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Khairoun A, Hawkins JF, Moore GE, Lescun TB, Adams SB. Electrohydraulic shockwave for treatment of forelimb superficial digital flexor tendinitis and proximal suspensory desmitis in horses. J Equine Vet Sci 2023:104504. [PMID: 37120117 DOI: 10.1016/j.jevs.2023.104504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
Superficial digital flexor tendinitis (SDFT) and proximal suspensory desmitis (PSD) are common causes of lameness in horses. Current treatment options include rest, controlled exercise, administration of anti-inflammatories, intralesional injections, surgery, and electrohydraulic shock wave therapy (ESWT). ESWT is safe, noninvasive, and is used to treat a variety of musculoskeletal abnormalities. Medical records between 2010 and 2021 were reviewed. Horses were separated into two categories: (group 1: ≥ 3 ESWT treatments; group 2: < 3 ESWT treatments). Our objective was to examine the effect of the number of ESWT treatments in the management of SDFT and PSD injuries and to compare short- and long-term outcomes for the two groups. For group 1, lameness scores between the first and third treatments were significantly reduced in both PSD (p<0.0001) and SDFT (p=0.016) horses. However, neither the PSD (p=0.062) nor SDFT's (p=0.125) ultrasound findings were significantly different at the end of the third treatment. Horses with PSD showed a significant improvement in forelimb lameness between the first and third treatments compared to hindlimb (p = 0.033). In the multivariable ordered logistic regression model, only time (months of follow-up) was significantly associated with a positive outcome (p=0.001) and there was no difference in short and long-term outcome between groups 1 and 2. Also, chronicity of injury was negatively associated with improvement of lameness (p=0.028).
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Affiliation(s)
- Ahmed Khairoun
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, 625 Harrison St., West Lafayette IN 47907 USA.
| | - Jan F Hawkins
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, 625 Harrison St., West Lafayette IN 47907 USA
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, 625 Harrison St., West Lafayette IN 47907 USA
| | - Timothy B Lescun
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, 625 Harrison St., West Lafayette IN 47907 USA
| | - Stephen B Adams
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, 625 Harrison St., West Lafayette IN 47907 USA
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Johnson SA, Richards RB, Frisbie DD, Esselman AM, McClure SR. Equine shock wave therapy ‐ where are we now? Equine Vet J 2022. [DOI: 10.1111/evj.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sherry A. Johnson
- Department of Clinical Sciences Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | | | - David D. Frisbie
- Department of Clinical Sciences Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - Angie M. Esselman
- Department of Clinical Sciences Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
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Garbin L, Soares A, Mendes H, Cassali G, Vasconcelos A, Faleiros R. Histological and immunohistochemical evaluation of two cell therapy protocols in equine suspensory ligament repair. ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-10683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This study aimed to histologically evaluate the quality of tissue repair in equine suspensory ligament treated with two cell therapy protocols. All four limbs of six animals were operated simultaneously to remove a fragment in each ligament using a skin biopsy punch. Two days later, intralesional injections were performed using bone marrow mononuclear fraction (BM group), cultivated cells derived from adipose tissue (AT group), saline (positive control group), or no treatment (negative control group), in such way that each horse received all treatments. After sixty days biopsies were performed for histological analysis (H & E, Masson’s trichrome and picrosirius red) and immunohistochemistry analysis (collagen type III). Histological findings (H & E and Masson’s trichrome), birefringence intensity (through picrosirius) and collagen type III expression (through immunohistochemistry) were analyzed. Samples from treated groups had better birefringence intensity (P=0.007) and fiber alignment scores were superior compared to controls, though not statistically significant (P=0.08). Presence of inflammatory cells and intense staining for collagen type III occurred in all groups demonstrating an active healing process. In conclusion, both protocols resulted in improvement of tissue repair indicating their potential to be used as an adjuvant treatment of equine suspensory ligament disorders.
