Enthesopathy occurs where muscles, tendons, and ligaments meet bones or joint capsules. It commonly involves inflammation, hampered function, and degeneration within the affected tissues. The two main forms of enthesopathy are tendonitis and bursitis.
Tendonitis is inflammation of a tendon that may results from repetitive action that puts extra pressure on the tendon. Continued activity slows down the bodyâ€™s natural repair process, which results in more tearing and increased pain. It usually causes pain in the joint area, such as the wrists, elbows, knees, hips, heels, and shoulders.
Tendonitis is classified by the affected body area, or may be classified by the activity that frequently causes the pain (e.g., tennis elbow). Tendonitis is a common, and becomes more likely with age. Types of tendonitis include:
Achilles tendonitis: Occurs in the Achilles tendon in the foot, which is the largest and strongest tendon in the human body. It is commonly seen in runners, or in middle-aged patients who play sports such as tennis or basketball only on the weekends.
Adductor tendonitis: Affects the inner thigh, hip, and groin area and is common in athletes. Adductor muscles are particularly active during running and kicking.
Biceps tendonitis: Involves the tendons that connect the bicep muscles to the shoulders. It often occurs when the arms are repeatedly lifted above the head. Swimming, tennis, and baseball are common activities that can cause this injury.
Golferâ€™s elbow: Affects the inside of the elbow, forearm, and wrist. It is also called medial epicondylitis and is due to excess or repetitive stress, especially forceful wrist and finger motions.
Patellar tendonitis: Also referred to as jumperâ€™s knee; the patellar tendon helps the muscles extend the knee so that a person can kick a ball, run uphill, or jump in the air. It is common in athletes who jump a lot.
Posterior tibial tendon dysfunction: Also referred to as PTTD or adult-acquired flatfoot; it is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn.
Rotator cuff tendonitis: Affects the group of four tendons that cover the head of the humerus, holds the head of the humerus into the scapula, and controls movement of the shoulder joint. When the tendons become inflamed, they can become frayed due to shoulder movements. Rotator cuff tendonitis is the mildest form of rotator cuff injury.
Tennis elbow: Similar to golferâ€™s elbow, except that the outside of the elbow, forearm, and wrist are affected. It is caused by repetitive gripping, especially of the thumb and first two fingers, and is most common in people 30-50 years of age.
Trigger finger: Affects the tendons in the fingers or thumb. The flexor tendon can become irritated from sliding through the tendon sheath, which may cause the tendon sheath to thicken or form nodules that make it difficult for the tendon to pass through.
Wrist tendonitis: Also referred to as tenosynovitis. One or multiple tendons in the wrist may be affected, often at points where the tendons cross each other, or pass over a bony prominence.
Bursitis is a painful condition affecting the bursae, commonly caused by repetitive motions or positions that irritate the bursae, or minor impact from a sudden injury, which causes them to become inflamed. Bursitis is more commonly seen in adults, especially over the age of 40. Typical sites include:
Shoulder bursitis occurs when there is inflammation between the top of the humerus and the acromion. The rotator cuff and bursa lie between these bones. The tendons normally slide through the space with no problems, but in some patients the space becomes too narrow for normal motion. This causes irritation to the tendons and bursa, which become inflamed. Over time, this causes the space to become too narrow for the tendons and bursa.
Elbow bursitis occurs when the olecranon bursa, which lies between the loose skin and the olecranon, becomes irritated or inflamed. Diseases such as rheumatoid arthritis and gout are also associated with elbow bursitis.
Hip bursitis affects the bursa that sits over the greater trochanter of the femur, causing sharp pain at the hip. There is another bursa on the inside of the hip called the iliopsoas bursa, which can also become inflamed, although it is not as common as the trochanteric bursitis in the hip.
Knee bursitis is an inflammation of the pes anserine bursa, located between the tibia and three tendons of the hamstring muscle, at the inside of the knee. This is typically an overuse injury.
Heel bursitis is inflammation of the retrocalcaneal bursa that is located at the back of the calcaneus (the heel bone), under the Achilles tendon, where it connects the calf muscles to the calcaneus. It is sometimes mistaken for Achilles tendinitis .
Documentation and Code Selection
Good clinical documentation should indicate the type of enthesopathy, the site, and laterality to assign the most appropriate code.
M70.1- Â Â Â Â Â Â Â Â Â Â Â Bursitis of hand
M70.2- Â Â Â Â Â Â Â Â Â Â Â Olecranon bursitis
M70.3- Â Â Â Â Â Â Â Â Â Â Â Other bursitis of elbow
M70.4- Â Â Â Â Â Â Â Â Â Â Â Prepatellar bursitis
M70.5- Â Â Â Â Â Â Â Â Â Â Â Other bursitis of knee
M70.6- Â Â Â Â Â Â Â Â Â Â Â Trochanteric bursitis
M70.7- Â Â Â Â Â Â Â Â Â Â Â Other bursitis of hip
M71 Â Â Â Â Â Â Â Â Â Â Â Other bursopathies
M75 Â Â Â Â Â Â Â Â Â Â Â Shoulder lesions
M76 Â Â Â Â Â Â Â Â Â Â Â Enthesopathies, lower limb, excluding foot
M77 Â Â Â Â Â Â Â Â Â Â Â Other enthesopathies
M06.2- Â Â Â Â Â Â Â Â Â Â Â Rheumatoid bursitis
M46.0- Â Â Â Â Â Â Â Â Â Â Â Spinal enthesopathy
M65.3- Â Â Â Â Â Â Â Â Â Â Â Trigger finger
Example: Jack, a runner, presents with pain in his feet and above his heels that starts mild and worsens while he runs. He stopped running for a few weeks and his pain subsided, but began again when he restarted his runs. He is diagnosed with bilateral achilles tendonitis.
Two codes are necessary to indicate this bilateral condition: M76.61 Achilles tendinitis, right leg and M76.62 Achilles tendinitis, left leg
Example: A 50-year-old patient presents with pain while moving his right shoulder or raising his arm above his head. He states he hears a crunching noise when he moves the shoulder. After X-ray and MRI, he is diagnosed with shoulder bursitis