Presence Of Enthesophytes Research Articles

Hematological indices in psoriatic enthesopathy: relation to clinical and ultrasound evaluation

BackgroundEnthesopathy is considered a crucial aspect of assessment and outcome in psoriatic arthritis (PsA). Musculoskeletal ultrasound (MSUS) is a critical tool for accurately detecting enthesitis. Recent research focuses on identifying simple biomarkers for detecting and monitoring psoriatic enthesopathy. Red cell distribution width (RDW), mean platelet volume (MPV), and neutrophil/lymphocyte ratio (NLR) are components of a complete blood count (CBC) and are reliable bio-inflammatory markers in various rheumatic diseases.Aim of workTo measure MPV, RDW, and NLR in psoriatic enthesopathy and determine their relationship to disease activity and MSUS findings.Patients and methodsThis study focused on 30 people with psoriatic arthritis (PsA) as per CASPAR criteria, along with 20 control subjects. Enthesopathy was evaluated clinically using the Leeds Enthesitis Index (LEI). The modified Disease Activity Index of Psoriatic Arthritis (DAPSA28) was calculated, and RDW, MPV, NLR, CRP, and ESR were measured. Each enthesis in LEI was radiologically assessed using plain radiography and MSUS according to OMERACT definitions.ResultsThere was a significant relationship between clinical tenderness, the presence of enthesophytes on plain radiography, and MSUS findings at entheses sites (p < 0.001 for each). Psoriatic patients had higher levels of RDW and MPV (p < 0.001 and 0.01, respectively) than controls, with no significant differences in NLR (p = 0.189) between the two groups. RDW and MPV levels were positively correlated with the DAPSA28 score.ConclusionMonitoring PsA disease activity can be improved by considering RDW and MPV as reliable indicators and using them to screen for psoriatic enthesopathy with MSUS indices.Key points• Clinically identifying enthesitis in patients with PsA can be challenging. Imaging MSUS indices hold promise for objective analysis, but there is no consensus on which indices to use in clinical trials and daily practice.• Patients with psoriatic enthesopathy have higher RDW and MPV levels, which are positively correlated with DAPSA28 score.• RDW and MPV can be considered in the turn of improved screening of psoriatic enthesopathy with MSUS scores.

Sonographic pathoanatomy of greater trochanteric pain syndrome.

To identify and highlight pertinent US features that could serve as imaging biomarkers to describe different patient phenotypes, within Great Trochanteric Pain Syndrome (GTPS) clinical diagnosis. Using ultrasound we evaluated eighty-eight clinically diagnosed patients with GTPS, for tendon matrix changes and calcium deposits in the gluteus medius (superoposterior and lateral aspects) and in the gluteus minimus. Peritrochanteric examination included fascia lata, trochanteric bursa, cortical irregularities and the presence of enthesophytes. The association of pathological changes with pain and functionality was evaluated using multivariate regression models. Out of the 88 patients, 86 examinations (97.7%) detected gluteus medius tendinopathy, and 54 patients (61.4%) had gluteus minimus tendinopathy in addition. Calcium deposits were present in 97.7% of patients, associated with tenderness (p = 0.009), and most often located in the gluteus medius rather than in the gluteus minimus (p = 0.014); calcifications were associated with tendon thickness (p = 0.042), hypoechogenicity (p = 0.005) and the presence of partial tears (p = 0.030). Bursa swelling occurred in 36 patients (40.9%); multivariate regression models predicted less pain in patients with bursa distension (p = 0.008) and dysfunction in patients with gluteal muscle atrophy (p = 0.001) and loss of fibrillar pattern in the gluteus medius (p = 0.002). GTPS involves both degenerative calcifying gluteal tendinopathy and alterations in the peritrochanteric space associated with physical function and pain. The severity of GTPS can be assessed using ultrasound imaging biomarkers.

