What is the Difference Between Enthesitis and Tendonitis

Enthesitis and tendonitis are two conditions affecting the tendon, a strong cord of flexible tissue that connects muscles to bones. It also helps to prevent muscle injury by absorbing some of the impact on muscles when running, jumping, or doing other movements. Both these conditions cause intense pain, swelling, and movement problems in the affected area. But they are two different conditions.

The key difference between enthesitis and tendonitis is their root cause. Enthesitis is the inflammation of the spot where a tendon or a ligament attaches to bone while tendonitis is the inflammation of the sheath covering the tendon. 

CONTENTS

1. Overview and Key Difference
2. What is Enthesitis  
3. What is Tendonitis
4. Similarities – Enthesitis and Tendonitis
5. Enthesitis vs Tendonitis in Tabular Form
6. FAQ – Enthesitis and Tendonitis
7. Summary – Enthesitis vs Tendonitis

What is Enthesitis?

Enthesitis occurs when an enthesis becomes inflamed. Enthesis is the place where a tendon or a ligament attaches to a bone. Enthesitis can be caused by excessive use, injury, and underlying diseases. The symptoms of enthesitis are pain, swelling, and stiffness in the affected enthesis, difficulty running, jogging, or climbing stairs because of the pain, heel spur, and fibrosis.

Figure 01: Joint

Enthesitis can be diagnosed through physical examination, medical history, blood test, ultrasound scan, and MRI scan. Furthermore, treatment options for enthesitis include nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, disease-modifying antirheumatic drugs (DMARDs) and physiotherapy.

What is Tendonitis?

Tendonitis is the inflammation or irritation of a tendon between the muscles and bones. The common symptoms of tendonitis may include pain at the site of the tendon and surrounding area, stiff joints or difficulty moving joints, hearing and feeling a cracking or popping sensation when moving, and swelling, often with skin discolouration. Tendonitis can be caused by overuse or repetitive movements over time, strain from sudden movements, injury, medications and certain underlying medical conditions.

Figure 02: Tendonitis

Tendonitis can be diagnosed by physical examination, X-ray, and MRI scan. Furthermore, tendonitis can be treated through icing the area the day of injury, avoiding activities, resting the injured area, taking anti-inflammatory medications, corticosteroid injections, physical therapy, and surgery.

Similarities Between Enthesitis and Tendonitis

1. Enthesitis and tendonitis are two conditions that involve tendons.
2. Both these conditions can be caused by overuse, injury and underlying condition.
3. These conditions cause pain, swelling, and inflammation.
4. Both conditions can be diagnosed through physical examination and imaging testing.
5. They can be treated through medications and physical therapy.

Difference Between Enthesitis and Tendonitis

Definition

1. Enthesitis is a condition due to the inflammation of enthesis.
2. Tendonitis is a condition due to the inflammation of the tendon.

Cause

1. Enthesitis is caused by excessive usage, injury and underlying condition.
2. Tendonitis is caused by overuse, injury, strain, certain medications and underlying diseases.

Symptoms

1. Symptoms of enthesitis include pain and stiffness, especially when you move and bone spurs.
2. Symptoms of tendonitis include pain and tenderness in the affected tendon, swelling, a grating sensation, a lump on the tendon, weakness in the affected area and decreased range of movement.

Diagnosis

1. Enthesitis is diagnosed by physical examination, medical history, blood test, ultrasound and MRI.
2. Tendonitis is diagnosed by physical examination, X-ray and MRI.

Treatment

1. Enthesitis is treated by NSAIDs, steroids, physical therapy and prolotherapy.
2. Tendonitis is treated by pain relievers, steroids, platelet rich plasma, physical therapy, dry needling and surgery.

The following table summarizes the difference between enthesitis and tendonitis.

Summary – Enthesitis vs Tendonitis

Enthesitis and tendonitis are two conditions in the tendons. Enthesitis is due to the inflammation of enthesis where a tendon or ligament attaches to the bone. Tendonitis is due to the inflammation of the tendon between your muscles and bones. This is the basic difference between enthesitis and tendonitis.

FAQ: Enthesitis and Tendonitis

1. What are entheses?

• Enthese is the place of attachment of tendon, ligament, fascia, or capsule to bone. There are two different types of entheses: fibrous entheses and fibrocartilaginous entheses. Fibrous entheses are found at insertion sites of stabilizing tendons while fibrocartilaginous entheses are found at insertions of tendons that contribute to joint movement.

2. How do you know if people have enthesitis or not?

• The typical symptoms of enthesitis include pain and stiffness, especially when are moving. Constant inflammation may promote abnormal bone growth, producing uncomfortable bone spurs.

3. What is the best treatment for enthesitis?

• Taking non-steroidal anti-inflammatory drugs (NSAIDs), like naproxen and ibuprofen, can help with inflammation and pain. If the enthesitis is caused by an autoimmune arthritis, the doctor also may prescribe a disease-modifying anti-rheumatic drug (DMARD) or biologics.

4. What is the cause of tendonitis?

• Tendinitis can occur as a result of injury or overuse, certain medications, and underlying diseases such as rheumatoid arthritis or diabetes. Playing sports is a common cause. Tendinitis also can occur with aging as the tendon loses elasticity.

5. What is the best treatment for tendonitis?

• To treat tendinitis, you can rest and use ice, compression and elevation. This treatment can help speed recovery and help prevent more problems. Other treatments include Pain relievers, steroids, platelet rich plasma, physical therapy, dry needling, and surgery.

Reference:

1. “Tendinitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research.
2. “Enthesitis: Locations, Causes, Diagnosis, and Treatment.” Medical News Today, MediLexicon International.

Image Courtesy:

1. “Achilles tendonitis” By Injurymap – InjuryMap – Free Human Anatomy Images and Pictures. (CC BY 4.0) via Commons Wikimedia

2. “Joint” By Madhero88 – Own work (CC BY-SA 3.0) via Commons Wikimedia

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