Rothschild BM. Clinical implications of reconsideration of enthesitis/enthesopathy/enthesial erosion, as tendon attachment-localized avulsions and stress fracture equivalents. World J Orthop 2024; 15(10): 902-907 [PMID: 39473521 DOI: 10.5312/wjo.v15.i10.902]
Corresponding Author of This Article
Bruce M Rothschild, MD, Professor, Department of Medicine, Indiana University Ball Memorial Hospital, 2401 W University Ave, Muncie, IN 47303, United States. spondylair@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Oct 18, 2024; 15(10): 902-907 Published online Oct 18, 2024. doi: 10.5312/wjo.v15.i10.902
Clinical implications of reconsideration of enthesitis/enthesopathy/enthesial erosion, as tendon attachment-localized avulsions and stress fracture equivalents
Bruce M Rothschild
Bruce M Rothschild, Department of Medicine, Indiana University Ball Memorial Hospital, Muncie, IN 47303, United States
Author contributions: Rothschild BM handled all aspects.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bruce M Rothschild, MD, Professor, Department of Medicine, Indiana University Ball Memorial Hospital, 2401 W University Ave, Muncie, IN 47303, United States. spondylair@gmail.com
Received: February 6, 2024 Revised: August 27, 2024 Accepted: September 13, 2024 Published online: October 18, 2024 Processing time: 247 Days and 20.7 Hours
Abstract
Recognizing the mechanical origin of enthesitis/enthesopathy and the avulsion-nature of what had previously been considered erosions, it seems inappropriate to attribute it to stresses related to a person’s normal activities. Conversely, sudden or unconditioned repetitive stresses appears the more likely culprit. Studies of enthesial reaction have lacked standardization as to findings present among individuals who appear to be healthy. Clinical evaluation by palpation and manipulation may be as effective as application of radiologic techniques. Recognition of the mechanical nature of the disease, including individuals with inflammatory arthritis suggests prescription of mechanical solutions that reduce stresses across the involved enthesis.
Core Tip: Enthesitis, unrelated to inflammatory diseases, is not the result of, and its presence is not a measure of, routine activities. It results from the application of sudden or unconditioned repetitive stresses. Bone defects at tendon/ligament insertion sites are not the result of biological erosion, but rather of avulsions. To avoid overinterpretation of osseous reaction at entheses, their presence needs to be compared to findings among individuals who appear to be healthy. Recognition of clinically significant enthesitis may be as effectively identified by physical examination, with radiologic techniques possibly redundant. An important component of treatment is reduction of the mechanical stresses to which a given enthesis is exposed.