FRI674 Association Between Metabolic Syndrome And The Presence Of Enthesophytes On Musculoskeletal Ultrasound Compared To Joint X-ray

Abstract Disclosure: S. Brown: None. J. Hardin: None. S.N. Mahmood: None. Background: Enthesophytes consist of calcium deposition on tendons or ligaments that are proposed to form in response to localized inflammation of the enthesis, either idiopathic or in response to repetitive strain. The exact etiology of these deposits is unknown, but it has been proposed that they form as a result of tendon degeneration or a cell-mediated reactive process, and one working theory postulates that enthesophyte formation could be correlated with metabolic disorders. It is suggested that metabolic syndromes contribute to enthesopathy through tendon degeneration, aging and overuse. While joint X-ray is known to identify enthesophytes, musculoskeletal ultrasound (MSUS) offers dynamic testing due to its non-invasive nature, decreased radiation burden, affordability and versatility. There is limited research that focuses on ultrasound identification of enthesophytes in relation to metabolic syndrome and compared to other imaging modalities. Methods: This pilot study compared the prevalence of metabolic syndrome, (characterized as hypertension, hyperlipidemia, diabetes mellitus, elevated Body Mass Index (BMI)) and enthesophytes identified on imaging between MSUS examinations and joint X-rays. The patients were identified through retrospective data collection taken from General Rheumatology Clinic and Rheumatology MSUS Clinic. 49 joints evaluated for joint pain by X-ray demonstrated enthesophytes and 5 joints evaluated for joint pain by MSUS demonstrated enthesophytes. We aimed to evaluate how many patients with joint pain found to have enthesophytes also had comorbid metabolic syndrome. Results: Of the 49 joints demonstrating enthesophytes on X-ray, this population showed a prevalence of comorbid metabolic syndrome per joint as follows: pelvis - 17/18, knee - 9/10, and ankle - 21/21. The joint X-ray population showed evidence of enthesophytes according to age range per joint as follows: pelvis - &amp;lt;40yo: 0/8, 40-70yo: 15/71, and &amp;gt;70yo: 3/11, knee - &amp;lt;40yo: 0/8, 40-70yo: 6/71, &amp;gt;70yo: 4/11, and ankle - &amp;lt;40yo: 0/8, 40-70yo: 16/71, and &amp;gt;70yo: 5/11. Of the 5 joints demonstrating enthesophytes with MSUS, this population showed a similar prevalence of comorbid metabolic syndrome in isolated studies of the hip/pelvis (n=1), ankle (n=3). Discussion: As a pilot study, we found that X-ray is useful in detecting enthesophytes as a pathologic cause of pain in patients with metabolic syndrome. This highlights the need to investigate further the mechanism that drives this force. Joint X-ray showed a correlation of metabolic syndrome and age with the presence of enthesophytes. In our early MSUS evaluations, detection is achievable as well and demonstrates the high prevalence metabolic syndrome and the presence of enthesophytes, which indicates that there may be a safer, faster, more affordable way to evaluate for this underlying comorbid condition. Presentation: Friday, June 16, 2023

ANATOMIC FACTORS ASSOCIATED WITH PARTIAL DISTAL BICEPS TENDON TEARS: A COMPARATIVE CONTROL STUDY

A larger radial tuberosity, and therefore a smaller radioulnar space, may cause mechanical impingement of the DBT predisposing to tear. We sought to investigate anatomic factors associated with partial DBT tears by retrospectively reviewing 3-T MRI scans of elbows with partial DBT tears and a normal elbow comparison group3-T MRI scans of elbows with partial DBT tears and elbows with no known pathology were reviewed retrospectively by two independent observers. Basic demographic data were collected and measurements of radial tuberosity length, radial tuberosity thickness, radio-ulnar space, and radial tuberosity-ulnar space were made using simultaneous tracker lines and a standardised technique. The presence or absence of enthesophytes and the presence of a single or double DBT were noted.26 3-T MRI scans of 26 elbows with partial DBT tears and 30 3-T MRI scans of 30 elbows without pathology were included. Basic demographic data was comparable between the two groups. The tear group showed statistically significant larger mean measurements for radial tuberosity length (24.3mm vs 21.3mm, p=0.002), and radial tuberosity thickness (5.5mm vs 3.7mm, p=&lt;0.0001. The tear group also showed statistically significant smaller measurements for radio-ulnar space (8.2mm vs 10.0mm, p=0.010), and radial tuberosity-ulnar space (7.2mm vs 9.1mm, p=0.013). There was a statistically significant positive correlation between partial DBT tears and presence of enthesophytes (p=0.007) as well as between partial DBT tears and having two discrete DBTs rather than a single or interdigitating tendon (p=&lt;0.0001).Larger radial tuberosities, and smaller radio-ulnar and radial tuberosity-ulnar spaces are associated with partial DBT tears. This may be due to chronic impingement, tendon delamination and consequent weakness which ultimately leads to tears. Enthesophytes may be associated with tears for the same reason. Having two discrete DBTs that do not interdigitate prior to insertion is also associated with partial tears.

