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Enthesitis
Enthesitis is inflammation of the entheses, the sites where tendons or ligaments insert into the bone. It is an enthesopathy, a pathologic condition of the entheses. Early clinical manifestations are an aching sensation akin to "working out too much", and it gets better with activity. It is worse in the morning (after sleeping and not moving). The muscle insertion hurts very focally as it joins into the bone, but there is little to no pain at all with passive motion. There are some cases of isolated, primary enthesitis which are very poorly studied and understood. It is known to be associated with other autoimmune diseases, like spondyloarthropathies and psoriasis (thought to often precede psoriatic arthritis). A common autoimmune enthesitis is at the heel, where the Achilles tendon attaches to the calcaneus. It is associated with HLA B27 arthropathies, such as ankylosing spondylitis, psoriatic arthritis, and reactive arthritis. Symptoms include multiple points of tenderness ...
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Psoriatic Arthritis
Psoriatic arthritis is a long-term inflammatory arthritis that occurs in people affected by the autoimmune disease psoriasis. The classic feature of psoriatic arthritis is swelling of entire fingers and toes with a sausage-like appearance. This often happens in association with changes to the nails such as small depressions in the nail (pitting), thickening of the nails, and detachment of the nail from the nailbed. Skin changes consistent with psoriasis (e.g., red, scaly, and itchy plaques) frequently occur before the onset of psoriatic arthritis but psoriatic arthritis can precede the rash in 15% of affected individuals. It is classified as a type of seronegative spondyloarthropathy. Genetics are thought to be strongly involved in the development of psoriatic arthritis. Obesity and certain forms of psoriasis are thought to increase the risk. Psoriatic arthritis affects up to 30% of people with psoriasis and occurs in both children and adults. Approximately 40–5 ...
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Reactive Arthritis
Reactive arthritis, also known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. By the time the patient presents with symptoms, often the "trigger" infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult. The arthritis often is coupled with other characteristic symptoms; this has been called Reiter's syndrome, Reiter's disease or Reiter's arthritis. The term "reactive arthritis" is increasingly used as a substitute for this designation because of Hans Reiter's war crimes with the Nazi Party. The manifestations of reactive arthritis include the following triad of symptoms: an inflammatory arthritis of large joints, inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women. Arthriti ...
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Enthesis
The enthesis (plural entheses) is the connective tissue between tendon or ligament and bone. There are two types of entheses: ''Fibrous entheses'' and ''fibrocartilaginous entheses''. In a fibrous enthesis, the collagenous tendon or ligament directly attaches to the bone. In a fibrocartilaginous enthesis, the interface presents a gradient that crosses four transition zones: # Tendinous area displaying longitudinally oriented fibroblasts and a parallel arrangement of collagen fibres # Fibrocartilaginous region of variable thickness where the structure of the cells changes to chondrocytes # Abrupt transition from cartilaginous to calcified fibrocartilage—often called 'tidemark' or 'blue line' # Bone Clinical significance A disease of the entheses is known as an '' enthesopathy'' or '' enthesitis''. Enthetic degeneration is characteristic of spondyloarthropathy and other pathologies. The enthesis is the primary site of disease in ankylosing spondylitis. Society and cultu ...
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Entheses
The enthesis (plural entheses) is the connective tissue between tendon or ligament and bone. There are two types of entheses: ''Fibrous entheses'' and ''fibrocartilaginous entheses''. In a fibrous enthesis, the collagenous tendon or ligament directly attaches to the bone. In a fibrocartilaginous enthesis, the interface presents a gradient that crosses four transition zones: # Tendinous area displaying longitudinally oriented fibroblasts and a parallel arrangement of collagen fibres # Fibrocartilaginous region of variable thickness where the structure of the cells changes to chondrocytes # Abrupt transition from cartilaginous to calcified fibrocartilage—often called 'tidemark' or 'blue line' # Bone Clinical significance A disease of the entheses is known as an ''enthesopathy'' or '' enthesitis''. Enthetic degeneration is characteristic of spondyloarthropathy and other pathologies. The enthesis is the primary site of disease in ankylosing spondylitis. Society and culture ...
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Apophysitis
In the skeleton of humans and other animals, a tubercle, tuberosity or apophysis is a protrusion or eminence that serves as an attachment for skeletal muscles. The muscles attach by tendons, where the enthesis is the connective tissue between the tendon and bone. A ''tuberosity'' is generally a larger tubercle. Main tubercles Humerus The humerus has two tubercles, the greater tubercle and the lesser tubercle. These are situated at the proximal end of the bone, that is the end that connects with the scapula. The greater/lesser tubercule is located from the top of the acromion laterally and inferiorly. The radius has two, the radial tuberosity and Lister's tubercle. Ribs On a rib, tubercle is an eminence on the back surface, at the junction between the neck and the body of the rib. It consists of an articular and a non-articular area. The lower and more medial articular area is a small oval surface for articulation with the transverse process of the lower of the two vertebrae ...
