Normally, where it is located, an enthesopathy causes: pain, swelling, soreness, warmth and a sense of stiffness.
The treatment of enthesopathy varies according to the nature of the suffering present: when there is a lesion / laceration, surgery is often essential; when instead there is an inflammation, the triggering factor must be treated and the symptoms managed by an anti-inflammatory treatment ad hoc.
Brief reminder of what the Tendons and Ligaments are
A tendon is a flexible band of fibrous connective tissue with a high collagen content that connects a skeletal muscle to a bone.
A ligament is something very similar to a tendon, with the difference that it joins two bones or two distinct parts of the same bone.
What is an enthesite? A few more details
Enthesitis is the term doctors use to define inflammation of one or more entheses.
Enthesitis represents the most common type of enthesopathy, so much so that, often, the words "enthesitis" and "enthesopathy" are used as synonyms (in spite of a different literal meaning).
Main offices of the Entesopathies
Any enthesis in the human body can develop an "enthesopathy.
However, there are entheses more affected than others; among the most affected entheses are those located at the level of:
- Shoulder;
- Elbow;
- Wrist;
- Carpus;
- Pubis;
- Hip;
- Knee;
- Ankle;
- Tarsus;
- Heel.
As the reader can see from this list, entheses of the most important synovial joints in the human body are particularly prone to enthesopathy.
Etymological origin and literal meaning of Entesopathy
The word enthesopathy derives from the "union of the terms" enthesus ", which refers to the innumerable entheses of the human body, and" patia ", which means" disease ".
Therefore, the literal meaning of "enthesopathy" is "disease of an" enthesis "or" disease of entheses ".
More known enthesopathies
The most common and best known enthesopathies are:
- Pubic enthesitis. Better known as pubalgia, it is the inflammatory enthesopathy, which involves the entheses present at the level of the pubic bone (or pubis).
- Yarrow tendonitis. It is the inflammatory enthesopathy which has as its object the enthesis of the Achilles tendon. Fundamental for walking, running and jumping, the "Achilles tendon is the tendon that connects the calf muscles (the twins and the soleus) to the" calcaneal bone.
- Plantar fasciitis. It is the most common cause of pain in the heel (heel bone) and corresponds to the suffering of the enthesis of the so-called plantar fascia. The plantar fascia is the thick ligament, located on the lower edge of the foot (sole), which runs from the heel to the bones. of the toes and which allows the foot to be curved during walking, running, etc.
- The tear of the rotator cuff tendons. The rotator cuff is the complex of 4 muscles and their respective tendons, which gives stability to the shoulder and allows the movement of the arm in different directions of space.
- Calcific tendonitis of the shoulder. It is the enthesopathy in the shoulder resulting from the accumulation of calcium deposits on the entheses of the rotator cuff.
- The acromial conflict syndrome. It is the "enthesopathy at the shoulder level, the result of the crushing of the tendon of the supraspinatus muscle, the origin of which is the anomalous compression of the head of the humerus against the acromion of the scapula (NB: the tendon of the supraspinatus muscle is located in the middle).
- Trochanteric enthesitis. Better known as trochanteritis, it is a pain in the hip, involving the synovial bursa located above the greater trochanter of the femur and the underlying tendons.
- Gluteal tendinopathy. Also known as trochanteric tendonitis, it is the enthesopathy which involves the enthesis of the gluteus medius muscle and which produces symptoms in the hip.
In practical terms, this means, for example, that the presence of an "enthesopathy affecting the Achilles tendon" is an obstacle to the movements of the affected lower limb.
Complications in inflammatory enthesopathies
When an "inflammatory enthesopathy does not receive the right treatments, at the level of the suffering enthesis it is possible to witness:
- The formation of calcifications. These calcifications compromise the elasticity of the connective-fibrous tissue of the affected enthesis (s);
- The deformation of the bone on which the enthesis or entheses find insertion. This deformation takes place, because the inflammatory process, with its molecules, is able to modify the normal anatomy of the bones.
The aforementioned phenomena - calcifications and bone deformations - combine to make an "inflammatory enthesopathy a condition with chronic connotations.
When it becomes a chronic condition, an "inflammatory enthesopathy gives signals of itself whenever the patient sets the suffering anatomical region in motion, which interferes with the performance of daily activities and, in the long run, also becomes a reason for frustration and low mood.
When inflammation leads to injury / laceration
In the absence of adequate treatment, some inflammatory enthesopathies can culminate in the lesion / laceration of the suffering enthesis.
This is the case, for example, with yarrow tendonitis or rotator cuff tendonitis.
Complications in enthesopathies with lesion of the enthesis
Enthesopathies characterized by a lesion / laceration of the enthesis are highly debilitating conditions from the motor point of view, since, upon their occurrence, the fundamental continuity between a given tendon or a given ligament and a certain bone surface is lost.
Unfortunately, if torn apart, the entheses of the human body rarely heal spontaneously.
and diagnostic imaging.
Report of symptoms, physical examination and anamnesis
The report of the symptoms and the physical examination serve to know the symptoms in detail, while the anamnesis clarifies the factor or factors at the origin of the present suffering.
Diagnostic for images
Tendon or ligamentous alterations produced by enthesopathies are observable by ultrasound and, even more, by magnetic resonance imaging.
In a context of enthesopathy, the use of diagnostic imaging is used to confirm what emerged during the previous investigations (report of symptoms, physical examination and anamnesis) and, in the event of complications, to show the extent of any calcifications and bone deformations .
To be effective, applications should last between 15 and 20 minutes;
In the presence of an "inflammatory enthesopathy, the use of these drugs occurs only when the NSAIDs have proved ineffective.