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Affiliation(s)
- L.C. Garbin
- University of the West Indies, Trinidad &Tobago
| | - A.S. Soares
- Universidade Federal de Minas Gerais, Brazil
| | - H.M.F. Mendes
- Universidade Federal do Vale do Jequitinhonha e Mucuri, Brazil
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Yocom AF, Bass LD. Review of the application and efficacy of extracorporeal shockwave therapy in equine tendon and ligament injuries. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.12780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. F. Yocom
- Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins Colorado USA
| | - L. D. Bass
- Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins Colorado USA
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Ortved KF. Regenerative Medicine and Rehabilitation for Tendinous and Ligamentous Injuries in Sport Horses. Vet Clin North Am Equine Pract 2018; 34:359-373. [DOI: 10.1016/j.cveq.2018.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Gutierrez-Nibeyro SD, McCoy AM, Selberg KT. Recent advances in conservative and surgical treatment options of common equine foot problems. Vet J 2018; 237:9-15. [PMID: 30089549 DOI: 10.1016/j.tvjl.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 12/25/2022]
Abstract
Foot problems are very common causes of lameness in horses. With the recent diagnostic advances to evaluate and treat foot pathology as well as to monitor response to therapy, it is now possible to more accurately evaluate the effectiveness of many of these treatments. This review details some of the recent advances of the most common conservative and surgical treatment options for foot problems in horses, including an overview of evidence on the efficacy to support the use of these treatment options and on factors that may affect prognosis.
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Affiliation(s)
- S D Gutierrez-Nibeyro
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA.
| | - A M McCoy
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA
| | - K T Selberg
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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Comparison of autogenous cancellous bone grafting and extra-corporeal shock wave therapy on osteotomy healing in the tibial tuberosity advancement procedure in dogs. Vet Comp Orthop Traumatol 2017; 28:207-14. [DOI: 10.3415/vcot-14-10-0156] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/11/2015] [Indexed: 11/17/2022]
Abstract
SummaryObjectives: To compare optical values in the osteotomy gap created after a tibial tuberosity advancement (TTA) treated with autogenous cancellous bone graft, extracorporeal shock wave therapy, a combination of auto-genous cancellous bone graft and extra -corporeal shock wave therapy, and absence of both autogenous cancellous bone graft and extracorporeal shock wave therapy using densitometry.Methods: Dogs that were presented for surgical repair of a cranial cruciate ligament rupture were randomly assigned to one of four groups: TTA with autogenous cancellous bone graft (TTA-G), TTA with autogenous cancellous bone graft and extracorporeal shock wave therapy (TTA-GS), TTA with extracorporeal shock wave therapy (TTA-S), and TTA with no additional therapy (TTA-O). Mediolateral radiographs at zero, four and eight weeks after surgery were evaluated to compare healing of the osteotomy gap via densitometry. An analysis of variance was used to compare the densitometric values between groups.Results: At four weeks after surgery, a significant difference in osteotomy gap density was noted between TTA-GS (8.4 millimetres of aluminium equivalent [mmAleq]) and TTA-S (6.1 mmAleq), and between TTA-GS (8.4 mmAleq) and TTA-O (6.4 mmAleq). There were no significant differences noted between any groups at the eight week re-evaluation.Clinical significance: There were no significant differences in the osteotomy gap density at eight weeks after surgery regardless of the treatment modality used. The combination of autogenous cancellous bone graft and extracorporeal shock wave therapy may lead to increased radiographic density of the osteotomy gap in the first four weeks after surgery. Densitometry using an aluminium step wedge is a feasible method for comparison of bone density after TTA in dogs.
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A review of the cellular and molecular effects of extracorporeal shockwave therapy. Vet Comp Orthop Traumatol 2017; 29:99-107. [DOI: 10.3415/vcot-15-04-0057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 11/15/2015] [Indexed: 12/31/2022]
Abstract
SummaryExtracorporeal shockwave therapy (ESWT) is a novel therapeutic modality and its use in promoting connective tissue repair and analgesic effect has been advocated in the literature. It is convenient, cost-effective, and has negligible complications; it therefore bypasses many of the problems associated with surgical interventions. This paper reviews the proposed mechanisms of action in promoting tissue repair and regeneration as well as analysing its efficacy providing an analgesic effect in clinical applications. Further research will be required to not only identify the underlying mechanisms more precisely, but will also be critical for ensuring consistency across the literature so that the most beneficial treatment protocol can be developed. Extracorporeal shockwave therapy stands as a promising alternative modality in promoting tissue repair.
