Generality
An enthesopathy is a suffering or a disease that afflicts an enthesis, that is the stretch of a tendon or a ligament that hooks onto a bone.
The group of enthesopathies includes both conditions in which there is an injury / tear of one or more entheses, and conditions in which there is an inflammation of one or more entheses.
The episodes of enthesopathy can be the result of traumatic injuries or functional overload, or they can be the consequence of systemic diseases, such as rheumatoid arthritis.
As a rule, where it is based, an internal dysfunction is due to: pain, swelling, soreness, heat and a sense of stiffness.
The treatment of enthesopathy varies according to the nature of the suffering present: when there is an injury / laceration, surgery is often essential; when, on the other hand, there is inflammation, it is necessary to treat the triggering factor and manage the symptoms using an ad hoc anti-inflammatory treatment.
Brief reminder of what tendons and ligaments are
A tendon is a band of fibrous connective tissue, with a certain flexibility and a high content of collagen, which combines a skeletal muscle with a bone.
A ligament is something very similar to a tendon, with the difference that it unites two bones or two distinct parts of the same bone.
What is an Enteopathy?
Entesopathy is the medical term that indicates any disease or suffering at an enthesis, that is the physiological insertion of a tendon or a ligament on a bone.
The enthesopathies can consist in real lesions / lacerations, or in conditions of inflammatory nature; in the second case - that is if they correspond to the inflammation of an enthesis - they are examples of enthesitis .
Depending on the triggering cause, an injury can affect only one tendon or ligament, or it can afflict tendons or ligaments in various parts of the human body.
What is an esite? Some more details
Enthesite is the term that doctors use to define the inflammation of one or more entheses.
Esentite is the most common type of enthesopathy, so much so that often the words "enthesite" and "enthesopathy" are used as synonyms (in spite of a different literal meaning).
Main sites of enthesopathies
Any enthesis of the human body can develop an esopathy.
However, there are enthes more affected than others; among the most affected entities are those located at:
- Shoulder;
- Elbow;
- Wrist;
- Carpo;
- pube;
- Hip;
- Knee;
- Ankle;
- Tarsus;
- Heel.
As the reader can see from this list, the enthesis of the most important synovial joints of the human body are particularly prone to enthesopathy.
Etymological origin and literal meaning of Entesopathy
The word enthesopatia derives from the union of the terms "enteso", which refers to the innumerable enthesis of the human body, and "patia", which means "disease".
Therefore, the literal meaning of "enthesopathy" is "entesis disease" or "enthesis disease".
Causes
Among the causes of a hipopathy include traumatic injuries or functional overload and systemic diseases that alter the normal anatomy of tendons and / or ligaments.
When they depend on a traumatic injury or overload, enthesopathies generally concern a single enthesis; when they depend on a systemic disease, on the other hand, they tend to affect different entheses in several parts of the human body.
Traumatic injuries or functional overload and enthesopathies
In a traumatic injury enthesopathy, suffering is the result of an acute event that undermines the integrity of an enthesis.
An acute event with such effects may be, for example, a fall in which a part of the body of the individual involved (eg: shoulder) receives a sharp and intense blow, to the point of alternating its normal anatomy.
In an enthesopathy due to an injury from functional overload, on the other hand, the tendon or ligament problem is the consequence of a harmless stimulation, if isolated or in contained doses, but extremely harmful, when it is repeated a large number of times in a fairly short period of time.
A circumstance of this kind is observable during all those activities that involve the repetition, for a long time, of a certain movement (eg: lifting above the head, due to work, weights or the throwing of a baseball).
In enthesopathies due to traumatic injuries, lesion / laceration of the affected enthesis is more likely .
In enthesopathies due to functional overload injuries, on the other hand, inflammation of the tendon or ligament insertion subject to suffering is more frequent .
INJURY ENTESOPATHY RISK FACTORS
The enthesopathies related to traumatic injuries or functional overload present as main risk factors:
- The sport practiced at high levels or in the wrong mode (ex: excess of training) e
- The work that requires the repeated execution of unnatural movements with certain parts of the human body.
Systemic diseases associated with enthesopathies
Among the systemic diseases that can play the role of cause of a dysentopathy, are:
- Gout;
- Rheumatoid arthritis;
- Psoriatic arthritis;
- Reactive arthritis;
- Ankylosing spondylitis;
- Diffuse idiopathic skeletal hyperostosis.
Most known enthesopathies
The most common and best known enthesopathies are:
- Pubic enthesite . Better known as pubalgia, it is an inflammatory internal dysopathy, which involves the entheses present in the pubic bone (or pubis).
- Yarrow tendinitis . It is the inflammatory internal disease 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 heel bone.
- Plantar fasciitis . It is the most common cause of heel pain (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 (plant), which runs from the calcaneus to the bones of the fingers and which allows the curvature of the foot during walking, running, etc.
- Tearing 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 tendinitis of the shoulder . It is shoulder dysplasia resulting from the accumulation of calcium deposits on enthesis of the rotator cuff.
