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In Search of Consensus: Terminology for Entheseal Changes (EC)

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In Search of Consensus: Terminology for Entheseal Changes (EC) In search of consensus: Terminology for entheseal changes (EC) Sébastien Villotte, Sandra Assis, Francisca Alves Cardoso, Charlotte Yvette Henderson, Valentina Mariotti, Marco Milella, Doris Pany-Kucera, Nivien Speith, Cynthia Wilczak, Robert Jurmain To cite this version: Sébastien Villotte, Sandra Assis, Francisca Alves Cardoso, Charlotte Yvette Henderson, Valentina Mariotti, et al.. In search of consensus: Terminology for entheseal changes (EC). International Journal of Paleopathology, Elsevier, 2016, 13, pp.49-55. 10.1016/j.ijpp.2016.01.003. hal-02266502 HAL Id: hal-02266502 https://hal.archives-ouvertes.fr/hal-02266502 Submitted on 19 Feb 2021 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. *Manuscript Click here to view linked References TECHNICAL NOTE 1 2 3 Title: In Search of Consensus: Terminology for Entheseal Changes (EC) 4 Short title: Terminology for EC 5 6 Authors and Affiliations: 7 8 9 Sébastien Villotte 10 Anthropologie des Populations Passées et Présentes, UMR 5199 PACEA, Bâtiment B8, Allée Geoffroy Saint 11 12 Hilaire, Université de Bordeaux, CS, 50023, Pessac Cedex, France 33615 13 [email protected] 14 15 16 Sandra Assis 17 18 CIAS – Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, 19 20 Portugal. 21 [email protected] 22 23 24 Francisca Alves Cardoso 25 26 NOVA CRIA – Centre for Research in Anthropology, Faculty of Social Sciences and Humanities, Universidade 27 NOVA de Lisboa, Portugal. 28 29 [email protected] 30 31 32 Charlotte Yvette Henderson 33 CIAS – Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, 34 Portugal. 35 36 [email protected] 37 38 39 Valentina Mariotti 40 1-Laboratorio di Bioarcheologia ed Osteologia Forense - Antropologia – Dipartimento di Scienze Biologiche, 41 42 Geologiche e Ambientali - Alma Mater Studiorum Università di Bologna,Via Selmi 3, 40126 Bologna. 43 2- ADÉS, UMR 7268 CNRS/Aix-Marseille Université/EFS, Aix-Marseille Université, CS80011, Bd Pierre 44 45 Dramard, 13344 Marseille Cedex 15 (France). 46 47 [email protected] 48 49 50 Marco Milella 51 52 Anthropological Institute & Museum, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland. 53 [email protected] 54 55 56 Doris Pany-Kucera 57 58 Natural History Museum Vienna, Department of Anthropology/Institute for Oriental and European Archaeology, 59 Austrian Academy of Sciences, Vienna, Austria 60 61 62 63 64 65 [email protected] 1 2 3 Nivien Speith 4 Department of Archaeology, Anthropology and Forensic Science, Bournemouth University, Talbot Campus, 5 6 Fern Barrow, Poole BH12 5BB, UK 7 [email protected] 8 9 10 Cynthia A Wilczak 11 12 Department of Anthropology, San Francisco State University, San Francisco, CA USA 13 [email protected] 14 15 16 Robert Jurmain 17 18 Department of Anthropology, San Jose State University, San Jose, CA USA 19 [email protected] 20 21 22 23 24 Corresponding author: 25 Sébastien Villotte, 26 27 Anthropologie des Populations Passées et Présentes, UMR 5199 PACEA, Bâtiment B8, Allée Geoffroy Saint 28 29 Hilaire, Université de Bordeaux, CS, 50023, Pessac Cedex, France 33615 30 31 32 Abstract 33 This article presents a consensus terminology for entheseal changes that was developed in English by an 34 35 international team of scholars and then translated into French, Italian, Portuguese, Spanish and German. Use of a 36 standard, neutral terminology to describe entheseal morphology will reduce misunderstandings between 37 38 researchers, improve the reliability of comparisons between studies, and eliminate unwarranted etiological 39 assumptions inherent in some of the descriptive terms presently used in the literature. 40 41 42 Keywords: Enthesis; terminology; Fibrocartilaginous enthesis; spondyloarthropathies; diffuse idiopathic skeletal 43 44 hyperostosis (DISH) 45 46 47 Abbreviations: 48 Entheseal change: EC 49 50 Fibrocartilaginous enthesis: FCE 51 52 53 1. Introduction 54 55 56 “Musculoskeletal stress markers”, renamed “entheseal changes” (ECs) by Jurmain and Villotte (2010), have 57 58 been widely studied in past populations as indicators of activity and social divisions of labor (e.g. Dutour, 1986; 59 Hawkey and Merbs, 1995; Robb, 1998; Villotte et al., 2010a; Havelková et al., 2011, 2013; Lieverse et al., 2013; 60 61 62 63 64 65 Villotte and Knüsel, 2014). However, the problem of oversimplified etiological interpretations that primarily 1 equated EC with increased muscle use became widely apparent at a workshop held in 2009 in Coimbra, Portugal 2 3 (Santos et al., 2011). Discussions at this meeting led to the establishment of three working groups aimed at 4 standardizing key EC research aspects, namely terminology, recording methodology, and the understanding of 5 6 definitions of occupation. The three working groups met again in Coimbra at a new workshop in 2013. 