Mander Enthesis Index (MEI) in Ankylosing Spondylitis

 

Patient selection: ankylosing spondylitis

 

Sites:

(1) single site (1)

(2) group sites (5)

(3) bilateral sites (12 sites on left and 12 on right)

 

Single site:

(1) manubriosternal joint

 

Group sites:

(1) costochondral junctions

(2) nuchal crests (superior nuchal line along the insertion of the trapezius)

(3) spinous processes of the cervical spine

(4) spinous processes of the thoracic spine

(5) spinous processes of the lumbar spine

 

Bilateral sites:

(1) greater tuberosity of the head of the humerus

(2) lateral epicondyle of the humerus at the elbow

(3) medial epicondyle of the humerus at the elbow

(4) iliac crest

(5) anterior superior iliac spine

(6) posterior superior iliac spine

(7) ischial tuberosity

(8) greater trochanter of the femur

(9) lateral condyle of the femur

(10) medial condyle of the femur

(11) Achilles tendon insertion into the calcaneus

(12) plantar fascia insertion into the calcaneus

 

where:

• The textual description of the sites is a little ambiguous. The listing above seems the only way to achieve the maximum score of 90 that all sources refer to.

Pain and Tenderness at Each Site	Points
none	0
mild tenderness	1
moderate tenderness	2
wince or withdraw (severe tenderness)	3

 

The scoring for a group site was based on the maximum pain/tenderness reading for all sites in the group.

 

total score =

= SUM(points for all sites)

 

Interpretation:

• minimum score: 0

• maximum score: 90

• The higher the score the greater the enthesis.