Diagnosis of subclinical psoriatic arthritis in patients with psoriasis using CASPAR criteria: a sonographic study

BackgroundWe aimed at screening for subclinical psoriatic arthritis (PsA) among psoriatic patients without musculoskeletal complaints using ultrasonography of the lower limbs and finding the best predictor for its development.ResultsSubclinical inflammatory articular affection was found by ultrasound in 33 patients, among whom 26 had psoriatic nail affection. According to CASPAR criteria, those 26 patients could be diagnosed as PsA (subclinical). The only statistically significant difference between psoriatic patients with PsA and those without was the mean quadriceps tendon thickness as well as the presence of enthesophytes and bilateral quadriceps thickening. The best and only predictor for subclinical PsA was the presence of enthesophytes.ConclusionUltrasound was more sensitive than clinical examination in detecting subclinical psoriatic arthritis which is highly prevalent in patients with psoriasis even in the absence of manifest arthritic complaints. The best and only predictor for subclinical PsA was the presence of enthesophytes.

Radiographic aspects in individuals infected by human T-lymphotropic virus type 1 (HTLV-1) with joint pain

BackgroundJoint pain in the absence or with little synovitis is observed in a large percentage of HTLV-1 infected subjects. As the virus infect CD4 + and CD8 + positive, macrophages and B cells an exaggerated production of pro-inflammatory cytokines is detected in these patients. However, the possible association of HTLV-1 infection with autoimmune diseases has not been documented definitively and the clinical characteristics of HTLV-1 associated arthropathy has not been defined. The objective this study is to describe clinic and radiographic features in HTLV-1-infected individuals with complaints of joint pain.MethodsCross-sectional study enrolling HTLV-1-infected individuals with chronic joint pain, aged up to 75 years, both genders and seronegative controls with osteoarthritis. All participants underwent conventional radiography of the hips, knees and ankles.ResultsEighty-one HTLV-1 infected patients and 30 subjects with osteoarthritis participated in the study. Polyarticular and symmetrical arthritis prevailed in the HTLV-1 positive group (54%), while oligoarticular and asymmetrical (44%) were more common in controls (p < 0.05). The frequency of enthesophytes (90%) in HTLV-1-infected patients was greater than in the control group (73%) (p < 0.05). Radiographic features were similar in HTLV-1 carriers and in patients with probable or definite HTLV-1 associated myelopathy. The presence of enthesophytes in the absence of joint space reduction or osteophytes was only observed in HTLV-1-infected individuals (p < 0.001). Magnetic resonance imaging of the ankles of five HTLV-1-infected patients and five controls demonstrated a higher frequency of enthesitis, bursitis and osteitis in the HTLV-1 infected group.ConclusionHTLV-1-associated arthropathy is clinically characterized by symmetrical polyarthralgia and the main radiological finding is the presence of enthesophytes in the absence of osteophytes and joint space narrowing.

Anatomic factors associated with partial distal biceps tendon tears: a comparative control study.