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Seabaugh KA, Thoresen M, Giguère S. Extracorporeal Shockwave Therapy Increases Growth Factor Release from Equine Platelet-Rich Plasma In Vitro. Front Vet Sci 2017; 4:205. [PMID: 29270410 PMCID: PMC5726030 DOI: 10.3389/fvets.2017.00205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/20/2017] [Indexed: 01/03/2023] Open
Abstract
Introduction Extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) are common treatments for soft tissue injuries in horses. Shockwave triggers cell specific responses to promote healing. Growth factors released from PRP also promote healing. It has been hypothesized that greater growth factor release would amplify the healing process. The combination of ESWT and PRP could promote healing in injured tendons and ligaments in the horse. The objective of this study was to determine if application of shockwaves to PRP samples increases the concentration of transforming growth factor-β1 (TGF-β1) and platelet-derived growth factor ββ (PDGF-ββ) released from the platelets in vitro. Materials and methods PRP was produced from blood drawn from six horses. The PRP from each horse was exposed to the following treatments: (1) positive control (freeze-thaw cycle), (2) untreated negative control, or shockwaves with either (3) a "standard probe" (ESWT-S) with a 2 cm focal width and medium energy density or (4) a "power probe" (ESWT-P) with a 1 cm focal width and high energy density. After each treatment, the samples were centrifuged, and the supernatant was harvested. The supernatant was then used for growth factor quantification via commercially available ELISA kits for TGF-β1 and PDGF-ββ. Results Concentrations of TGF-β1 and PDGF-ββ in PRP that underwent a freeze-thaw cycle were significantly increased compared with all other treatments. Both ESWT-S and ESWT-P resulted in significantly increased TGF-β1 concentrations, 46 and 33%, respectively, when compared with the negative control. Both ESWT-S and ESWT-P resulted in significantly increased PDGF-ββ concentrations, 219 and 190%, respectively, when compared with the negative control. Discussion These data indicate that the application of ESWT to PRP increases the expression of growth factors in vitro. This suggests that the combination therapy of local PRP injection followed by ESWT may stimulate release of growth factors from platelets after they have been injected into the area of injury. Conclusion The combination of PRP and ESWT might result in synergism of two modalities previously utilized individually for tendon and ligament injuries in horses.
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Affiliation(s)
- Kathryn A Seabaugh
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States.,Department of Large Animal Medicine, University of Georgia, Athens, GA, United States
| | - Merrilee Thoresen
- Department of Large Animal Medicine, University of Georgia, Athens, GA, United States.,Department of Pathobiology & Population Medicine, College of Veterinary Medicine, Mississippi State University, Starkville, MS, United States
| | - Steeve Giguère
- Department of Large Animal Medicine, University of Georgia, Athens, GA, United States
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Schlachter C, Lewis C. Electrophysical Therapies for the Equine Athlete. Vet Clin North Am Equine Pract 2016; 32:127-47. [PMID: 27012509 DOI: 10.1016/j.cveq.2015.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A good rehabilitation program takes into account the possible causes for the injury. Once the underlying cause of the injury is determined, a veterinarian can construct an appropriate rehabilitation plan and use the available electrophysical therapies to their greatest effect. Treating the horse correctly for the type and location of injury, and the stage of rehabilitation of the tissue, helps ensure full rehabilitation success. This article discusses when and how to use the most common electrophysical therapies in horses including transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, functional electric stimulation, pulsed electromagnetic field therapy, therapeutic ultrasound, laser therapy, shockwave therapy, and vibration therapy.
