Stephen Bird

Hi Mike,

Psoriatic arthritis is an attacker of the enthesis organ unit.
So you need to be vigilant of the enthesis of supra, subscap, infra etc.
If the seronegative psoriatic arthritis is attacking this shoulder I would expect these enthesis to show signs of erosive change and sub-periosteal cost formation.
In the MSK pathology principles webinar or perhaps even in the Joints webinar I discuss seronegative arthritis and have a great example of a youngish man who has multi enthesis destruction in the shoulder as result of his seronegative psoriatic arthritis despite a sedentary job.

In your case the enthesis of supra looks normal.

The flow you have is along the edge of the biceps tendon and seems to be arising from he greater tuberosity immediately adjacent to the biceps tendon.
This is a common spot for a small bony irregularity and personally I don’t put too much emphasis on it.
I am currently working on a presentation for the website that is called “what is that bony irregularity”. It will explore enthesis traction injuries, OA changes, gout and RA erosions as well as normal pits in the bone surface from synovial herniation pits. In the end it is all about location, location, location!

O in this location I often see what I believe to be a normal synovial herniation pit at the point where the SGHL is inserting into the humerus. So the bony chink is not necessarily pathological.
But you have flow arising from the enthesis and this raises further questions.
Is the flow due to a pathological enthesis as a result of the seronegative arthritis?
Or is the flow simply a normal vessel?

It is a good question.

I feel the chink in the bone is normal, but the presence of the blood vessel is more concerning as flow across any enthesis is in my view abnormal and consistent with either traction induced enthesopathy or a pathological enthesis due to the seronegative arthritis.

So I am suspicious.

Let’s monitor the other enthesis in the shoulder and see if any other erosions or vessels appear.

You can also monitor other articulations for the same thing.


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