Enthesopathy is an inflammatory disorder affecting the site where muscles and ligaments attach to the joints and bones.
The exact cause of the disease is not known but it is associated with rheumatic conditions such as seronegative spondylitis, Crohn’s disease, and ankylosing spondylitis. However, these enthesopathies flare up due to repetitive stresses on these areas where tendon or ligaments or fascia attach to bone. Also, these inflammatory conditions can be treated effectively.
Tennis Elbow in Enthesopathy:
Tennis elbow is one of the most common enthesopathy where the muscles to the hand and fingers are attached to the outer aspect of the elbow. Those who suffer from this condition have pain on playing tennis or shuttle, badminton, gripping objects while washing clothes or cleaning dishes.
Treatment includes x-rays to rule out any other cause of pain, and blood tests to find out for rheumatic conditions. Anti-inflammatories, physiotherapy, and exercises normally are sufficient. Sometimes in intractable pain, steroid injections locally can be given for relief.
Plantar Fasciitis:
Enthesopathy of the heel, a painful condition experienced when rising from bed or prolonged sitting, results from the inflammation of tissue detached from the heel bone. While rest often alleviates the pain, treatment may involve anti-inflammatory drugs, physiotherapy, and specialized footwear. In rare cases where conservative measures fail, surgery may be considered.
Ta Insertional Tendinitis:
Tendo Achilles is the largest tendon in the body and it connects the calf muscle to heel bone. Inflammation at this site leads to pain and swelling. Calcium deposits tend to occur stimulating new bone formation. This is commonly due to stand for longer time or overweight, again special footwear, rest, anti-inflammatory drugs, and physiotherapy should give relief
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Rotator Cuff Tendinopathy:
Inflammation at site rotator group of muscles inserted on the shoulder joint is called rotator cuff tendinopathy. This is a repetitive stress injury where the tendon gets inflamed due to overhead activities. Athletes, workers who do overhead work many develop this condition. Strengthening muscles, healing tendons, and rest will relieve the symptoms. In older individuals, arthroscopic surgery may be indicated.
Despite all these measures, sometimes the pain persists or recurs as the tendon and enthesis fail to heal. Various treatments are used to promote the healing of tendons. To treat plantar fasciitis and calcific rotator cuff tendinopathy, Extracorporeal shockwave therapy (ESWT) has been used. These shockwaves decrease the conduction of signals along fibers that are responsible for the sensation of pain, hence resulting in pain relief. Furthermore, the shockwaves stimulate the release of chemicals that causes the growth of blood vessels important for the healing process.
Another more recent technique called platelet-rich plasma is used to harvest the platelets in the person’s blood and inject them into the area which is to be treated. Platelets take part in the natural process of healing by forming a clot to seal off an area of injury and also release chemicals that help of healing. The procedure thus augments the body’s natural healing process.
In severe cases where the pain is persistent despite the above treatment, surgery may be necessary to relieve the painful conditions.