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Ligament and tendon injuries, joint replacement
#268188 08/27/14 07:07 AM
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Eilatan Offline OP
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After a blessed period of minimal discomfort, pain is creeping back into some joints. My left shoulder and right wrist flared again, though not at quite the level of the previous episode. The new one is the left hip, both on the outside and inside of the joint. I've also noticed pain reaching into my lower back in the last few days. With the pain now presenting in the pelvis area and back, I would say this strengthens considerably the conclusion of the rheumatologist I consult that it's AS.

What I'm wondering though is this: I've had the hip pain before, a number of times, dating back to years ago, on both sides. One time that was especially bad, I saw my doctor. He referred me to an orthopedist. That physician determined I had a small tear in the ligament. I don't doubt his interpretation of the x-ray. It's just that I thought I had seen a few posts in the past on persons who suffer ligament and tendon injury, implying there's a connection. Is there anything to that? To those of you with AS, have you suffered a higher than average rate of damage to the soft tissue? I ask because I've had the hip pain before, going back to a long ago time. I now wonder if that pain was actually tied to earlier signs of AS.

One more questions: is joint replacement an eventual certainty for those with AS?

Re: Ligament and tendon injuries, joint replacement
Eilatan #268189 08/27/14 07:36 AM
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Tendonitis is known commonly(by the experts) as a first sign of AS. IBD is often an early finding too in back pain dominant crohn's. I'm sure that the Tendonitis is a manifestation of the original enthesitis, because of the anatomy. This is why the EULAR classification is the most sensitive and specific, and thus the best.

That is 1 thing I do know! There's a lot about this condition that myself and most others don't. Only took me 10 years to figure this out. Even though I've shown the EULAR classification to clueless rheums for over 6 years. But even that should not have mattered in my case..

But I think my measurements have =d AS for a little over a year. By the modified NY thing(e.g. when I lost most of my chest expansion).


-Doing the things that help prevent spondylitis while not doing the things that do
Re: Ligament and tendon injuries, joint replacement
Eilatan #268191 08/27/14 02:42 PM
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Well, most of my original tendon issues were bursitis, which is extreme pain at a certain angle. Had it on both shoulders and both hips several times. No ortho thought to mention AS but of course, my SED rate was always normal and they did test that.

You can easily damage your tendons by favoring one because the other hurts. I thought my original ankle damage was because of burstitis in hips.

Take care of your tendons, do not over do.

Anna


Actema IV once a month (with pre loading for allergic reaction), Cymbalta x1 daily, Arava 20mg daily. Diagnosed with AS in 2004, suffered undiagnosed since 1982.
Re: Ligament and tendon injuries, joint replacement
Eilatan #268195 08/27/14 04:39 PM
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I'm unclear exactly where tendonitis ends and enthesitis starts. Enthesitis is fairly classic in AS,and repeated inflammation at the entheses (where tendon joins onto bone) I guess could lead to other damage. When I get enthesitis flares it makes it incredibly easy to feel like I have damaged a tendon from the slightest exertion though I've never had imaging done to confirm that. Regular stretching does seem to help avoid injury.


Cauda equina type neurogenic bladder problems. Coeliac disease. Sicca syndrome. Ataxic gait and use crutches. Non-specific gut problems. Current treatment: Low dose naltrexone, low starch diet (Guts shredded by NSAIDs. Previously diclofenac worked well, not eligible for anti-tnfs, hypersensitivity to SSZ). Also short bursts of pred for bad flares
Re: Ligament and tendon injuries, joint replacement
Eilatan #268220 08/28/14 07:10 AM
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Thanks to all the replies. The Dx of the inside hip joint pain was ligament tear, not tendinitis. The other issue I've suffered a lot is severe foot pain, often originating in the heel, then spreading sometimes to the arch. A few years ago, when the heel pain was especially bad and persisted many months, I consulted a podiatrist. I was told this pain is the fascia ligament with a tear. The podiatrist said the fascia is a ligament that attaches at the heel, stretches across the bottom of the foot like a big rubber band, attaching at the bones to the toes. He said my arches are weak and not arched enough, which puts me at risk for frequent "micro-tears", either at the heel, or at the arch. I realize the heel isn't a joint, but the heel is just below the ankle joint, and the other end of the ligament are the toes, which are jointed in two places. I'm just wondering if there might be a connection to the AS. Perhaps not. Perhaps the current hip pain is unrelated to the past ligament tears, and perhaps I have weak arches after all, causing the plantar's fascia.

Re: Ligament and tendon injuries, joint replacement
Eilatan #268249 08/29/14 01:10 AM
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I saw my rheumy today. He confirmed what some of you said about ligament tears, tendon involvement and enthesitis. He ordered an x-ray of my hip and advised me to finish the meldral pack. If the pain isn't gone after that, he said he would recommend trying an injectable, either enbrel or humira.

Re: Ligament and tendon injuries, joint replacement
Eilatan #268263 08/30/14 06:27 AM
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I had x-rays of the left side of the pelvis Thu. I was surprised to get results today. Surprisingly, the doctor said the pictures don't look too bad. Not much inflammation and not a lot sign of arthritis. He said to finish the meldral pack and if the pain is worse, or there's no improvement, I should call and he'll order an MRI.

This is very strange. I'm not imagining the pain. What could it be that doesn't show up in x-ray, but might in an MRI? I know I don't have the qualifications to challenge the x-ray, but my gut tells me this has got to be related to arthritis. And I'm having some pain radiating up my back. It would be nice to know.

Re: Ligament and tendon injuries, joint replacement
Eilatan #268274 08/31/14 12:45 PM
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X-rays only show damage. That doesn't mean you won't eventually have damage, just that you don't have damage at this point.

There is not a direct correlation between pain and damage. You can have lots of pain and no damage. You can also have lots of damage with little to no pain.

MRI's can show evidence of inflammation that does not show in x-rays.


Ginny - 58 year old female
Dx with USpA in March 2013; changed to AS in July 2015
Iritis and Scleritis, both currently in remission
unicompartmental knee replacements: right-June 2014, left-Aug 2018
MTX, Humira, Cyclobenzaprine, plus Celebrex as needed
Supplements: Folic Acid, Vitamin A, Vitamin D, Calcium, Fish Oil, Culturelle probiotic, Melatonin (as needed)
Re: Ligament and tendon injuries, joint replacement
Eilatan #268312 09/06/14 03:37 AM
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Ligament and tendons are not seen with any degree of accuracy on plain film x-ray. MRI is necessary to image the kind of damage you are talking about. I am not a radiologist or doctor but I did work in diagnostic imaging for roughly 30 years. I was blessed to work with radiologists who loved to teach.


Poppa John:
Symptomatic since 1988, diagnosed with Spondylitis, Fibromyalgia, probable IBD March 2013. HLA B27 neg. Sacroillitis, Osteitis, Fibromyalgia
Fused T 2-12, Fused C 5-7, HNP L4-5 with laminectomy/discectomy 2014.

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