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More information on enthesopathy

Q) I had a left hip replacement just over two years ago due to severe osteoarthritis. Since then I have struggled to regain normal walking ability, despite a lot of physiotherapy. My surgeon has put a great deal of effort to find out why I am still slow and stiff. From the scans he has done, he tells me that I have an ‘enthesopathy’ affecting the medial gluteal muscle. I am to have a guided steroid injection soon, as a last-ditch attempt to ease the stiffness and discomfort. I have not heard of this problem before. Can you tell me anything about this condition?
Clare Passingham, via email (Summer 2014)

A) The enthesis is the point where ligaments, tendons and muscles attach themselves to bone, and is a common cause of pain. The most common enthesopathies (that just means pathological abnormalities at the enthesis) are tennis elbow and plantar fasciitis (formerly called policeman’s heel, in the days when policemen used to walk their beat all day). Sometimes enthesopathies can be part of a more widespread inflammatory arthritis such as ankylosing spondylitis and psoriatic arthritis. And sometimes they can occur after surgery, as in your case. The symptoms are pain at the point of attachment and stiffness after rest. If there is inflammation then a steroid injection at the point of attachment will help, as will stretching exercises. Since the injection has to be given right at the point of inflammation, a guided approach is often used – the guide can be ultrasound or sometimes x-rays.



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