There is minimal literature on the anatomic factors associated with partial distal biceps tendon (DBT) tears. It has been proposed that a larger radial tuberosity size-and, therefore, a smaller radioulnar space during pronation-may cause mechanical impingement of the DBT predisposing to tears. We sought to investigate the anatomic factors that may be associated with partial DBT tears by retrospectively reviewing the DBT anatomy using 3-T magnetic resonance imaging (MRI) scans of elbows with partial DBT tears and a comparison group of normal elbows. Two independent observers retrospectively reviewed 3-T MRI scans of elbows with partial DBT tears and elbows without visible pathology. Basic demographic data were collected, and measurements of radial tuberosity length, radial tuberosity thickness, radioulnar space, and radial tuberosity-ulnar space were made using simultaneous tracker lines and a standardized technique. The ratio of radial tuberosity thickness to radial diameter and the ratio of radioulnar space to radial tuberosity-ulnar space were calculated. The presence or absence of enthesophytes and the presence of a single DBT vs. double DBTs were noted. This study included twenty-six 3-T MRI scans of 26 elbows with partial DBT tears and thirty 3-T MRI scans of 30 elbows without pathology. Basic demographic data were comparable between the 2 groups. The tear group showed statistically significantly larger mean measurements for radial tuberosity length (24.3 mm vs. 21.3 mm, P=.002) and radial tuberosity thickness (5.5 mm vs. 3.7 mm, P < .0001). The tear group also showed statistically significantly smaller measurements for radioulnar space (8.2 mm vs. 10.0 mm, P=.010) and radial tuberosity-ulnar space (7.2 mm vs. 9.1 mm, P=.013). The ratio of radial tuberosity thickness to radial diameter was statistically significantly larger in the tear group (0.389 vs. 0.267, P < .0001). There was a statistically significant positive correlation between partial DBT tears and the presence of enthesophytes (P=.007), as well as between partial DBT tears and the presence of 2 discrete DBTs rather than a single tendon or 2 DBTs that interdigitated prior to insertion (P < .0001). Larger radial tuberosities and smaller radioulnar and radial tuberosity-ulnar spaces are associated with partial DBT tears. Larger tuberosities and a smaller functional space for the DBT may lead to chronic impingement, tendon delamination, and consequent weakness, which ultimately lead to tears. Enthesophytes may be associated with tears for the same reason. The presence of 2 discrete DBTs that do not interdigitate prior to insertion is also associated with partial tears. This study will help clinicians understand the pathogenesis of partial DBT tears.

Ultrasound in Evaluation of Subclinical Enthesitis of Extensor Digitorum Tendon and Nail Unit Changes in Psoriasis

Abstract Background Subclinical inflammation at entheseal level has been detected in patients with psoriasis without previous history of arthropathy or Psoriatic arthritis (PsA). Ultrasound (US) is a valid and sensitive tool for the assessment of inflammatory involvement at entheseal level in PsA patients. Objective To detect subclinical arthritis or enthesitis at distal interphalangeal (DIP) fingers and nail unit changes in psoriatic patient for early detection of PsA Patients and Methods This study included 30 adult psoriatic patients and 30 healthy matched controls. All underwent history, clinical examination, Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI) score calculation and musculoskeletal US both grey and power Doppler (PD) assessed at enthesis of extensor digitorum tendon insertion at distal phalanx, DIP joints from 2nd to 5th finger bilaterally examined for detection of synovitis and over the nail for morpho-structural evaluation. Results Patient’s ages ranged from 18-65 years and controls 20-60 years (mean ±SD 45.07 ± 13.52, 38.37 ± 11.96 respectively), male to female ratio 1:2. DIP joint affection in the form of synovial hypertrophy and effusion with PD was found in 13.3% of cases. Enthesophyte with PD in 56.7% of cases. On comparison between NAPSI score by clinical examination versus US examination, the sensitivity of US was 100%, all cases clinically positive by NAPSI were positively affected by US (20 cases). Also 30% of cases were negative by NAPSI and were positive by US (7cases). Three cases were negative by both NAPSI and US. A significant positive correlation was observed between disease duration and NAPSI Score (r = 0.429, pvalue&amp;lt;0.05), similarly between presence of enthesophyte with PD and PASI Score (r = 0.547, pvalue&amp;lt;0.02). Conclusion Detection of subclinical enthesopathy at DIP joint by ultrasound is not infrequent, so it is an important tool for examining enthesis in psoriatic patients. The presence of a high PASI score and long disease duration could be considered as predictive parameters for the presence of psoriatic enthesitis ongoing to arthritis.

