This article has been cited by other articles in PMC. Abstract Entheses are sites where tendons, ligaments, joint capsules or fascia attach to bone. As entheses are associated with adjacent, functionally related structures, the concepts of an enthesis organ and functional entheses have been proposed. Conventional radiographs and CT are able to depict the chronic changes associated with enthesitis but are of very limited use in early disease.
Abstract Entheses insertion sites, osteotendinous junctions, osteoligamentous junctions are sites of stress concentration at the region where tendons and ligaments attach to bone.
Consequently, they are commonly subject to overuse injuries enthesopathies that are well documented in a number of sports. In this review, we focus on the structure—function correlations of entheses on both the hard and the soft tissue sides of the junction.
Particular attention is paid to mechanical factors that influence form and function and thus to exploring the relationship between entheses and exercise.
The molecular parameters indicative of adaptation to mechanical stress are evaluated, and the basis on which entheses are classified is explained. A distinction is made between different locations of fat at entheses, and possible functions include space-filling and proprioception.
The ability of entheses for self-repair is emphasized and a range of enthesopathies common in sport are reviewed e. Attention is drawn to the degenerative, rather than inflammatory, nature of most enthesopathies in sport.
The biomechanical factors contributing to the development of enthesopathies are reviewed and the importance of considering the muscle—tendon—bone unit as a whole is recognized.
Bony spur formation is assessed in relation to other changes at entheses which parallel those in osteoarthritic synovial joints. They distribute the loads applied to them dynamically in order to execute movement patterns. Their complex response to loading allows for multi-axis bending, and this adds to the stress concentration in the region where they attach to bone.
It is stress concentration at the hard—soft tissue interface which makes entheses vulnerable to acute or overuse injuries in sport. Entheses are also of clinical significance to orthopaedic surgeons who may be faced with the challenge of reattaching a tendon or ligament to bone, particularly when creating an autograft for a ruptured anterior cruciate ligament ACL.
In the present review, we focus on the structure—function correlations of entheses and pay particular attention to mechanical factors that influence form and function and thus to the relationship between entheses and exercise.
However, far less attention has been paid to tendons and ligaments than to bone and much of the current interest has its roots in the pioneering work of PloetzKummer, and Pauwels We have termed them fibrous and fibrocartilaginous according to the type of tissue present at the attachment site Fig.
They equate to the indirect and direct attachments, respectively, of Woo et al. These authors based their classification system on the location of entheses associated with long bones, i. The former are fibrocartilaginous and the latter are fibrous.May 24, · We have noted that patients with active SpA may have florid hip osteitis/enthesitis possibly as part of the enthesis organ (fig 6 6).
Hip involvement in SpA may progress more rapidly than the rate of progression of synovial‐based disease such as rheumatoid arthritis. NICE guidance - adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor.
In Enthesopathy X-rays are also carried out to detect variations in the bone and Enthesis. Ultrasound and MRI scans help detect inflammation or thickening in the deeper soft tissues. The two trials of tofacitinib for psoriatic arthritis — the Oral Psoriatic Arthritis Trial (OPAL) Broaden 1 and OPAL Beyond 2 (Oct.
19 issue) — used the ACR20 response (defined as at least 20%. Classification of Psoriatic Arthritis. Just like psoriasis, psoriatic arthritis ranges from mild to severe.
The number of joints affected will have a large impact on the particular treatment plan a rheumatologist will recommend, and the prognosis for an individual.
Common spots for enthesitis to happen are around your heel, knee, hip, toes, fingertips, elbow, backbone, and the bottom of your foot. You'll feel pain and stiffness, especially when you're moving.