obsolete wrist or carpus enthesopathy

Enthesopathy of the Wrist and Carpus: An Obsolete Term

Enthesopathy of the wrist and carpus, also known as obsolete wrist or carpus enthesopathy, is a term that was previously used to describe a condition affecting the tendons and ligaments in the wrist and carpal area. This condition is characterized by degenerative disorders of ligaments, muscles, and tendon attachments to bones (entheses) [6].

Definition and Causes

Enthesopathy refers to any condition or disorder that affects an enthesis, which is a boney insertion site of tendons and ligaments [12]. The most common differential diagnosis for enthesopathy of the wrist and carpus is degenerative change (osteoarthritis) at the first carpometacarpal joint [5].

Symptoms and Treatment

The symptoms of enthesopathy can vary, but they often include pain and inflammation in the affected area. In some cases, the condition may be associated with other rheumatic, metabolic, or endocrine disorders [7]. Treatment for enthesopathy typically involves managing symptoms through medication, physical therapy, and lifestyle modifications.

Classification and Variations

Enthesopathies can be classified into two main types: fibrous and fibrocartilaginous. Fibrous entheses insert directly onto the periosteum, whereas fibrocartilaginous enthesis lack periosteum [12]. Enthesopathy of the wrist and carpus is a specific type of enthesopathy that affects the tendons and ligaments in this region.

References

• [1] Definition of Enthesopathy
• [5] Most common differential diagnosis for enthesopathy of the wrist and carpus
• [6] Description of degenerative disorders of ligaments, muscles, and tendon attachments to bones (entheses)
• [7] Association with other rheumatic, metabolic, or endocrine disorders
• [12] Classification of enthesopathies into fibrous and fibrocartilaginous types

Based on the provided context, here are the signs and symptoms of obsolete wrist or carpus enthesopathy:

• Stiffness and spasms of the wrist and hand [2]
• Enthesophyte formation in both appendicular and axial regions [3]
• Joint pain, fever, and rash [4]
• Severe early morning stiffness and hand-wrist pain [8]
• Severely limited mobility in the affected part of the hand or wrist [8]
• Trigger points in the affected area [8]
• Joint tenderness and swelling [9]
• Positive Phalen and Tinel signs in patients with carpal tunnel syndrome [9]

Additionally, enthesopathy can cause pain and other symptoms where your tendons and ligaments connect to your bones, including:

• Pain and inflammation around joints, including wrists, knees, and ankles [13]
• Widespread joint pain that can feel like enthesopathy [12]

It's worth noting that the underlying cause of enthesopathy is often systemic (body-wide) inflammation related to arthritis, which can lead to irritated entheses and pain [15].

Based on the provided context, it appears that diagnostic tests for wrist or carpal enthesopathy have evolved over time. Here are some outdated diagnostic methods:

• X-rays: While X-rays can still be used to look at the bones, they may not provide sufficient information about the soft tissue around the bones (see [2] and [6]).
• Ultrasounds: Although high-frequency ultrasound testing is effective in diagnosing enthesopathy (see [4] and [6]), older ultrasound technology might not have been as effective.
• Magnetic Resonance Imaging (MRI): MRI scans can be used to see the soft tissue around the bones, but they may not always provide a clear diagnosis for enthesopathy (see [2]).
• Joint fluid analysis: This test involves analyzing the fluid in the joint to diagnose conditions like enthesopathy. However, it might not be as commonly used today.
• Blood tests and Urinalysis: These tests can help identify underlying conditions that may lead to enthesopathy, but they are not specific diagnostic tools for the condition itself.

It's essential to note that these outdated methods have been largely replaced by more modern and effective diagnostic techniques. A healthcare provider will typically use a combination of physical examination, medical history, and imaging studies (such as high-frequency ultrasound testing) to diagnose enthesopathy.

