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There are two types of entheses: fibrous and fibrocartilaginous (the latter more common in rheumatic conditions; a tough, elasticated compressible tissue).
Admittedly, in university I hadn’t heard much about an enthesis, enthesitis or enthesopathy – not even in cadaver anatomy classes.
It just wasn’t something that was talked about, perhaps laying low under the radar compared to its better known neighbour; insertional tendinopathies, who were the focus of our ‘attachment-site’ injury understanding.
The enthesis organ complex is thought to encompass not only the enthesis but also the bursa, fat pad, adjacent trabecular bone and perhaps even deep fascia (Kehl et al., 2016).
Arguably, this could be why enthesitis is a diffuse process of intricacies beyond the scope of this article.
Clinically, enthesitis may be difficult to recognise without the presence of swelling.
The enthesis is a relatively avascular structure and so inflammatory markers, Erythrocye Sedimentation Rate (ESR) or C-Reactive Protein (CRP) for example, may not be elevated in entheseal-related disorders (Mc Gonagle & Benjamin, 2009; Kehl ., 2016)., much like tendinopathy for tendons, is an umbrella term used in the literature to describe any disease process or disorder of an enthesis.Mechanically-related enthesopathy can arise from injury and micro-injury and may have a degenerative element (Mc Gonagle & Benjamin, 2009).For all healthcare professionals, understanding the enthesis organ complex is key in explaining synovitis and osteitis, while pain, stiffness and other clinical signs (erythema, heat and swelling) may still be the determining factors which raise our suspicions of enthesopathy without imaging.#Think Inflammatory Chris References Benjamin, M., Moriggl, B., Brenner, E., Emery, P., Mc Gonagle, D., & Redman, S. J., Schueller-Weidekamm, C., Sudoł-Szopińska, I., Rennie, W., Åström, G., Feydy, A., Giraudo, C., Guerini, H. Recommendations of the ESSR Arthritis Subcommittee on Ultrasonography in Inflammatory Joint Disease.Historically, it was thought that these pathologies were focal insertional abnormalities at the enthesis site, but that viewpoint has changed (Kehl et al., 2016).Coined by Benjamin is now the preferred reference for enthesis-related pathology, incorporating more of the surrounding structures in the disease process.This article is a brief overview of enthesitis, providing useful references for further reading.is the connective tissue between tendons, ligaments or joint capsule insertions to the bone.Additionally, many insertions are either inaccessible to the examiner, not evident on X-ray imaging early in the disease process, and present with poorly localised pain.It is also believed that tender points of enthesitis may be difficult to distinguish from those of Fibromyalgia (Mc Gonagle & Tan, 2015).