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Mark G.l. Sayers - One of the best experts on this subject based on the ideXlab platform.
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Prominent exostosis projecting from the occipital squama more substantial and prevalent in young adult than older age groups
Scientific Reports, 2018Co-Authors: David Shahar, Mark G.l. SayersAbstract:Recently we reported the development of prominent exostosis young adults’ skulls (41%; 10–31 mm) emanating from the external occipital protuberance (EOP). These findings contrast existing reports that large Enthesophytes are not seen in young adults. Here we show that a combination sex, the degree of forward head protraction (FHP) and age predicted the presence of enlarged EOP (EEOP) (n = 1200, age 18–86). While being a male and increased FHP had a positive effect on prominent exostosis, paradoxically, increase in age was linked to a decrease in Enthesophyte size. Our latter findings provide a conundrum, as the frequency and severity of degenerative skeletal features in humans are associated typically with aging. Our findings and the literature provide evidence that mechanical load plays a vital role in the development and maintenance of the enthesis (insertion) and we suggest possible associations between aberrant loading of the EOP enthesis, sustained poor posture and EEOP formation. Accordingly, the higher numbers of individuals with EEOP in the 18-30 age group out of all cases examined raises concern about the future musculoskeletal health of this population and suggests a potential avenue for prevention intervention through posture improvement education.
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a morphological adaptation the prevalence of enlarged external occipital protuberance in young adults
Journal of Anatomy, 2016Co-Authors: David Shahar, Mark G.l. SayersAbstract:Enthesophytes are bony projections that arise from the sites of ligament, tendon or joint capsule attachment to a bone. They are seen rarely in radiographic findings in young adults, as these bony adaptations are assumed to develop slowly over time. However, in recent years, the presence of an enlarged external occipital protuberance (EEOP) has been observed frequently in radiographs of relatively young patients at the clinic of the lead author. Accordingly, the aim of this project was to assess the prevalence of an EEOP in a young adult population. Analysis involved a retrospective analysis of 218 lateral cervical radiographic studies of 18–30-year-old participants. Group A (n = 108; males = 45, females = 63) consisted of asymptomatic university students, while Group B (n = 110; males = 50, females = 60) were an age-matched mildly symptomatic, non-student population. The external occipital protuberance (EOP) size was defined as the distance from the most superior point of the EOP (origin) to a point on the EOP that is most distal from the skull. To avoid ambiguity, the threshold for recording the size of an EOP was set at 5 mm, and an EOP was classified as enlarged if it exceeded 10 mm. Reliability testing was also undertaken. Results indicated that an EEOP was present in 41% of the total population, with 10% of all participants presenting with an EOP ≥ 20 mm. An EEOP was significantly more common in males (67.4%) than in females (20.3%), with the mean EEOP size for the combined male population (15 ± 7 mm) being significantly larger (P < 0.001) than for females (10 ± 4 mm). The longest EEOP in the male population was 35.7 mm, while in the female population it was 25.5 mm. Additionally, the mean EEOP size for Group A (14 ± 7 mm) was also significantly greater (P = 0.006) than that recorded for Group B (12 ± 6 mm). This study identified that an EEOP is a condition that is prevalent in the populations tested. The age of the populations, and the prevalence of EEOP, suggest that biomechanical drivers for this phenomenon may be the main reason for this condition in these populations.
Guilherme Dos Reis Borges Coelho Da ,fonseca - One of the best experts on this subject based on the ideXlab platform.
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Associações entre Alterações Degenerativas Acromiais, Sexo, Idade, Lateralidade e Morfologia.
