Tear of rotator cuff and enthesopathy caused by seronegative spondyloarthropathy

[Xue Heng]

Hi, Steve!
How can we distinguish tears of rotator cuff and enthesopathy caused by seronegative spondyloarthropathy?
Since both of the two enterties may have bony irregularities on the humerus and disappearance of hypoechoic fibrocartilage.
Can we rely on age and laboratory test? (Patients with tears of rotator cuff are usually older? Patients with seronegative spondyloarthropathy are HLA-B27 positive?)
Can we rely on whether the patient had psoriasis or lower back pain?
Can we rely on whether multiple joints are affected?
Or can we rely on whether the tendons of totator cuff are intact? (Enthesopathy does not involve the tendons?)
Thank you very much, Steve.

[Stephen Bird]

Hi Xue,

Take a look at the “joints” webinar as this will help with this question.

The supraspinatus can get enthesopathic changes as a result of chronic traction injury and this indeed commonly can lead to enthesis based partial then full thickness tears.
Seronegative patients can also get enthesopathic based disease which may similarly result in partial and then full thickness tears.
So there is some overlap for sure.

The times I suggest it is from seronegative origin is when the following things come into my consideration.

Enthesis disease in someone who has a desk job and is not active enough to have traction injury.
Patients with clinical skin psoriasis
Patients with multi locational disease
This may be multiple enthesis involvement in the same shoulder (eg supra and subscap) or multi seperate joints with enthesopathy
Patients with prior scaro-iliac joint inflammation previously
Patients with haematology evidence of seronegative disease
Patients with nail pitting, sausage finger, conjunctivitis etc

So I am looking for a pattern rather than features at a single tendon.

The clinical history, occupation and recreational activity is a good context for how much traction change you can expect.

Steve

[Xue Heng]

Thank you, Steve. Your answer really helps me a lot.
You never answer the question with one sentence or two.
Your answer is very detailed and you not only tell me the answer but focus more on “why”.
Thank you!

[Stephen Bird]

My pleasure mate,

You never ask easy questions, you always ask great questions, so they deserve a thorough answer and explanation of why I believe what I do,

Keep them coming mate,

If I can come to Beijing and be with you in person this is the next best thing.

Steve.

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