Enthesopathy refers to a problem with the attachment of tendons, ligaments or components of a joint onto the bone.
People with enthesopathy typically experience pain and may have stiffness or difficulty moving the affected joint or area of the body.
When an inflammatory condition, such as rheumatoid arthritis, causes the pain of enthesopathy, it is called enthesitis.
The symptoms of enthesitis and enthesopathy are the same and can feel like generalized joint pain, or pain at a specific location near the joint. The pain gets worse with movement. For example, a person with enthesopathy in the Achilles tendon will experience worsening pain when running or walking.
When enthesopathy is related to another condition, such as rheumatoid arthritis, treating the underlying cause can help. Lifestyle remedies and physical therapy may also treat the condition.
Fast facts on enthesopathy:
The main symptom is pain in the affected joint or area of the body.
Common causes include repetitive movement.
Stiffening can occur at joints, further limiting the range of motion and movement.
Treatment focuses on solving the underlying issue, and lifestyle changes to reduce symptoms.
How is enthesopathy caused?
Causes of enthesopathy include:
Overuse, particularly from repetitive movements, such as running or playing tennis.
Trauma, such as a fall or a blow to an affected area, or micro injury to an area.
Autoimmune diseases, such as rheumatoid arthritis or other inflammatory conditions.
Genetics, when certain genes make individuals more susceptible to certain injuries.
Enthesopathy can develop at any joint or area where tendons or ligaments attach and may cause pain near several different joints. The heel, knees, hips, fingers, toes, elbows, and backbone are common sites for enthesopathy to develop.
Tendons and ligaments are both bundles of connective tissue. Tendons attach muscles to bones while ligaments attach bones to other bones.
The enthesisTrusted Source is the bundle of tissue that attaches tendons and ligaments and the joint capsule to the bones. Enthesopathy is any disorder in the enthesis, or entheses if there is more than one.
What are the symptoms of enthesopathy?
Pain is one of the ways doctors diagnose enthesopathy. People with enthesopathy tend to experience pain when a doctor presses on the tendon or ligament where it inserts into the bone.
Other symptoms of enthesopathy can include:
difficulty moving the joint
swelling, especially when affecting the feet or legs
warmth near the affected joint
Enthesopathy is often a symptom of another disorder, such as inflammatory arthritis of the spine or an autoimmune condition. So people with enthesopathy may experience symptoms of these other conditions, which may, in turn, help diagnose the underlying cause of the joint pain.
For example, gout is a type of arthritis that causes uric acid crystals to deposit within and around some joints. This can cause enthesopathy. People with gout may have pain involving a variety of joints, particularly those in the feet and toes.
Diagnosing and treating enthesopathy
A doctor can diagnose enthesopathy based on symptoms and an examination alone. When symptoms are unclear, or when another condition might be the cause, imaging scans, such as an ultrasound, X-ray or magnetic resonance imaging (MRI) scan, can be helpful. These images look for swelling and damage at the enthesis and can rule out other diagnoses.
Treatments include:
Medications
People with enthesopathy may get better with various arthritis medications, and other treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), biologics if their symptoms are related to an autoimmune condition, corticosteroids, or other medications to manage the discomfort.
Physical therapy
Physical therapy can reduce pain and stiffness of the joints and nearby areas. Most physical therapy focuses on strengthening and loosening tense muscles, along with improving flexibility near the enthesis. For instance, people with Achilles tendon enthesopathy may benefit from calf muscle stretches performed 2-3 times each day.
Performing these exercises on both sides, and not just the side affected by enthesopathy can prevent muscle imbalances, problems with posture, and worsening pain.
Physical therapy can help people with enthesopathy work around their injuries without making the pain worse.
Orthotics
Orthotic devices, such as heel cup shoe inserts, can reduce the pain of some types of enthesopathy. They may also prevent further injury. A splint can help support the joint and stretch surrounding muscles, particularly at night.
Lifestyle changes
People with enthesopathy may need to avoid exercises that increase stress on the joints. Running can irritate enthesopathy, as can some weight-bearing exercises. Individuals who develop enthesopathy may benefit from non-weight bearing exercises, such as biking, swimming, and rowing. Other treatments that can help include:
cold or hot packs, or alternating the two, to reduce inflammation
massaging the affected joint, or of surrounding muscles
cold laser therapy (low-level laser therapy), a light therapy that may reduce inflammation and pain
alternative therapies, such as acupuncture
corticosteroid injections for inflammatory enthesitis
If a movement is painful, then a person would be recommended to avoid it, as much as they can.
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