level and reduced motion of the spine.

Spinal enthesopathy can also be seen in patients suffering from psoriatic arthritis. Symptoms are chronic pain accompanied by stiffness and insomnia at night.

Treatments for spinal enthesopathy are – Corticosteroid injections, non-steroidal, anti-inflammatory medications. But Anti-TNF is preferred as standard treatment for spinal enthesopathy.

Achilles Tendon Enthesopathy

When ligaments insert in Achilles’ tendon then the condition is known as Achilles’ tendon Enthesopathy. Patients who are obese or sedentary are at risk factor because of shortening of the calf muscles. Patients also feel pain while walking and in posterior heels.

There are three treatments recommended for Achilles tendon Enthesopathy – Physical therapy (stretching), heel lifts, and splinting. All these treatments are effective in reducing the pain caused by Achilles’ tendon Enthesopathy.

The treatment of heels lift should be temporary because it can increase the pain. But it is advised to avoid the movement of hips; as it can elevate the pain in lower back.

What is Calcaneal Enthesopathy?

Calcaneal Enthesopathy is a phenomenon which happens when there is a repeated injury at the site of joining of the Achilles tendon. This leads to a spur in the tendon from the Calcaneum.

Symptoms of Calcaneal Enthesopathy are pain and tenderness accompanied by other conditions like Tendonitis and Bursitis. Diagnosis of Calcaneal Enthesopathy is done by performing X-ray test.

With proper treatment, Calcaneal Enthesopathy can be cured if diagnosed early. It is better to go through a medical checkup when symptoms appear. Also, if you are diagnosed with Calcaneal Enthesopathy, then start the treatment immediately because early treatment helps in fast recovery.

Natural Remedies For Enthesopathy

When it comes to natural treatment for enthesopathy, there are few types of research. But, there are some natural remedies to help in curing psoriatic arthritis along with the medical treatment.

There are few supplements or vitamins known to reduce the symptoms of psoriatic arthritis.

1. Fish oil

Intake of fish oils helps in reducing the swelling caused by enthesopathy.

2. Acupuncture

Acupuncture relieves pain and also helps in the movement of muscles.

3. Turmeric

Turmeric contains protein which has property to reduce inflammation. It also eases the symptoms of psoriatic arthritis.

4. Willow bark

It is also known as ‘Herbal aspirin’. It relieves the pain caused in enthesopathy.

5. Vitamin D

Intake of Vitamin D can reduce the joint pain hence treating enthesopathy.

6. Vitamin K

Vitamin K found in green leafy vegetables (kale, broccoli, and spinach) is effective in joint health. These vegetables make the joint stronger.

7. Vitamin B 12

People who suffer from enthesopathy have a deficiency of Vitamin B 12. Intake of Vitamin B 12 can reduce the symptoms of joint pain.

8. Traditional Chinese medicines

Herbs used in Chinese medicines are famous in benefitting people with arthritis. They have anti-inflammatory effects in enthesopathy.

What To Do When Diagnosed With Enthesopathy?

There are few things which you can do at home to reduce the symptoms of enthesopathy. But, it is advised to consult a doctor first after you experience the symptoms of enthesopathy.

Few things to do to reduce the effect of enthesopathy

1. Icing the affected area

Take few ice cubes and wrap them in a cloth and place it on the affected area. It will help to reduce the pain and swelling.

2. Practice acupuncture

Consult a physician and learn some acupuncture techniques and practice them at home.

3. Exercise

Perform basic exercises such as stretching and splitting.

4. Medication

Take prescribed medications for relieving swelling and pain in the affected area.

5. Massage

You can also massage the affected area gently with pain relieving ointments or oils.

6. When suffering from enthesopathy in heels take a bucket full of cold water and add salt to it. Soak your heels in them for 20 minutes; it will reduce the inflammation and swelling.

7. Do not operate heavy machinery when suffering from any kind of enthesopathy. As it will lead to an increased pain in the affected areas.

When the symptoms are severe then consult a doctor immediately.

Wrapping Up

Enthesopathy is a common medical condition. It is mostly observed in old age people because of the weak joints. Enthesopathy in general case is normal and is curable by natural treatments. But if the condition is severe, then it can lead to more complications. So, it is always good to consult a doctor about the joint pains experienced.

Stay healthy!

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