Enthesopathy is a blanket term for any condition affecting the entheses — the attachment sites of bones to tendons or ligaments. Ensopathies develop from a disease or injury and may be temporary or chronic. Doctors can diagnose some cases based on symptoms and a physical exam alone, but additional imaging tests may be necessary to rule out other conditions. Many cases are preventable and treatable; medication and therapy can manage the symptoms and complications of chronic forms.
What are Tendons and Ligaments?
Ligaments and tendons are connective tissues instrumental in musculoskeletal stability and mobility. Ligaments attach bone to bone at joints such as the knees, elbows, shoulders, and ankles. Tendons join bone to muscle, aiding in fluid movement and the structural integrity of the skeleton. Inflammation of tendons or ligaments impacts stability and movement.
Symptoms and Signs of an Enthesopathy
Symptoms of an enthesopathy vary, though several general commonalities exist. Most forms present in a dull, aching pain or tenderness at the site of the inflammation that is made worse with movement or touch. Joint stiffness and swelling are also common, in addition to a reduced range of motion.
Diagnosing an Enthesopathy
A doctor can often diagnose an enthesopathy based on a physical exam and symptom history. During the exam, the doctor will check for a range of motion and areas of tenderness. Diagnostic imaging such as an x-ray, ultrasound, or MRI may be necessary, most often to rule out other possible causes.
Treatment
The most appropriate course of treatment is based on the cause of the inflammation, symptoms, and degree of discomfort. A doctor may prescribe medication to reduce pain and inflammation. Long-term medication therapy may be necessary for chronic forms of enthesopathy. Physical therapy is often beneficial for regaining and maintaining musculoskeletal mobility and strength.
What Causes an Enthesopathy?
Enthesopathy most often occurs as a result of a chronic inflammatory disease of the joints or an injury. Inflammatory diseases, including arthritis and ankylosing spondylitis, are characterized by progressive degeneration leading to permanent joint damage. Injuries may be acute but most often develop following long-term wear on a ligament, tendon, or joint.
Arthritis
Arthritis is a chronic enthesopathy characterized by inflammation that affects the cartilage, tendons, ligaments, and lining of joints. Many experts believe the disease develops as a result of a genetic predisposition triggered by a virus or injury. Symptoms of arthritis include painful, stiff, and swollen joints. There is no cure, but doctors often prescribe medication to ease discomfort and slow the progression.
Ankylosing Spondylitis
Ankylosing spondylitis is a chronic inflammatory disease primarily affecting the spine, hips, and pelvis. The cause of ankylosing spondylitis is not known, though research suggests genetics play a key role in its development. The disease presents pain and stiffness in the areas affected, particularly the back and hips. The main goals of treatment are reducing pain and inflammation and preventing skeletal deformities.
Plantar Fasciitis
Plantar fasciitis is an enthesopathy caused by inflammation of the ligament on the bottom of the foot, the plantar fascia. The telltale symptom of plantar fasciitis is a sharp pain in the heal. This condition often occurs in long-distance runners, people who spend most of the day on their feet, and people with obesity. The condition is typically easy to diagnose and is often treated with rest, ice, stretching, and over-the-counter pain relievers.
Tendinitis
Tendinitis is inflammation of a tendon due to an acute or long-term injury. Common forms of tendinitis include tennis elbow, swimmer’s shoulder, and jumper’s knee. Most people experience swelling tenderness and dull, aching pain in and around the affected areas. In most cases, rest, ice, and non-prescription pain relief medication are sufficient to treat tendinitis.
Preventing Enthesopathies
An enthesopathy occurring as a result of injury or overuse is often preventable. Many complications and uncomfortable symptoms of the conditions underlying chronic forms of enthesopathy can be avoided or alleviated, also. Engaging in regular physical activity and targeted muscle exercises and maintaining good posture and a healthy weight is vital in supporting strong tendons, ligaments, and bones. Treating minor inflammation with rest, elevation, and hot or cold therapy is important to prevent exacerbating the problem. Identifying and adapting activities or movements that aggravate chronic inflammation can also reduce the likelihood of complications.