Enthesopathies as occupational stress markers: Evidence from the upper limb

Abstract

Enthesopathies--that is, "musculo-skeletal stress markers"--are frequently used to reconstruct past lifestyles and activity patterns. Relatively little attention has been paid in physical anthropology to methodological gaps implicit in this approach: almost all methods previously employed neglect current medical insights into enthesopathies and the distinction between healthy and pathological aspects has been arbitrary. This study presents a new visual method of studying fibrocartilaginous enthesopathies of the upper limb (modified from Villotte: Bull Mém Soc Anthropol Paris n.s. 18 (2006) 65-85), and application of this method to 367 males who died between the 18th and 20th centuries, from four European identified skeletal collections: the Christ Church Spitalfields Collection, the identified skeletal collection of the anthropological museum of the University of Coimbra, and the Sassari and Bologna collections of the museum of Anthropology, University of Bologna. The analysis, using generalized estimating equations to model repeated binary outcome variables, has established a strong link between enthesopathies and physical activity: men with occupations involving heavy manual tasks have significantly (P-value < 0.001) more lesions of the upper limbs than nonmanual and light manual workers. Probability of the presence of an enthesopathy also increases with age and is higher for the right side compared with the left. Our study failed to distinguish significant differences between the collections when adjusted for the other effects. It appears that enthesopathies can be used to reconstruct past lifestyles of populations if physical anthropologists: 1) pay attention to the choice of entheses in their studies and 2) use appropriate methods.

Enthesopathic patterns of two South African female cadavers

“…Mariotti et al [14] and Villotte et al [21] stated that osteophytic enthesopathies are generally more pronounced in elderly individuals, a finding which reflected unilaterally in both cases of this report. As a result, Villotte et al [21] reported that the incidence of enthesopathies were higher on the right side than on the left side. Although the frequency of enthesopathies is deemed to be greater in males, this report was notably focused on females [14].…”

“…The "activity-specific" nature of the upper limb osteology is the focal point in bioarchaeology for the geo-social exploration of ancient human civilizations [11,14,21]. Recent studies have redefined the enthesis as an organ comprising of interconnected anatomical tissue performing the common function of stress dissipation [15,20].…”

“…9, 17]. Although enthesopathies are considered to be important musculoskeletal markers of human skeletal remains in the field of paleontology, the clinical focus is attributed to the underlying traumatic, metabolic, inflammatory, degenerative and endocrine diseases [1,9,11,17,21,22]. Mariotti et al [14] described enthesopathies as osteophytic, displaying proliferative change, and osteolytic, that of which is characterised by erosion.…”

The Coimbra Workshop in Musculoskeletal Stress Markers (MSM): an annotated review

“…These entheseal changes include surface irregularity, hyperostotic reactions (i.e. enthesophytes), osteolytic reactions (erosions) and neo vascularization (Mariotti et al, 2004(Mariotti et al, , 2007Cardoso and Henderson, 2010;Villotte et al, 2010).…”

“…Descriptions of other attempts to reconstruct past behaviours from bone analysis can be found in Jurmain (1999) and in Pearson and Buikstra (2006). After the Workshop, several papers that discussed the occurrence of entheseal changes in known occupation samples (Alves- Cardoso and Henderson, 2010;Niinimäki, in press;Villotte et al, 2010) and archaeological samples (Molnar, 2010;Molnar et al, in press) have been published.…”