7 8 This technical note focuses on the results from the terminology working group (SV, RJ). A survey of researchers 9 10 taken prior to the 2013 workshop clearly showed the need for standardized descriptions of ECs. Only one third 11 of respondents described the EC in Figure 1c using the same term (Table 1), and a similar lack of consensus was 12 13 found for other types of ECs. During the 2013 workshop, the terminology working group compiled an initial list 14 of neutral terms and descriptions of the most common EC types. The terms proposed by this group have been 15 16 discussed with the members of the other working groups (SA, FAC, CYH, VM, MM, DPK, NS, CAW), and a 17 consensus was finally reached. The terminology proposed here includes neutral (i.e. without inherent etiological 18 19 concepts), descriptive terms with figures (Fig. 1 and 2, see also Table 2 for other illustrations of the EC defined 20 here in previous publications by the authors), which researchers can use to describe ECs arising from any 21 22 etiology, including those associated with pathological conditions, e.g. the seronegative spondyloarthropathies or 23 diffuse idiopathic skeletal hyperostosis. It should be noted that similar changes can occur at other anatomical 24 25 locations (e.g. synovial joints), but this is outside the scope of this paper. The proposed terminology (Fig. 3), 26 alongside its translation into five major European languages (Table 2), should reduce communication barriers as 27 28 well as lead to improved data sharing amongst researchers if widely adopted. 29 30 31 32 TABLE 1 33 34 35 2. Proposed terminology 36 37 38 Two groups of entheses can be distinguished according to the tissue type present at the skeletal attachment site 39 (Benjamin et al., 1986, 2002; Cooper and Misol, 1970; see Villotte et al., 2010b for a list of the main post-cranial 40 41 fibrous and fibrocartilaginous entheses). A normal fibrocartilaginous enthesis (FCE) is smooth, well 42 circumscribed and devoid of vascular foramina (Benjamin et al., 2002; Henderson, 2009; Henderson et al., 2015; 43 44 Villotte, 2006, 2009; Villotte et al., 2010b); thus any alteration from this definition is considered an EC. For 45 46 fibrous entheses, for which there is no clear definition of a “normal” aspect, we consider a theoretical smooth 47 cortical surface as a base line (Henderson, 2009; Villotte, 2006, 2009). In the following text “fibrous entheses” 48 49 refers only to fibrous tendon attachment sites, and not to sites where fleshy muscle fibers attach to the 50 periosteum (e.g. the origin of tibialis anterior muscle). 51 52 We distinguished three main categories of EC: mineralized tissue formation, surface discontinuity, and complete 53 54 loss of original morphology with subcategories where appropriate (Fig. 3). Note that the definition of EC does 55 not include architectural variation (e.g. a more or less developed deltoid tuberosity, or “waving” of the surface 56 57 itself). 58 59 60 2.1. Mineralized tissue formation 61 62 63 64 65 The morphological change exceeds the level of the original surface, from roughness of the surface to a clear 1 structure of any size or shape. 2 3 4 2.1.1. Diffuse and non-protruding formation 5 6 Not clearly distinct from the surface of the enthesis. Two morphological subtypes are identified according to the 7 enthesis type. 8 9 10 2.1.1.1 Grained surface 11 12 A textural change of a diffuse granular nature (similar to fine grained sandpaper, Henderson et al., 2015) at FCEs 13 (Fig. 1a). The surface does not look as smooth as it is in unaltered FCEs, and it can feel roughened to the touch. 14 15 Based on a picture of a histological section of such a change (Fig. 6-11 and 6-63 in Schultz, 2003), this granular 16 texture is likely to be related to the mineralization of the uncalcified fibrocartilage.1 This type of change is 17 18 mainly seen at the ischial and radial tuberosities. 19 20 21 2.1.1.2 Diffuse cortical irregularity 22 The area is rough to the touch due to diffuse tissue formation (Fig. 1b). The surface looks well remodeled (i.e. 23 24 likely to be long standing). This is an extremely common feature at fibrous entheses and may be related to the 25 direct attachment of tendon fibers to bone (Villotte and Knüsel 2013). It is also seen at the margin (Zone 1 in 26 27 Henderson et al. 2013, see also Villotte, 2006) of FCEs, a region with little fibrocartilage.
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