- Acromial conflict syndrome . It is the shoulder injury resulting from the crushing of the supraspinatus tendon, a crushing at the origin of the abnormal compression of the humeral head against the acromion of the scapula (NB: the supraspinatus tendon is located in the half).
- Trochanteric enthesitis . Better known as trochanteritis, it is a pain in the hip area, which involves the synovial bursa located above the large trochanter of the femur and the underlying tendons.
- Gluteal tendinopathy . Also known as trochanteric tendinitis, it is the osteopathy that has as its object the entesis of the average gluteus muscle and that produces a symptomatology at the hip level.
Symptoms and Complications
Based at where the enthesis is injured or only inflamed, the typical symptoms of any enthesopathy are:
- Ache;
- Swelling;
- Sense of rigidity of the muscle connected to the suffering entesis;
- Soreness;
- Heat.
Recalling that enthesopathies mainly localize at the level of the great synovial joints (knee, ankle, elbow, shoulder, etc.), the aforementioned symptomatology - in particular pain - produces a motor dysfunction of the muscle and of the joint element connected to the suffering enthesis.
In practical terms, this means, for example, that the presence of an arthropathy affecting the Achilles tendon is an obstacle to the movements of the affected lower limb.
Complications in inflammatory enthesopathies
When an inflammatory internal disease does not receive the right treatments, at the level of the ailing entity or patients it is possible to attend:
- The formation of calcifications . These calcifications compromise the elasticity of the connective-fibrous tissue of the affected entesis;
- The deformation of the bone on which the enthesis or entheses are inserted. 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 internal disease a condition with chronic connotations .
When it becomes a chronic condition, an inflammatory internal disease gives signals of itself whenever the patient sets in motion the suffering anatomical region, which interferes with the performance of daily activities and, in the long run, also becomes a cause for frustration and low mood.
When inflammation leads to injury / laceration
In the absence of adequate care, some inflammatory enthesopathies can culminate with the lesion / laceration of the suffering enthesis.
This is the case, for example, of yarrow tendinitis or tendonitis in the rotator cuff.
Complications in Enthesopathies with lesion of enthesis
The enthesopathies characterized by a lesion / laceration of the enthesis are highly debilitating conditions from the motor point of view, since, when they occur, the fundamental continuity between a given tendon or a given ligament and a certain bone surface is lost.
Unfortunately, if the subject of tearing, the entheses of the human body rarely heal spontaneously.
Diagnosis
As a rule, information coming from the patient's symptoms, physical examination, medical history and diagnostic imaging are essential in diagnosing a hipopathy.
Tale of symptoms, physical examination and medical history
The story of the symptoms and the physical examination serve to know the symptomatology in detail, while the anamnesis clarifies the factor or the factors at the origin of the present suffering.
Diagnostic imaging
Tendon or ligament alterations produced by enthesopathies can be observed by ultrasound and, even more, by magnetic resonance .
In a context of enthesopathy, the use of diagnostic imaging serves to confirm what emerged during the previous investigations (symptom report, physical examination and anamnesis) and, in the case of complications, to show the extent of any calcifications and bone deformations .
Therapy
The treatment of a hysteropathy varies depending on whether the suffering of the ongoing entesis is of an injurious / lacerative nature or of an inflammatory nature.
Treatment of Enthesopathies with laceration of Enthesis
As a rule, the therapy of a dysentopathy characterized by the lesion / laceration of a tendon or a ligament involves:
- A surgical operation, designed to eliminate the lesion / laceration (thus restoring the original tendon / ligament continuity);
- A specific post-operative rehabilitation program, aimed at giving elasticity to the "new" tendon or ligament and strengthening the neighboring muscles in the area of intervention.
Treatment of enthesopathies with inflammation of Enthesis
Generally, the therapy of an inflammatory internal disease includes:
- A treatment aimed at canceling / eliminating / counteracting the triggering cause . Acting on the causal factor is fundamental for achieving healing;
- Rest . It is fundamental above all in the acute phase, that is, at the beginning of suffering;
- Taking non-steroidal anti-inflammatory drugs (so-called NSAIDs ). These drugs are used to relieve pain and inflammation in general;
- Application of ice on the painful area. Ice is an excellent remedy for pain, swelling and inflammation as a whole.
In order for them to be effective, applications should last between 15 and 20 minutes;
- Intake of corticosteroid drugs by injection. Corticosteroids are powerful anti-inflammatories, which if used inappropriately can have unpleasant side effects.
In the presence of an inflammatory hysteropathy, the use of these medicines occurs only when the NSAIDs have proved to be less effective.
Prognosis
If the treatment is timely and appropriate, most episodes of enthesopathy have a positive prognosis.
The exceptions are the cases of enthesopathy sustained by those chronic diseases, for which there is no totally resolving therapy (eg: rheumatoid arthritis).
Is it possible to recover from a chronic inflammatory Enthopathy?
It is possible to recover from a chronic inflammatory internal disease; however, healing times are much longer, compared to when the inflammatory enthesopathy itself is treated at the beginning (and is not yet chronic).
