Do diseases cause entheseal changes at fibrous entheses?

Fibrous entheses have been widely used to study activity-related stress to infer behavioural patterns in past populations. Unlike their fibrocartilaginous counterparts, the effect of disease processes has been less widely discussed in the osteoarchaeological literature. This study uses a literature review to ascertain whether specific pathological changes should be taken into account when recording fibrous entheses. Due to the anatomical structure of fibrous entheses it was hypothesised that diseases which affect the structure of bone or the periosteum might be a factor in causing entheseal changes. A search of over one hundred terms was performed in PubMed with no year range stipulated, but no papers were found which related to entheseal changes caused by any of the expected pathological processes. The paucity of literature might be due to lack of symptoms in living individuals, it is therefore suggested that a systematic study of skeletal remains is performed using recently developed recording methods to determine if pathological conditions need to be taken into account when recording entheseal changes to study activity-related stress. The search did highlight a link between calcific tendinitis and cortical erosion at fibrous entheses, and it is recommended that this is taken into account when interpreting entheseal changes in past populations.