Lesions in sheep elbows: Insights from a large-scale study

ObjectivesEnthesophytes on sheep elbow joints are commonly reported in archaeological material. Although these lesions are often described as ‘penning elbow’, little is known of their aetiology. In this study, a new method for recording these lesions is presented, and the effect of age, sex and body size is explored to understand their potential for informing upon past human-animal interactions. Materials1133 distal humerii and proximal radii from 16 archaeological sites. MethodsThe presence and severity of enthesophytes were recorded and findings compared with modern data from a group of 17 complete Soay sheep skeletons. ResultsSignificant, positive correlations between age and body size and the presence of enthesophytes were demonstrated. Environmental factors and trauma may also play a role in their formation. ConclusionThe aetiology of enthesophytes on sheep elbows is complex and varied, affected by age, body size and environment. SignificanceThis is the first study of enthesophytes on sheep elbows to combine archaeological data with modern animals of known age and sex. Blanket explanations of husbandry methods for the cause of these lesions are dispelled, and use of the term ‘penning elbow’ is redundant. LimitationsThe sample of modern specimens is relatively small and would benefit from the inclusion of older individuals and those raised in different environments. Future researchThe method developed here can be adopted in future studies.Interpretations should take age, size and environmental factors into consideration, and only when these variables are established can the role of husbandry be evaluated.

Comparative Evaluation of the Presence of Insertion Enthesophyte in the Achilles Tendon by X-Ray and Magnetic Resonance Imaging: Intra and Inter Observer Reliability

Category:Other; SportsIntroduction/Purpose:To evaluate the intra and interobserver variation on the presence of enthesophyte in patients with Achilles insertional tendinopathy and the clinical radiological correlation of x-ray (X-ray) and magnetic resonance images (MRI).Methods:We selected Lateral X-ray images of the calcaneus and videos of ankle MRI in which we showed the entire thickness of the calcaneus in the coronal, sagittal and axial views, in both T1 and T2 weightings, of 20 patients with Achilles insertional tendinopathy. 5 foot and ankle surgeons and 5 musculoskeletal radiologists, with varied experience time, analysed the images. Intra and Interobserver correlations were studied with the kappa index.Results:The average Ƙ intraobserver of the results of the MRI analyzes was 0.49, and the average Ƙ interobserver of the results of the MRI analyzes was 0.47. The mean Ƙ intraobserver values of the results of the X-ray analyzes were 0.61, while the Ƙ interobserver had a value of 0.60. We also observed that the group of less experienced surgeons and radiologists showed a worse Ƙ intraobserver than the more experienced ones.Conclusion:The values are in agreement with previous studies, confirming moderate intraobserver and interobserver reproducibility in MRI exams and good or substantial interobserver and interobserver reliability in X-ray exams.

Plantar fascia enthesitis: Clinical, radiographic and ultrasound findings in patients with axial spondyloarthritis

Aim of the workTo assess the clinical, radiographic and sonographic presentation of plantar fascia in axial spondyloarthritis (ax-SpA) and to identify the radiographic and ultrasonographic signs most associated with clinical disease parameters. Patients and methodsThe study included 74 patients with ax-SpA. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Functional Index (BASFI) and Ankylosing Spondylitis Quality of Life (ASQoL) were assessed. Clinical assessment of plantar fascia included the plantar fascia palpation pain severity on a visual analogic scale (VAS); and the enthesitis-specific scores: The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and the Spondyloarthritis Research Consortium of Canada (SPARCC) score. All patients were explored by lateral heel radiographs and musculoskeletal ultrasound (US) at plantar fascia insertions. ResultsThe mean age was 36 ± 11.4 years. Plantar fascia enthesis was painful in 17% of cases. Standard radiographs showed plantar fascia involvement in 37% and US in 71% of patients. The clinical involvement of plantar fascia correlated with BASDAI (p = 0.02), as well as BASFI (p = 0.03) and ASQoL (p < 0.0001). X-ray enthesophyte was the most related to plantar fascia pain palpation (p < 0.01), MASES(p < 0.001) and SPARCC(p < 0.05). US entheseal thickening was related with pain palpation (p < 0.001) and MASES (p < 0.05). US enthesophyte was related with palpation pain (p < 0.05). Bony erosion was related to SPARCC (p < 0.05). ConclusionPlantar fascia in ax-SpA is often asymptomatic and associated with disease activity and functional impairment. The presence of enthesophyte was the radiographic sign most associated with clinical enthesitic involvement. Entheseal thickening, enthesophyte and bony erosion were the sonographic signs most associated with enthesitic.

