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.
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.
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:
- joint stiffness
- 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.
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.
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 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.
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.
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.
Enthesopathy may involve any area of the body, but it is most common in the heel, spine, hip, elbow, and knee. However, a wide variety of medical conditions can also cause joint and localized pain.
Since many conditions can cause pain at or near a joint, people with joint or muscle pain should not self-diagnose. It is important to see a doctor so that a proper diagnosis can be made.
Conditions that may appear similar to enthesopathy include:
- strains and sprains
- bone injuries, including fractures
- overuse injuries affecting tendons
- medical conditions, such as gout or rheumatoid arthritis
Occasionally, warmth, swelling, and pain can signal a potentially life-threatening blood clot in the deep veins.
The calves are the most common sites for deep vein blood clots, but blood clots can form anywhere, including near joints, for example, behind the knee. A suddenly red, warm and swollen joint can also be a sign of a serious bacterial infection within the joint. Anyone experiencing these types of changes in any joint should seek urgent medical attention.
Symptoms of enthesopathy can ease with time and proper treatment. But the long-term prognosis depends on the cause of enthesopathy.
People with chronic illnesses who experience enthesopathy may continue to experience flare-ups, either at the same location or different spots throughout the body.
Someone who develops enthesopathy because of overuse or other external causes will often recovery permanently if they get prompt treatment.
Left untreated, enthesopathy can get worse. A person’s posture or gait may change because of the pain and stiffness that the condition causes. This can lead to muscle stiffness, injury to nearby muscles, and more pain.