2017Co-Authors: Guilherme Dos Reis Borges Coelho Da ,fonsecaAbstract:Dissertação de Mestrado em Evolução e Biologia Humanas apresentada à Faculdade de Ciências e TecnologiaINTRODUCTION: In clinical contexts, it is assumed hooked acromia contribute to subacromial impingement and rotator cuff tears. However, it remains unclear whether acromial morphology is influenced by the presence of coracoacromial Enthesophytes. Similarly, little is known about the relationship of Enthesophytes with other degenerative signs at the glenohumeral and acromioclavicular joints, despite the existing anatomical interdependencies between these shoulder structures. OBJECTIVES: To explore associations between coracoacromial Enthesophytes, glenohumeral degeneration, acromioclavicular degeneration, sex, age, side, and acromial morphology. MATERIALS AND METHODS: A total 160 scapulae of 80 identified subjects in the Luís Lopes anthropological collection were inspected for signs of coracoacromial enthesopathy, glenohumeral, and acromioclavicular degeneration. Additionally, the posterior and lateral orthogonal planes of all right scapulae were photographed and morphometrically assessed on eight morphological parameters. Statistically, Yule’s Q tests (Q) and Point Biserial Correlation tests (rpb) were used to assess the strength and direction of relevant associations. RESULTS AND DISCUSSION: Positive associations existed between age (>55 years) and coracoacromial Enthesophytes (Q= 0.67; p< 0.05), glenohumeral (Q= 0.97; p< 0.05) and acromioclavicular degeneration (Q= 0.96; p< 0.05). Also, Enthesophytes were associated with diminished subacromial (rpb= -0.22; p< 0.05) and glenohumeral spaces (rpb= -0.44; p< 0.05) and with increased acromial postero-anterior lengths (rpb= 0.23; p< 0.05). Moreover, acromia with Enthesophytes often exhibited inferiorly protruding, non-native, oval “facets” of remodelled bone. Overall, concepts regarding bone biology, shoulder evolution and biomechanics help explain these clinically relevant associations.INTRODUÇÃO: Em contextos clínicos, é assumido que acrómios com morfologia em gancho contribuem para o surgimento de fenómenos de constrição subacromial e roturas tendinosas dos músculos da coifa dos rotadores. Contudo, não se sabe se o formato acromial em gancho é uma característica congénita ou se é consequente à entesopatia ossificante do ligamento coracoacromial. Similarmente, não se conhece a essência das relações que estes entesófitos acromiais têm com outras alterações degenerativas nas articulações glenoumeral e acromioclavicular, apesar de haverem interdependências anatómicas entre estas estruturas do ombro. OBJETIVOS: Determinar a natureza das relações entre entesófitos coracoacromiais, degeneração glenoumeral e acromioclavicular, sexo, idade, lateralidade e morfologia acromial. MATERIAIS E MÉTODOS: Foram estudadas um total de 160 escápulas de 80 indivíduos identificados da coleção antropológica Luís Lopes. Especificamente, foi analisada a presença de entesófitos coracoacromiais e de sinais de degeneração glenoumeral e acromioclavicular. Além disso, foi realizada uma análise morfométrica de oito parâmetros morfológicos nas escápulas direitas da amostra, tendo sido utilizadas fotografias ortogonais dos planos lateral e posterior para o efeito. Estatisticamente, foram utilizados Yule’s Q tests (Q) e Point Biserial Correlation tests (rpb) para definir a direção e força de associações relevantes. RESULTADOS E DISCUSSÃO: Foram encontradas associações positivas entre idade (>55 anos) e a presença de entesófitos coracoacromiais (Q= 0.67; p< 0.05), degeneração glenoumeral (Q= 0.97; p< 0.05) e acromioclavicular (Q= 0.96; p< 0.05). Também foram descobertas associações entre a presença de entesófitos com espaços subacromiais (rpb= -0.22; p< 0.05) e glenoumerais (rpb= -0.44; p< 0.05) diminuídos e com distâncias acromiais postero-anteriores aumentadas (rpb= 0.23; p< 0.05). Os acrómios com entesófitos exibiam frequentemente, nas suas superfícies caudais, sinais de remodelação óssea com formato de pequenas “facetas” ovoides. Globalmente, conceitos nas áreas da biologia óssea, da evolução e biomecânica do ombro auxiliam a compreensão das associações verificadas neste estudo
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Associações entre Alterações Degenerativas Acromiais, Sexo, Idade, Lateralidade e Morfologia.
