What is it about?
The revelation of large enthesophytes (bone spurs) in young adults’ skulls is surprising, as enthesophytes are common findings in the elderly’s radiographic studies as they develop slowly over time. To our knowledge, the phenomenon of large enthesophyte development in high prevalence in young adults’ skulls is recent and is most likely linked to the aberrant head and neck postures associated with the prolonged use of hand-held technologies. As such, this occurrence provides a rare opportunity to better understand the primary cause of large enthesophyte development. Furthermore, inflammation and genetic pre-disposition are perceived to be prerequisites for the development of large enthesophytes. The aim of this project was to assess the involvement of genetic predisposition, inflammatory and/or mechanical influences in the development of large enthesophytes emanating from the external occipital protuberance (back of the head) (14.5–30.5mm) in four teenage males. Importantly, the literature implies that large enthesophytes are exclusive to genetically predisposed individuals and to Spondyloarthropathies sufferers. This study included assessment of radiographs, MRI scans, blood-work, history, the SF-36 health survey, and the comparison of these data with the relevant literature.
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Why is it important?
This study has shown that mechanical factors have a vital role in the development of large enthesophytes, notwithstanding the influence of inflammation and/or genetic predisposition. Furthermore, a primary condition associated with enthesophyte development is Axial Spondyloarthritis (AxSpA). Leading experts on AxSpa recently indicated that while modern drug therapy may reduce inflammation, those are ineffective in limiting enthesophyte development with this malady and that other means for intervention may be necessary. Recent projects in animals provide evidence that unloading joints may protect the entheses from inflammation and enthesophyte's formation.
Perspectives
Enthesis (insertion) is the site of tendon, ligament or joint capsule attachment to bone. The role of the enthesis is to transfer stress from the soft tissue end (e.g. tendon) of the enthesis to the hard tissue end (bone) of the enthesis through transitional zones and then to distribute the load over a wide area through a divergent footprint on the bone. Thus, this gradual transition and spread of load, provides a protective mechanism to the structural integrity of both ends of the insertion. Enthesophytes commonly emerge from the bone surface into the “pulling” soft tissue as an adaptation to the abnormal stress acting on the enthesis over time. Therefore, a mechanical intervention (e.g. posture improvement) to limit enthesophyte formation may be prudent.
DC PhD David Shahar
University of the Sunshine Coast
Read the Original
This page is a summary of: Large enthesophytes in teenage skulls: Mechanical, inflammatory and genetic considerations, Clinical Biomechanics, March 2018, Elsevier,
DOI: 10.1016/j.clinbiomech.2018.02.004.
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