References:

• [2] Diagnostic Tests: Laboratory tests reflect the nature of the underlying pathology and cause.
• [4] High-frequency ultrasound testing is particularly effective in diagnosing enthesopathy.
• [6] Blood tests; Joint fluid analysis; X-rays. High-frequency ultrasound testing is particularly effective in diagnosing enthesopathy.

Based on the provided context, it appears that there are some outdated treatment options for wrist or carpal enthesopathy.

According to search result [14], the mainstay of treatment for overuse enthesopathy in the past included ice, rest, and nonsteroidal anti-inflammatory drugs (NSAIDs) for 7-10 days. However, it's worth noting that NSAID use is somewhat controversial in the acute period as they may inhibit healing by blunting the inflammatory response [11].

Additionally, search result [8] mentions that disease-modifying therapy with sulfasalazine or MTX have anecdotally been effective, but this information seems to be from 2014 and might not reflect current treatment guidelines.

It's also mentioned in search result [9] that nonsurgical treatments are recommended for the initial management of acute LE (likely referring to a condition affecting the wrist or carpal area), which includes rest, NSAIDs, physical therapy, and other conservative measures.

However, it's essential to note that these treatment options might not be relevant or effective in current medical practice. For up-to-date information on treating wrist or carpal enthesopathy, it would be best to consult a healthcare professional or recent medical literature.

Here are some possible treatment options for wrist or carpal enthesopathy:

• Rest and activity modification: Temporary rest and avoidance of activities that exacerbate symptoms can help relieve pain and promote healing of the affected entheses [13].
• Ice, compression, elevation, and rest (ICEER): This is a common treatment approach for many injuries, including those affecting the wrist or carpal area [10].
• Physical therapy: Gentle exercises and physical therapy may be helpful in improving function and reducing pain [9].

Please consult a healthcare professional for personalized advice on treating wrist or carpal enthesopathy.

The differential diagnosis for obsolete wrist or carpus enthesopathy involves considering various conditions that may present with similar symptoms. Based on the search results, here are some possible causes:

• Osteoarthritis: Pisotriquetral osteoarthritis has a high prevalence in the older donor population and may be a cause of ulnar-sided wrist pain [1]. This condition can lead to enthesopathy, which is characterized by inflammation and degeneration of the tendons and ligaments at their insertion points.
• Enthesitis: Enthesitis is an inflammatory condition that affects the entheses (the boney insertion sites of tendons and ligaments) [3]. It can cause pain and other symptoms where your tendons and ligaments connect to your bones. Enthesopathy, including enthesitis, is a broad term for conditions that can affect your tendons and ligaments.
• Tendinosis: Tendinosis is a type of mechanical enthesopathy that affects the tendons [4]. It can cause chronic wrist pain and may be a differential diagnosis for obsolete wrist or carpus enthesopathy.
• Intersection syndrome: Intersection syndrome is a condition that affects the tendons and ligaments at the intersection point between the forearm and the wrist [13]. It can cause pain and swelling in the affected area and may be a differential diagnosis for obsolete wrist or carpus enthesopathy.
• de Quervain syndrome: de Quervain syndrome is another condition that affects the tendons and ligaments at the base of the thumb [13]. It can cause pain and swelling in the affected area and may be a differential diagnosis for obsolete wrist or carpus enthesopathy.

It's worth noting that the differential diagnosis for obsolete wrist or carpus enthesopathy can be extensive, as mentioned in search result 6. A careful history and physical examination are essential to determine the underlying cause of the symptoms [8].

References:

[1] Signs of enthesopathy were seen in seven wrists. Pisotriquetral osteoarthritis has a high prevalence in the older donor population and may therefore be a cause of ulnar sided wrist pain.

[3] Enthesopathy is a broad term for conditions that can affect your tendons and ligaments.

[4] Tendinosis – Mechanical enthesopathy ...

[13] Differential local anesthetic injections may help in supporting the diagnosis or in differentiating between intersection syndrome and de Quervain syndrome.