2017Co-Authors: Guilherme Dos Reis Borges Coelho Da ,fonsecaAbstract:Dissertação de Mestrado em Evolução e Biologia Humanas apresentada à Faculdade de Ciências e TecnologiaINTRODUCTION: In clinical contexts, it is assumed hooked acromia contribute to subacromial impingement and rotator cuff tears. However, it remains unclear whether acromial morphology is influenced by the presence of coracoacromial Enthesophytes. Similarly, little is known about the relationship of Enthesophytes with other degenerative signs at the glenohumeral and acromioclavicular joints, despite the existing anatomical interdependencies between these shoulder structures. OBJECTIVES: To explore associations between coracoacromial Enthesophytes, glenohumeral degeneration, acromioclavicular degeneration, sex, age, side, and acromial morphology. MATERIALS AND METHODS: A total 160 scapulae of 80 identified subjects in the Luís Lopes anthropological collection were inspected for signs of coracoacromial enthesopathy, glenohumeral, and acromioclavicular degeneration. Additionally, the posterior and lateral orthogonal planes of all right scapulae were photographed and morphometrically assessed on eight morphological parameters. Statistically, Yule’s Q tests (Q) and Point Biserial Correlation tests (rpb) were used to assess the strength and direction of relevant associations. RESULTS AND DISCUSSION: Positive associations existed between age (>55 years) and coracoacromial Enthesophytes (Q= 0.67; p55 anos) e a presença de entesófitos coracoacromiais (Q= 0.67; p< 0.05), degeneração glenoumeral (Q= 0.97; p< 0.05) e acromioclavicular (Q= 0.96; p< 0.05). Também foram descobertas associações entre a presença de entesófitos com espaços subacromiais (rpb= -0.22; p< 0.05) e glenoumerais (rpb= -0.44; p< 0.05) diminuídos e com distâncias acromiais postero-anteriores aumentadas (rpb= 0.23; p< 0.05). Os acrómios com entesófitos exibiam frequentemente, nas suas superfícies caudais, sinais de remodelação óssea com formato de pequenas “facetas” ovoides. Globalmente, conceitos nas áreas da biologia óssea, da evolução e biomecânica do ombro auxiliam a compreensão das associações verificadas neste estudo
Fanton, Ricardo H.t. - One of the best experts on this subject based on the ideXlab platform.
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Radiographic and ultrasonographic evaluation of the podotrochlear apparatus in American Quarter horses diagnosed with navicular syndrome
Colégio Brasileiro de Patologia Animal - CBPA, 2010Co-Authors: Peixoto, Cintia I.c. [unesp], Vulcano, Luis C. [unesp], Machado, Vânia M.v. [unesp], Alves, Ana Liz Garcia [unesp], Fanton, Ricardo H.t.Abstract:O objetivo deste estudo foi avaliar as alterações do aparato podotroclear de 22 cavalos da raça Quarto de Milha acometidos pela síndrome do navicular utilizando o acesso transcuneal. Esses equinos foram submetidos ao exame radiográfico e ultrassonográfico. No exame radiográfico foi observado a presença de invaginação sinovial de diferentes tipos, além de calcificação da bursa podotroclear e tendão flexor digital profundo, entesiófitos, osteófitos e alteração do limite córtico-medular. No exame ultrassonográfico observou-se alterações da bursa podotroclear, aderência e irregularidades nos bordos do tendão flexor digital profundo, diminuição do coxim digital, calcificação do ligamento sesamóide distal ímpar e irregularidade da superfície flexora do osso sesamóide distal. Todos os equinos que apresentavam alterações radiográficas também apresentaram alterações no exame ultrassonográfico compatíveis com a síndrome do navicular. O exame ultrassonográfico utilizando o acesso transcuneal foi um método prático e eficiente para avaliação das lesões do aparato podotroclear dos eqüinos, sendo um método complementar ao exame radiográfico.The objective of this study was to evaluate radiographically and ultrasonographically the podotrochlear apparatus using a transcuneal approach in 22 American Quarter horses suffering from navicular syndrome. on the radiographs, different forms of synovial invaginations, calcification of the podotrochlear bursa and deep digital flexor tendon, Enthesophyte and osteophyte formation, and changes in the cortical-medullary margin were observed. on the ultrasound scans, changes of the podotrochlear bursa, adhesions and irregularities at the surface of the deep digital flexor tendon, the digital cushion area reduction, calcification of the impar distal sesamoideal ligament, and irregularities of the flexor surface of the distal sesamoid bone were observed. Radiographic and ultrasonographic abnormalities compatible with navicular syndrome were present in all patients. Ultrasonography using transcuneal approach was a practical and efficient method to evaluate podotrochlear apparatus injuries in equine, thus being a complementary method to radiography