Evaluation of calcaneal enthesophytes in insertional Achilles tendinopathy by radiography and magnetic resonance imaging: intra- and inter-observer reliability

Objective: Evaluate intra- and inter-observer variation in the presence of enthesophytes in patients with insertional Achilles tendinopathy on radiographic (X-ray) and magnetic resonance imaging (MRI) images. Methods: We selected X-ray and MRI images of 20 patients diagnosed with an injury. We sent a questionnaire to five foot and ankle surgeons and five radiologists. We obtained answers about diagnosis accuracy and the presence of insertional enthesophytes (bone spurs). Results: Intra-observer agreement with regards to diagnosis accuracy in the MRI analysis was a K of 0.77 (0.62 to 1.00), while in the X-ray analysis, the K was 0.95 (0.77 to 1.00). Intra-observer agreement on the presence of enthesophytes in the MRI analysis had a K coefficient of 0.90 (0.68 to 1.00) and intra-observer agreement in the X-ray of 0.93 (0.86 to 1.00). The evaluation of inter-observer agreement on the diagnosis accuracy had a K coefficient between 0.09 and 0.20. Inter-observer agreement regarding the presence of enthesophytes was a K value between 0.59 and 0.63 for the MRI and a K between 0.81 and 0.82 for the X-ray results. Conclusion: Intra-observer values for diagnosis accuracy of the MRI and X-ray tests indicated strong to almost perfect agreement, similar to the intra-observer values for evaluation of the presence of enthesophytes, but the X-ray had better agreement. In both tests, intra-observer agreement on the presence of osteophytes was weak in comparison to inter-observer agreement, yet in the inter observer evaluation of the presence of enthesophytes, the X-ray agreement was greater than the MRI values. Level of Evidence III; Diagnostic Study.

Comparison of Insall-Salvati Index and Its Modification in Normal Dogs from Four Different Body Weight Groups.

The objectives of this study were to record the values of Insall-Salvati (IS) index and its modification in dogs classified into four different body weight groups and to determine whether these index values were influenced by sex. Bilateral mediolateral radiographs of 86 dogs were obtained. The dogs were classified into four different body weight groups: small, medium, large and giant. The patellar length (PL), caudal and cranial patellar ligament lengths (LLca and LLcr), stifle angle and superimposition of the femoral condyles were measured on the radiographs. The IS index and its modification (LLcr:PL) were calculated by dividing LLca or LLcr by the PL respectively. Spearman's correlation test and analysis of variance were used for statistical analyses. The sex of the dog and the presence of enthesophytes at the apex of the patella were two influential factors for the IS and LLcr:PL values. The mean IS values were 1.60 ± 0.28 in small dogs, 1.73 ± 0.27 in medium dogs, 1.82 ± 0.21 in large dogs and 1.97 ± 0.13 in giant dogs. The mean LLcr:PL for the same groups were 2.05 ± 0.23, 2.13 ± 0.19, 2.23 ± 0.21 and 2.27 ± 0.16 respectively. The reference intervals for the IS index were 1.04 to 2.16 in the small dogs, 1.19 to 2.27 in the medium dogs, 1.40 to 2.24 in the large dogs and 1.71 to 2.23 in the giant dogs. The reference intervals for the LLcr:PL index were 1.59 to 2.51 in the small dogs, 1.75 to 2.51 in the medium dogs, 1.81 to 2.65 in the large dogs and 1.95 to 2.59 in the giant dogs. Dogs with values exceeding these reference intervals have patella alta and those with values below these intervals have patella baja.

Study of Acromial Shapes in Relation to Gender

Abstract Introduction Subacromial impingement syndrome is considered to be one of the most common musculoskeletal disorders affecting the shoulder joint. The objectives of the study were to find out the morphology of acromion process and the presence of enthesophytes in male and female scapulae. Methodology The study was done on 100 male and 100 female adult dry human scapulae of different people, collected from the Department of Anatomy, Kempegowda Institute of Medical Sciences, Bangalore. Acromial shapes were classified into 4 types—type I (flat), type II (curved), type III (hooked), and type IV (convex). Acromial spurs (enthesophytes), if any, in the anterior one-third of acromion was noted. Results The most common type of acromion found in both the sexes is type I. Even the enthesophytes were more commonly associated with type I acromion. The study revealed that the acromial shape of dried scapulae did not vary significantly with sex. Conclusion In the present study we could find the four types of acromion mentioned in the literature. Since acromial shapes influence the shoulder pathologies involving acromion, the knowledge on acromial morphology and enthesophytes aid the clinicians during its diagnoses and treatment (acromioplasty). Also, data on morphology of acromion could be used for forensic and anthropological purposes for determining gender, ethnicity, and so forth.

