The Relationship Between Physical Examination and Ultrasonography of Large Entheses of the Achilles Tendon and Patellar Tendon Origin

Sibel Zehra Aydin; Sibel Bakirci; Esen Kasapoglu; Concepcion Castillo-Gallego; Fatıma Arslan Alhussain; Zoe R Ash; Esra Kurum; Dennis McGonagle; Helena Marzo-Ortega; Dafna Gladman; Lihi Eder

doi:10.3899/jrheum.190169

The Relationship Between Physical Examination and Ultrasonography of Large Entheses of the Achilles Tendon and Patellar Tendon Origin

J Rheumatol. 2020 Jul 1;47(7):1026-1030. doi: 10.3899/jrheum.190169. Epub 2019 Sep 1.

Authors

Sibel Zehra Aydin^{1

2}, Sibel Bakirci^{3

4}, Esen Kasapoglu^{3

4}, Concepcion Castillo-Gallego^{3

4}, Fatıma Arslan Alhussain^{3

4}, Zoe R Ash^{3

4}, Esra Kurum^{3

4}, Dennis McGonagle^{3

4}, Helena Marzo-Ortega^{3

4}, Dafna Gladman^{3

4}, Lihi Eder^{3

4}

Affiliations

¹ From the University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute, Department of Internal Medicine, Division of Rheumatology, Ottawa, Ontario, Canada; Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey; Complejo Hospitalario Torrecárdenas, Department of Internal Medicine, Division of Rheumatology, Almería, Spain; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; University of California, Department of Statistics, Riverside, California, USA; University of Toronto, Department of Internal Medicine, Division of Rheumatology, Krembil Research Institute, Toronto Western Hospital; University of Toronto, Women's College Research Institute, Women's College Hospital, Rheumatology, Toronto, Ontario, Canada. saydin@toh.ca.
² S.Z. Aydin, MD, Assoc. Professor, University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute, Department of Internal Medicine, Division of Rheumatology; S. Bakirci, MD, University of Ottawa Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology; E. Kasapoglu, MD, Assoc. Professor, Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology; C. Castillo-Gallego, MD, Complejo Hospitalario Torrecárdenas, Department of Internal Medicine, Division of Rheumatology; F. Arslan Alhussain, MD, Istanbul Medeniyet University, Department of Internal Medicine; Z.R. Ash, MD, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; E. Kurum, PhD, Assistant Professor, University of California, Department of Statistics; D. McGonagle, MD, Professor, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; H. Marzo-Ortega, MD, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; D. Gladman, MD, Professor of Medicine, University of Toronto, Department of Internal Medicine, Division of Rheumatology, Krembil Research Institute, Toronto Western Hospital; L. Eder, MD, PhD, Assistant Professor, University of Toronto, Women's College Research Institute, Women's College Hospital, Rheumatology. saydin@toh.ca.
³ From the University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute, Department of Internal Medicine, Division of Rheumatology, Ottawa, Ontario, Canada; Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey; Complejo Hospitalario Torrecárdenas, Department of Internal Medicine, Division of Rheumatology, Almería, Spain; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; University of California, Department of Statistics, Riverside, California, USA; University of Toronto, Department of Internal Medicine, Division of Rheumatology, Krembil Research Institute, Toronto Western Hospital; University of Toronto, Women's College Research Institute, Women's College Hospital, Rheumatology, Toronto, Ontario, Canada.
⁴ S.Z. Aydin, MD, Assoc. Professor, University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute, Department of Internal Medicine, Division of Rheumatology; S. Bakirci, MD, University of Ottawa Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology; E. Kasapoglu, MD, Assoc. Professor, Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology; C. Castillo-Gallego, MD, Complejo Hospitalario Torrecárdenas, Department of Internal Medicine, Division of Rheumatology; F. Arslan Alhussain, MD, Istanbul Medeniyet University, Department of Internal Medicine; Z.R. Ash, MD, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; E. Kurum, PhD, Assistant Professor, University of California, Department of Statistics; D. McGonagle, MD, Professor, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; H. Marzo-Ortega, MD, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; D. Gladman, MD, Professor of Medicine, University of Toronto, Department of Internal Medicine, Division of Rheumatology, Krembil Research Institute, Toronto Western Hospital; L. Eder, MD, PhD, Assistant Professor, University of Toronto, Women's College Research Institute, Women's College Hospital, Rheumatology.

PMID: 31474590
DOI: 10.3899/jrheum.190169

Abstract

Objective: To investigate the relationship between physical examination (PE) and sonographic features of enthesitis, based on anatomical sites.

Methods: The analysis was done using merged raw data of 3 studies on 2298 entheses.

Results: Patients with clinical Achilles enthesitis had more abnormalities on ultrasound (US): hypoechogenicity, p < 0.001; thickening, p = 0.001; Doppler signals, p = 0.002; and erosions, p = 0.02. The patellar tendon origin also correlated with PE but distal patellar tendon insertion and plantar aponeurosis were uncoupled from the US.

Conclusion: The relationship between clinical and sonographic findings for large entheses is dependent on the anatomical site. For the patellar tendon origin and Achilles entheses, PE is significantly linked to US findings.

Keywords: ENTHESOPATHY; PHYSICAL EXAMINATION; ULTRASOUND.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Achilles Tendon* / diagnostic imaging
Enthesopathy*
Humans
Patellar Ligament* / diagnostic imaging
Physical Examination
Ultrasonography
Ultrasonography, Doppler