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Avaliação radiográfica e ultrassonográfica do aparato podotroclear de cavalos Quarto de Milha diagnosticados com síndrome do navicular
Colégio Brasileiro de Patologia Animal - CBPA, 2010Co-Authors: Peixoto, Cintia I.c., Vulcano, Luis C., Machado, Vânia M.v., Alves, Ana Liz Garcia, Fanton, Ricardo H.t.Abstract:O objetivo deste estudo foi avaliar as alterações do aparato podotroclear de 22 cavalos da raça Quarto de Milha acometidos pela síndrome do navicular utilizando o acesso transcuneal. Esses equinos foram submetidos ao exame radiográfico e ultrassonográfico. No exame radiográfico foi observado a presença de invaginação sinovial de diferentes tipos, além de calcificação da bursa podotroclear e tendão flexor digital profundo, entesiófitos, osteófitos e alteração do limite córtico-medular. No exame ultrassonográfico observou-se alterações da bursa podotroclear, aderência e irregularidades nos bordos do tendão flexor digital profundo, diminuição do coxim digital, calcificação do ligamento sesamóide distal ímpar e irregularidade da superfície flexora do osso sesamóide distal. Todos os equinos que apresentavam alterações radiográficas também apresentaram alterações no exame ultrassonográfico compatíveis com a síndrome do navicular. O exame ultrassonográfico utilizando o acesso transcuneal foi um método prático e eficiente para avaliação das lesões do aparato podotroclear dos eqüinos, sendo um método complementar ao exame radiográfico.The objective of this study was to evaluate radiographically and ultrasonographically the podotrochlear apparatus using a transcuneal approach in 22 American Quarter horses suffering from navicular syndrome. on the radiographs, different forms of synovial invaginations, calcification of the podotrochlear bursa and deep digital flexor tendon, Enthesophyte and osteophyte formation, and changes in the cortical-medullary margin were observed. on the ultrasound scans, changes of the podotrochlear bursa, adhesions and irregularities at the surface of the deep digital flexor tendon, the digital cushion area reduction, calcification of the impar distal sesamoideal ligament, and irregularities of the flexor surface of the distal sesamoid bone were observed. Radiographic and ultrasonographic abnormalities compatible with navicular syndrome were present in all patients. Ultrasonography using transcuneal approach was a practical and efficient method to evaluate podotrochlear apparatus injuries in equine, thus being a complementary method to radiography
David Shahar - One of the best experts on this subject based on the ideXlab platform.
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Prominent exostosis projecting from the occipital squama more substantial and prevalent in young adult than older age groups
Scientific Reports, 2018Co-Authors: David Shahar, Mark G.l. SayersAbstract:Recently we reported the development of prominent exostosis young adults’ skulls (41%; 10–31 mm) emanating from the external occipital protuberance (EOP). These findings contrast existing reports that large Enthesophytes are not seen in young adults. Here we show that a combination sex, the degree of forward head protraction (FHP) and age predicted the presence of enlarged EOP (EEOP) (n = 1200, age 18–86). While being a male and increased FHP had a positive effect on prominent exostosis, paradoxically, increase in age was linked to a decrease in Enthesophyte size. Our latter findings provide a conundrum, as the frequency and severity of degenerative skeletal features in humans are associated typically with aging. Our findings and the literature provide evidence that mechanical load plays a vital role in the development and maintenance of the enthesis (insertion) and we suggest possible associations between aberrant loading of the EOP enthesis, sustained poor posture and EEOP formation. Accordingly, the higher numbers of individuals with EEOP in the 18-30 age group out of all cases examined raises concern about the future musculoskeletal health of this population and suggests a potential avenue for prevention intervention through posture improvement education.
