EQUINE VETERINARY EDUCATION / AE / MAY 2019
effects of ESWT when used in three successive treatments for back pain (DSPs, caudal thoracic arthropathy, supraspinous ligament strains, or non-specific soft tissue pain). The three treatments provided analgesia for up to 5 months, depending on the horse. Allen et al. (2010), showed improvement in 89% of 74 horses treated for back pain; 30% of horses improved for 2–4 months, 28% of horses improved for 4–6 months, and 31% of horses improved for >6 months. These horses were treated with multiple modalities and no control horses were used, so it cannot be determined how much of a role ESWT played in these horses’ improvement. It should also be noted that these parameters were based on anecdotal experience, not experimental evidence, so can be used a guideline, but have not been scientifically proven as treatment parameters.
Specific literature recommendations • Proximal suspensory ligament injury (hindlimb)
○ Crowe et al. (2004) reported faster resolution of lameness in horses treated with RPWT compared to
horses in a previous study treated with rest and gradual return to exercise alone. Horses received three total treatments (time 0, 2, and 4 weeks after initial diagnosis) of 2000 pulses at 10 Hz (1000 pulses applied to each the medial and lateral aspects of the limb, directed towards the plantar aspect of MTIII; Swiss Dolorclast Vet5).
○ Caminoto et al. (2005) reported increased
production of TGF-b1, greater decrease in proportion of the affected ligament, and faster filling of the defects in those limbs treated with ESWT compared to untreated limbs. Horses received three total treatments, 3 weeks apart; 1500 pulses were applied with an energy of 0.15 mJ/mm2; 500 pulses to the medial and lateral aspects of the lesion with a 5 mm probe, and 500 pulses to the plantar aspect of the lesion with a 35 mm probe (Versatron2).
• Proximal suspensory ligament injury (forelimb)
○ McClure et al. (2004) and McClure and Evans (2002) reported faster filling of PSD lesions and decrease in percentage of cross sectional area on ultrasonographic examination with three treatments, 3 weeks apart. Each treatment consisted of 500 pulses from the palmar aspect of the limb with a 35 mm probe, and 500 pulses from palmar–medial and palmar–lateral directions with a 5 mm probe, for total of 1500 pulses. In one study (McClure et al. 2004), these pulses were administered at 0.14 mJ/ mm2, and in a second study (McClure and Evans 2002) at 0.13 mJ/mm2 (Equitron2).
• ALDDFT
○ Waguespack et al. (2011) showed no significant ultrasonographic or ligament microstructure changes in ESWT-treated limbs in a collagenase-induced model. Each treatment consisted of 500 pulses at 0.15 mJ/mm2 using a 20 mm probe, directed to the medial and lateral aspect of the limb, palmar to the second and fourth metacarpal bones. Three treatments were performed, 3 weeks apart (Versatron2).
• Superficial digital flexor tendonitis (forelimb) ○ Kersh
et al.
275
(2006) showed increased
neovascularisation, but no ultrasonographic changes in treated vs. untreated horses using three treatments, 3 weeks apart. Each treatment was with a 5 mm probe, using 1500 pulses at 0.14 mJ/mm2 (Equitron2).
• Back pain
○ Allen et al. (2010) reported ESWT guidelines for spinous process impingement (SPI) and dorsal articular process (DAP) osteoarthritis cases (based on anecdotal evidence). For SPI, a 35 mm probe was used axially and abaxially over the entire length of the thoracolumbar spinous processes. For DAP, an 80 mm probe was used abaxially over the left and right sides of the vertebral column. These treatments were performed with 1000–2000 pulses per session at the highest energy level available. Horses had 2 days rest following each treatment, followed by 3–5 days of gradual return to exercise. Further therapy was anywhere from 4 to 12 months apart, based on response (Versatron2).
○ McClure and Weinberger (2003) provided guidelines based on anecdotal treatment successes: for horses
with bone sclerosis of the DSPs, 50 pulses at an energy setting of 0.15 mJ/mm2 with a 35 or 80 mm probe was performed on both right and left sides for every 1 cm length of bony sclerosis. Five treatments were performed at 2–4 week intervals over 1–3 months.
Conclusions
The use of ESWT in soft tissue injuries in horses has been shown to be beneficial in healing certain injuries and provides an analgesic effect. ESWT can be successfully used to treat proximal suspensory ligament injuries, both in returning horses to performance faster, and filling of defects when examined ultrasonographically. ESWT may help to fill in defects in the SDFT more quickly, but no conclusion can be made regarding the degree of lameness or return to function. The evidence for ESWT successfully treating injuries to the ALDDFT is limited, so we do not feel a conclusion can be made regarding ESWT as an appropriate treatment for these injuries. Horses treated with ESWT for back pain were noted to have less back pain; however, many of these horses were simultaneously treated with other therapies, so the benefitof ESWT alone cannot be definitively determined. Extracorporeal shockwave therapy (ESWT) can be a safe
and successful therapy depending on the anatomical region treated, severity of injury, and interactions of other treatments being performed on the horse. Specific treatment protocols validating energy settings, probes, and the number of pulses to be applied per therapy have yet to be determined in a research setting. Further research may be able to help specify what settings provide both faster and more effective healing of injuries, and may help to determine at what interval ESWT should be applied. Researching the timing of ESWT in cases where regenerative biological therapies are used would be important in determining appropriate ESWT protocols. Comparing horses treated with ESWT alone to horses treated
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