Reply To: Left shoulder

[Michael Shilton]

Hi Steve, many thanks. I’ve just taken a look at the joints webinar which was very informative. I’m having a little difficulty with my terminology/anatomy. Where does the enthesis start and end with LHB? Is there attachment into the bone at this point in the groove thereby classifying it as enthesitis? Good to know your opinion regarding the small c shaped herniation pit looking structure on the axial view, is there more suspicious possible erosive cortex on the long view do you think?
In terms of the other tendons they looked okay to me, I’ll recheck periodically if the patient is willing. Do you know if there tends to be a multi joint systemic coordination of flaring so that if I check her painful ankles for example and they are actively inflamed then that would increase the chance of her shoulder being due to her Psoriatic arthritis or are they independent of each other in terms of the activeness?
I’ll write to her rheumatologist and I’m considering reporting “there is some increased blood flow in the LHB enthesis adjacent to the greater tuberosity with possible cortical erosion which, given the known psoriatic arthritis, is suspicious for pathological enthesitis.” Sound okay, or is the erosion to strong and it’s still a normal pit?
Mike

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