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a morphological adaptation the prevalence of enlarged external occipital protuberance in young adults
Journal of Anatomy, 2016Co-Authors: David Shahar, Mark G.l. SayersAbstract:Enthesophytes are bony projections that arise from the sites of ligament, tendon or joint capsule attachment to a bone. They are seen rarely in radiographic findings in young adults, as these bony adaptations are assumed to develop slowly over time. However, in recent years, the presence of an enlarged external occipital protuberance (EEOP) has been observed frequently in radiographs of relatively young patients at the clinic of the lead author. Accordingly, the aim of this project was to assess the prevalence of an EEOP in a young adult population. Analysis involved a retrospective analysis of 218 lateral cervical radiographic studies of 18–30-year-old participants. Group A (n = 108; males = 45, females = 63) consisted of asymptomatic university students, while Group B (n = 110; males = 50, females = 60) were an age-matched mildly symptomatic, non-student population. The external occipital protuberance (EOP) size was defined as the distance from the most superior point of the EOP (origin) to a point on the EOP that is most distal from the skull. To avoid ambiguity, the threshold for recording the size of an EOP was set at 5 mm, and an EOP was classified as enlarged if it exceeded 10 mm. Reliability testing was also undertaken. Results indicated that an EEOP was present in 41% of the total population, with 10% of all participants presenting with an EOP ≥ 20 mm. An EEOP was significantly more common in males (67.4%) than in females (20.3%), with the mean EEOP size for the combined male population (15 ± 7 mm) being significantly larger (P < 0.001) than for females (10 ± 4 mm). The longest EEOP in the male population was 35.7 mm, while in the female population it was 25.5 mm. Additionally, the mean EEOP size for Group A (14 ± 7 mm) was also significantly greater (P = 0.006) than that recorded for Group B (12 ± 6 mm). This study identified that an EEOP is a condition that is prevalent in the populations tested. The age of the populations, and the prevalence of EEOP, suggest that biomechanical drivers for this phenomenon may be the main reason for this condition in these populations.
Annamaria Iagnocco - One of the best experts on this subject based on the ideXlab platform.
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defining enthesitis in spondyloarthritis by ultrasound results of a delphi process and of a reliability reading exercise
Arthritis Care and Research, 2014Co-Authors: Lene Terslev, Annamaria Iagnocco, Peter V Balint, Philippe Aegerter, Esperanza Naredo, Richard J Wakefield, Sibel Zehra Aydin, Artur Bachta, Hilde Berner Hammer, George Arthur Willem BruynAbstract:Objective To standardize ultrasound (US) in enthesitis. Methods An initial Delphi exercise was undertaken to define US-detected enthesitis and its core components. These definitions were subsequently tested on static images taken from spondyloarthritis patients in order to evaluate their reliability. Results Excellent agreement (>80%) was obtained for including hypoechogenicity, increased thickness of the tendon insertion, calcifications, Enthesophytes, erosions, and Doppler activity as core elementary lesions of US-detected enthesitis. US definitions were subsequently obtained for each elementary component. On static images, the intraobserver reliability showed a high degree of variability for the detection of elementary lesions, with kappa coefficients ranging from 0.13–1. The interobserver kappa values were variable, with the lowest kappa coefficient for Enthesophytes (0.24) and the highest coefficient for Doppler activity at the enthesis (0.63). Conclusion This is the first consensus-based US definition of enthesitis and its elementary components and the first step performed to ensure a higher degree of homogeneity and comparability of results between studies and in daily clinical work.
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ultrasound imaging for the rheumatologist xlv ultrasound of the shoulder in psoriatic arthritis
Clinical and Experimental Rheumatology, 2013Co-Authors: L. Riente, Delle A. Sedie, E. Filippucci, Annamaria Iagnocco, G. Sakellariou, R. Talarico, L. Carli, L. Di Geso, Fulvia Ceccarelli, S. BombardieriAbstract:OBJECTIVES: The aims of this study were to investigate the prevalence of ultrasound (US) pathologic abnormalities in the shoulders of psoriatic arthritis (PsA) patients and to compare them with the main clinical findings. METHODS: Ninety-seven PsA patients were enrolled in the study. The subacromial/subdeltoid bursa, the sheath of the long biceps tendon, the glenohumeral joint and the acromion-clavicular joint were examined for the presence of synovial effusions and synovial hypertrophy. Rotator cuff tendons (supraspinatus, subscapularis, infraspinatus) were imaged for tendinosis, calcifications and total or partial tears, while deltoid enthesis were evaluated for local enthesitis and the lesser and greater tuberosity of the humerus for the presence of Enthesophytes. RESULTS: Tendinosis represented the most frequent abnormal finding. Supraspinatus tendinosis was detected more often than subscapularis and infraspinatus tendinosis. When considering tendon tear, supraspinatus was also the most frequently involved anatomical structure. Clinical examination frequently failed to detect abnormalities in patients in whom US examination showed pathological findings. This is particularly true for tendon involvement, i.e. effusion within the sheath of the biceps tendon was imaged in 43 shoulders but clinical assessment reported abnormalities only in 22 shoulders (p<0.0001). CONCLUSIONS: US examination appears to be a useful and sensitive imaging technique, specifically in identifying joint and tendon involvement of the shoulder.