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Tendinopathy
Tendinopathy, a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder (rotator cuff tendinitis, biceps tendinitis), elbow (tennis elbow, golfer's elbow), wrist, hip, knee (jumper's knee, popliteus tendinopathy), or ankle (Achilles tendinitis). Causes may include an injury or repetitive activities. Less common causes include infection, arthritis, gout, thyroid disease, diabetes and the use of quinolone antibiotic medicines. Groups at risk include people who do manual labor, musicians, and athletes. Diagnosis is typically based on symptoms, examination, and occasionally medical imaging. A few weeks following an injury little inflammation remains, with the underlying problem related to weak or disrupted tendon fibrils. Treatment may include rest, NSAIDs, splinting, and physiotherapy. Less commonly steroid injections or surgery may be done. About 80% of patients ...
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Inflammation
Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and initiate tissue repair. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', ''dolor'', ''rubor'', ''tumor'', and ''functio laesa''). Inflammation is a generic response, and therefore it is considered as a mechanism of innate immunity, as compared to adaptive immunity, which is specific for each pathogen. Too little inflammation could lead to progressive tissue destruction by the harmful stimulus (e.g. bacteria) and compromise the survival of the organism. In contrast, too much inflammation, in ...
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Pathology
Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatment, the term is often used in a narrower fashion to refer to processes and tests that fall within the contemporary medical field of "general pathology", an area which includes a number of distinct but inter-related medical specialties that diagnose disease, mostly through analysis of tissue, cell, and body fluid samples. Idiomatically, "a pathology" may also refer to the predicted or actual progression of particular diseases (as in the statement "the many different forms of cancer have diverse pathologies", in which case a more proper choice of word would be " pathophysiologies"), and the affix ''pathy'' is sometimes used to indicate a state of disease in cases of both physical ailment (as in cardi ...
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Heel
The heel is the prominence at the posterior end of the foot. It is based on the projection of one bone, the calcaneus or heel bone, behind the articulation of the bones of the lower leg. Structure To distribute the compressive forces exerted on the heel during gait, and especially the stance phase when the heel contacts the ground, the sole of the foot is covered by a layer of subcutaneous connective tissue up to 2 cm thick (under the heel). This tissue has a system of pressure chambers that both acts as a shock absorber and stabilises the sole. Each of these chambers contains fibrofatty tissue covered by a layer of tough connective tissue made of collagen fibers. These septa ("walls") are firmly attached both to the plantar aponeurosis above and the sole's skin below. The sole of the foot is one of the most highly vascularized regions of the body surface, and the dense system of blood vessels further stabilize the septa. The Achilles tendon is the muscle tendon ...
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Achilles Tendon
The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone. These muscles, acting via the tendon, cause plantar flexion of the foot at the ankle joint, and (except the soleus) flexion at the knee. Abnormalities of the Achilles tendon include inflammation ( Achilles tendinitis), degeneration, rupture, and becoming embedded with cholesterol deposits (xanthomas). The Achilles tendon was named in 1693 after the Greek hero Achilles. History The oldest-known written record of the tendon being named for Achilles is in 1693 by the Flemish/Dutch anatomist Philip Verheyen. In his widely used text he described the tendon's location and said that it was commonly called "the cord of Achilles." The tendon has been described as early as the time of Hippocrates, who described it as the "" (Lat ...
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Calcaneus
In humans and many other primates, the calcaneus (; from the Latin ''calcaneus'' or ''calcaneum'', meaning heel) or heel bone is a bone of the tarsus of the foot which constitutes the heel. In some other animals, it is the point of the hock. Structure In humans, the calcaneus is the largest of the tarsal bones and the largest bone of the foot. Its long axis is pointed forwards and laterally. The talus bone, calcaneus, and navicular bone are considered the proximal row of tarsal bones. In the calcaneus, several important structures can be distinguished:Platzer (2004), p 216 There is a large calcaneal tuberosity located posteriorly on plantar surface with medial and lateral tubercles on its surface. Besides, there is another peroneal tubecle on its lateral surface. On its lower edge on either side are its lateral and medial processes (serving as the origins of the abductor hallucis and abductor digiti minimi). The Achilles tendon is inserted into a roughened area on its sup ...
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HLA B27
Human leukocyte antigen (HLA) B27 (subtypes B*2701-2759) is a class I surface antigen encoded by the B locus in the major histocompatibility complex (MHC) on chromosome 6 and presents antigenic peptides (derived from self and non-self antigens) to T cells. HLA-B27 is strongly associated with ankylosing spondylitis and other associated inflammatory diseases, such as psoriatic arthritis, inflammatory bowel disease, and reactive arthritis. Prevalence The prevalence of HLA-B27 varies markedly in the global population. For example, about 8% of Caucasians, 4% of North Africans, 2–9% of Chinese, and 0.1–0.5% of persons of Japanese descent possess the gene that codes for this antigen. In northern Scandinavia ( Lapland), 24% of people are HLA-B27 positive, while 1.8% have associated ankylosing spondylitis. Disease associations The relationship between HLA-B27 and many diseases has not yet been fully elucidated. Though HLA-B27 is associated with a wide range of pathology, it does n ...
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