Clinical implications of reconsideration of enthesitis/enthesopathy/enthesial erosion, as tendon attachment-localized avulsions and stress fracture equivalents

Core Tip

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.