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Ultrasound imaging for the rheumatologist XLV. Ultrasound of the shoulder in psoriatic arthritis
2013Co-Authors: L. Riente, Delle A. Sedie, E. Filippucci, Annamaria Iagnocco, G. Sakellariou, R. Talarico, L. Carli, L. Di Geso, Fulvia Ceccarelli, S. BombardieriAbstract:Objectives. The aims of this study were to investigate the prevalence of ultrasound (US) pathologic abnormalities in the shoulders of psoriatic arthritis (PsA) patients and to compare them with the main clinical findings. Methods. Ninety-seven PsA patients were enrolled in the study. The subacromial/ subdeltoid bursa, the sheath of the long biceps tendon, the glenohumeral joint and the acromion-clavicular joint were examined for the presence of synovial effusions and synovial hypertrophy. Rotator cuff tendons (supraspinatus, subscapularis, infraspinatus) were imaged for tendinosis, calcifications and total or partial tears, while deltoid enthesis were evaluated for local enthesitis and the lesser and greater tuberosity of the humerus for the presence of Enthesophytes. Results. Tendinosis represented the most frequent abnormal finding. Supraspinatus tendinosis was detected more often than subscapularis and infraspinatus tendinosis. When considering tendon tear, supraspinatus was also the most frequently involved anatomical structure. Clinical examination frequently failed to detect abnormalities in patients in whom US examination showed pathological findings. This is particularly true for tendon involvement, i.e. effusion within the sheath of the biceps tendon was imaged in 43 shoulders but clinical assessment reported abnormalities only in 22 shoulders (p
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clinical and ultrasonography assessment of peripheral enthesitis in ankylosing spondylitis
Rheumatology, 2011Co-Authors: Antonio Spadaro, Annamaria Iagnocco, Fabio Massimo Perrotta, M Modesti, A Scarno, Guido ValesiniAbstract:Objective. The aim of this study was to compare clinical examination with power Doppler US (PDUS) in the detection of entheseal abnormalities in patients with AS. Methods. Thirty-six AS patients underwent clinical and PDUS examination of the following bilateral entheseal sites: common extensor tendon at its insertion at the lateral humeral epicondyle; gluteus tendons at their insertion at the greater trochanter; quadriceps tendon at its insertion at the superior pole of the patella; patellar tendon at its proximal insertion at the inferior pole of the patella; patellar tendon at its distal insertion at the tibial tuberosity; Achilles tendon at its insertion at the calcaneus; and plantar aponeuroses at its insertion at the calcaneus. Results. Clinical and PDUS examination revealed at least one abnormal enthesis in 23 (63.9%) and 35 (97.2%) AS patients, respectively. Furthermore, of 432 entheses examined in our 36 AS patients, 64 (14.8%) were considered abnormal by clinical examination and 192 (44.4%) by PDUS. US abnormalities most commonly found were Enthesophytes (31.7%), calcifications (33.7%), thickening (29.8%) and hypoechogenicity (26.6%). We found erosions and PD signals in 9.7 and 6% of examined entheseal sites, respectively. The evidence of entheseal abnormalities by clinical examination has a poor likelihood ratio (LR) for the presence of US abnormalities with vascularization (LR = 1.61), without vascularization (LR = 1.24) or erosions (LR = 1.51) at all sites. Conclusions. PDUS permits detection of structural and inflammatory abnormalities of the enthesis in AS and may complement the physical examination in order to better evaluate enthesitis.