Enthesopathy

  • November 9, 2019

Enthesopathy is a disorder which causes pain along with restriction of movement at the attachment of a ligament, tendon, fascia or components of a joint to a bone.

The site of attachment is called as enthesis which ensure that there is reduction in mechanical stress on border of tissue with various elasticity and strength.

Causes:

  • Overuse due to repetitive movements for example playing cricket or tennis.
  • Trauma due to fall on the affected area.
  • Autoimmune Disease like rheumatoid arthritis or inflammatory conditions.
  • Genetics some certain genes make individuals more susceptible to certain injuries.

Facts or Symptoms:

  • Pain is the main symptom in affected area of the body or joint.
  • Repetative movements.
  • Stiffness occurs at joints which causes restriction of range of motion.
  • Swelling in affected feet and legs.
  • Warmth near affected joints.
  • Difficulty in moving the joint.
  • Treatment focuses on solving the underlying issues and lifestyle to reduce symptoms.

Common Sites for Enthesis to Develop:

It can develop at any joint or area where ligament and tendon attaches to the bone and causes pain near several joints such as heel, knee, hip, fingers, toes, elbows, backbone.

Some examples of these enthesis are listed below:

  • Adhesive Capsulities of Shoulder.
  • Rotator Cuff Syndrome of Sholder.
  • Periarthritis of Shoulder.
  • Deltoid Enthesopathy.
  • Scapulohumeral Fibrosites.
  • Hand and Wrist Synovities.
  • Wrist Periarthritis.
  • Gluteal Periarthritis.
  • Iliac Crest Spur.
  • Psoas Tendinitis.
  • Trochantric Tendinitis.

Diagnosis:

It can be diagnose based on symptoms and on examination alone, if symptoms are unclear or other condition might be the cause then we can go for Ultrasound, X-ray and MRI to look for swelling and damage at the site of enthesis.

Differential Diagnosis:

  • Strains and sprains.
  • Bruises.
  • Bone injuries and fractures.
  • Overuse injuries affecting tendon.
  • Medical conditions like gout and rheumotid arthritis.

Medication:

People with Enthesopathy may get better with various arthritis medication and other treatments to manage the discomfort such as:

  • NSAIDS (Non steroidal anti inflammatory drugs).
  • Corticosteriods.

Physical Therapy:

  • It can reduce pain and stiffness of joint and nearby areas. Most physical therapist focuses on loosening and strengthening tense muscles and improving the flexibility near the site of enthesis.
  • Performing these exercises on both the sides will not only reduces symptoms on effected side but also prevent the muscle imbalance, posture problems and worsening of pain.
  • Physical therapy helps people with enthesopathy work around their injuries without making pain worse.
  • Cold or hot packs to reduce inflammation.
  • Cold laser therapy (low level laser therapy) to reduce inflammation and pain.
  • Strengthening exercises to improve the affected areas of joints.
  • Isometric exercises to strengthen the weeken muscles.
  • Stretches to reduce the stiffness and tightness of the affected muscles.

Note: If any movement is painful the person or individual is asked to avoid the movement as much as possible.

Lifestyle Modifications:

  • People with Enthesopathy may avoid daily physical activities that increases stress on the affected joints such as running and playing tennis which can irate Enthesopathy and some weight bearing activities.
  • Some individuals may be benifited from non-bearing activities such as biking, swimming and rowing.

Prognosis:

  • Untreated Enthesopathy may get worse and effect persons posture and gait due to the pain which can lead to muscle stiffness and can cause injury to nearby muscles and can cause more pain.
  • People with chronic illness may continue to experience flare ups either at same joint or different parts of the body.
  • Enthesopathy can ease with time and proper treatment, long term prognosis depends on cause of Enthesopathy.
  • Someone who has developed Enthesopathy because of overuse or any other external cause will often recovery permanently if taken prompt treatment.

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