A morphometric study of acromion process of scapula and its clinical significance

Objective: The acromion process is associated with a variety of ailments in the shoulder. Therefore, the aim of this study was to record and study all the morphometric values of the acromion process and its morphological features. Materials and Methods: The study was carried out on 50 unpaired dried scapulae. The length, width, and thickness of the acromion process were measured, and the length and width of scapula was also measured using vernier calipers. The acromiocoracoid and acromioglenoid distances were also measured. The shape, type of acromion process, and the presence of enthesophytes were noted and whether the anterior 2/3 rd of inferior surface of acromion process is rough or smooth was also noted. Results: The mean length, width, and thickness of acromion process were 4.21, 2.42, and 0.73 cm, respectively. The mean length and width of scapula were 13.93 and 10.14 cm, respectively. The mean acromiocoracoid distance and acromioglenoid distance were 3.09 and 2.47 cm, respectively. The most common shape of the acromion process noted was quadrangular in 40% of scapulae. In 90% of scapulae, the anterior 2/3 rd of inferior surface was rough and in 80% scapulae, enthesophytes were present. Conclusions: This study will help the clinicians in understanding and curing various shoulder joint disorders.

Achilles tendon biomechanics in psoriatic arthritis patients with ultrasound proven enthesitis

Objective: To investigate Achilles tendon (AT) biomechanics in psoriatic arthritis (PsA) patients with ultrasound confirmed features of enthesitis.Method: PsA patients and healthy control subjects underwent three-dimensional (3D) gait analysis to measure walking speed, rotational joint motion and the moments, power, and AT force at the ankle–subtalar joint complex. The Glasgow Ultrasound Enthesitis Scoring System (GUESS) was used to score the presence of enthesophytes, erosions, retrocalcaneal bursitis, and tendon thickening. Power Doppler ultrasound signal (PDUS) was used to detect active disease. Peripheral joint arthritis, acute-phase reactants, global health, disability, and foot impairments were recorded. A core set of biomechanical variables that influence the insertion of the AT and indirect estimates of tendon loading were compared between PsA patients and control subjects with and without enthesitis.Results: Forty-two PsA patients with a mean disease duration of 10.6 (SD 9.4) years and 29 control subjects were studied. Seventeen (40%) PsA patients had clinically detectable AT entheseal pain. Twenty-eight (67%) PsA patients and nine (31%) control subjects had one or more GUESS enthesitis features, predominantly enthesophytes. PsA patients with enthesitis walked significantly more slowly than control subjects (p = 0.019) and generated lower peak ankle joint moments (p = 0.006), power (p = 0.001), and AT force (p = 0.003). Ankle–subtalar joint complex motion was comparable and no between-group differences were found for peak dorsiflexion (p = 0.59), eversion (p = 0.05), and internal rotation (p = 0.19).Conclusions: In this group of PsA patients, the AT insertional angle was not influenced by ankle–subtalar joint motion in those with and without enthesitis. Moreover, the PsA patients with enthesitis had significantly lower AT loading.

Altered bone biology in psoriatic arthritis.

Psoriatic arthritis (PsA) is characterized by focal bone erosions mediated by osteoclasts at the bone–pannus junction. The bulk of research over the past decade has centered on mechanisms that underlie osteoclastogenesis along with new insights into osteoimmunology; however, recent advances that focus on steps that lead to new bone formation are beginning to emerge. New revelations about bone formation may have direct relevance to PsA given the presence of enthesophytes, syndesmophytes, and bony ankylosis frequently observed in patients with this disorder. In this review, we discuss current developments in the pathogenesis of new bone formation, novel imaging approaches to study bone remodeling and highlight innovative approaches to study the effect of inflammation on bone. Lastly, we discuss promising therapies that target joint inflammation and osteitis with the potential to mediate pathologic bone formation.

Antemortem pathological changes suggestive of reactive and degenerative arthritic disorders

ABSTRACTThe present case displays severe antemortem skeletal malformations suggestive of antemortem reactive arthritis (ReA), spondyloarthropathies and diffuse idiopathic skeletal hyperostosis (DISH). The ossified anterior longitudinal ligament on the right side of the thoracic vertebral bodies, with the presence of extraspinal enthesophytes, together indicates DISH. Fused lumbar vertebrae with costovertebral and sacroiliac joint fusion, combined with numerous large enthesophytes collectively suggest ankylosing spondylosis and ReA. Finally, some vertebrae showed evidence of age related osteoarthritis. However, the anatomical evidence for these conditions displays some inconsistencies with the known pathogenesis; therefore, a definitive account of this individual's antemortem condition remains uncertain. As no biological or medical information is known about the individual, skeletal morphology, irregular skeletal fusion and the presence of enthesophytes have been collectively used to propose the antemortem disorders that appear to have affected this individual's skeleton. Copyright © 2010 John Wiley &amp; Sons, Ltd.

Correlation between the four types of acromion and the existence of enthesophytes: A study on 423 dried scapulas and review of the literature

The purpose of this study was to correlate the four types of acromial shape with the existence of enthesophytes, which together comprise two important parameters for subacromial impingement syndrome and rotator cuff tears. In addition, a review of the literature was carried out. Four hundred twenty-three dried scapulas were studied at the Department of Anatomy in the University of Cologne, Germany. Four types of acromion were found: the three classical ones as described by Bigliani et al. ([1986] Orthop Trans 10:216) and a fourth one, where the middle third of the undersurface of acromion was convex (Gagey et al. [1993] Surg Radiol Anat 15:63-70). The correlation between the four types of acromion and the presence of enthesophytes at its anterior undersurface was also recorded. The distribution of acromial types was as follows: type I, flat, 51 (12.1%); type II, curved, 239 (56.5%); type III, hooked, 122 (28.8%); and type IV, convex, 11 (2.6%). Enthesophytes were found in 1 of type I (2%), in 19 of type II (7.9%), in 46 of type III (37.7%), and in 0 (0%) of type IV acromions. Overall, 66 (15.6%) out of 423 scapulas had enthesophytes. In all cases, they were localized at the site of the coracoacromial ligament insertion on the acromion. Enthesophytes were significantly (P < 0.05) more common in type III acromions and this combination is particularly associated with subacromial impingement syndrome and rotator cuff tears. In type I and in type IV acromions, the incidence of enthesophytes is very small and, according to other studies, with these two acromial types rotator cuff tears are also rare.

Acromial morphology: relation to sex, age, symmetry, and subacromial enthesophytes.

To evaluate acromial shape in relation to age, sex, symmetry, and presence of subacromial enthesophytes. Three hundred ninety-four cadaveric scapulas were reviewed. Specimens were categorized by sex and age (age range, 20-89 years). Acromial morphology was typed according to the Bigliani classification: type I, flat; type II, curved; and type III, hooked. The presence and degree of subacromial enthesopathy was recorded. Selective radiographic correlation was obtained. The relative percentages of acromial types I, II, and III were 22.8% (90 acromions), 68.5% (270 acromions), and 8.6% (34 acromions), respectively. There was a greater percentage of type III in men (10.2% [21 of 205] vs 6.9% [13 of 189] and type I in women (27.5% [52 of 189] vs 18.5% [38 of 205]). There was no relationship between acromial type and age (P = .667). Enthesophytes were most common in type III (20 [59%] of 34 acromions) versus type II (115 [42.6%] of 270 acromions) and type I (22 [24%] of 90 acromions). Acromial morphology was symmetric in 135 (70.7%) of 191 pairs of acromions and asymmetric in 56 pairs (29.3%). Acromial shape does not vary significantly with age. It does, however, differ between sexes. The relative percentages of the types differ from previously reported values. Acromial shape tends to be symmetric. A trend between acromial type and the presence of enthesophytes is observed.