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Brokken MT, Schneider RK, Roberts GD, Holmes SP, Gavin PR, Sampson SN, Farnsworth KD, Dahlgren LA. Evaluation of a New Surgical Treatment for Equine Hind Limb Proximal Suspensory Desmitis. Vet Surg 2016; 45:868-878. [DOI: 10.1111/vsu.12527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 05/04/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Matthew T. Brokken
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; Washington State University; Pullman Washington
| | - Robert K. Schneider
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; Washington State University; Pullman Washington
| | - Gregory D. Roberts
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; Washington State University; Pullman Washington
| | - Shannon P. Holmes
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; Washington State University; Pullman Washington
| | - Patrick R. Gavin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; Washington State University; Pullman Washington
| | - Sarah N. Sampson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; Washington State University; Pullman Washington
| | - Kelly D. Farnsworth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine; Washington State University; Pullman Washington
| | - Linda A. Dahlgren
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine; Virginia Tech; Blacksburg Virginia
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Mizobe F, Okada J, Shinzaki Y, Nomura M, Kato T, Yamada K, Spriet M. Use of standing low-field magnetic resonance imaging to assess oblique distal sesamoidean ligament desmitis in three Thoroughbred racehorses. J Vet Med Sci 2016; 78:1475-1480. [PMID: 27320360 PMCID: PMC5059375 DOI: 10.1292/jvms.15-0656] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Desmitis of the oblique distal sesamoidean ligaments (ODSL) is caused by hyperextension
of the metacarpophalangeal/metatarsophalangeal joint and has been described as a
significant cause of lameness in racehorses. In this study, three Thoroughbred racehorses
(age range: 3–6 years) were diagnosed with desmitis of the forelimb ODSL using standing
low-field magnetic resonance imaging (sMRI). Radiography and ultrasonography were
inconclusive with regard to a definitive diagnosis. For all horses, the sMRI
characteristics included increased signal intensity within the medial ODSL on T1-weighted
gradient echo, T2-weighted fast spin echo and short tau inversion recovery fast spin echo
images, which use a fat suppression technique. Effusion of the digital flexor tendon
sheath was also clearly visible on sMRI. Following rest and controlled exercise for
roughly 3 months, two horses successfully returned to racing within 5 months. Our findings
support the use of sMRI for diagnosing ODSL injuries in Thoroughbred racehorses.
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Affiliation(s)
- Fumiaki Mizobe
- Racehorse Hospital, Ritto Training Center, Japan Racing Association, 1028, Misono, Ritto, Shiga 520-3085, Japan
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Link KA, Koenig JB, Silveira A, Plattner BL, Lillie BN. Effect of unfocused extracorporeal shock wave therapy on growth factor gene expression in wounds and intact skin of horses. Am J Vet Res 2013; 74:324-32. [DOI: 10.2460/ajvr.74.2.324] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gallagher A, Cross AR, Sepulveda G. The Effect of Shock Wave Therapy on Patellar Ligament Desmitis after Tibial Plateau Leveling Osteotomy. Vet Surg 2012; 41:482-5. [DOI: 10.1111/j.1532-950x.2012.00958.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Waguespack RW, Burba DJ, Hubert JD, Vidal MA, Lomax LG, Chirgwin SR, Lopez MJ. Effects of Extracorporeal Shock Wave Therapy on Desmitis of the Accessory Ligament of the Deep Digital Flexor Tendon in the Horse. Vet Surg 2011; 40:450-6. [DOI: 10.1111/j.1532-950x.2011.00800.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shockwave therapy: Is there an application to enhance wound healing in horses? EQUINE VET EDUC 2010. [DOI: 10.2746/095777309x478590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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The effect of focused extracorporeal shock wave therapy on collagen matrix and gene expression in normal tendons and ligaments. Equine Vet J 2010; 41:335-41. [DOI: 10.2746/042516409x370766] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Bosch G, Lin YL, van Schie HTM, van De Lest CHA, Barneveld A, van Weeren PR. Effect of extracorporeal shock wave therapy on the biochemical composition and metabolic activity of tenocytes in normal tendinous structures in ponies. Equine Vet J 2010; 39:226-31. [PMID: 17520973 DOI: 10.2746/042516407x180408] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Extracorporeal shockwave therapy (ESWT) has recently been introduced as a new therapy for tendon injuries in horses, but little is known about the basic mechanism of action of this therapy. OBJECTIVES To study the effect of ESWT on biochemical parameters and tenocyte metabolism of normal tendinous structures in ponies. METHODS Six Shetland ponies, free of lameness and with ultrasonographically normal flexor and extensor tendons and suspensory ligaments (SL), were used. ESWT was applied at the origin of the suspensory ligament and the mid-metacarpal region of the superficial digital flexor tendon (SDFT) 6 weeks prior to sample taking, and at the mid-metacarpal region (ET) and the insertion on the extensor process of the distal phalanx (EP) of the common digital extensor tendon 3 h prior to tendon sampling. In all animals one front leg was treated and the other front leg was used as control. After euthanasia, tendon explants were harvested aseptically for in vitro cell culture experiments and additional samples were taken for biochemical analyses. RESULTS In the explants harvested 3 h after treatment, glycosaminoglycan (GAG) and protein syntheses were increased (P<0.05). The synthesis of all measured parameters was decreased 6 weeks after ESWT treatment. Biochemically, the level of degraded collagen was increased 3 h after treatment (P<0.05). Six weeks after treatment, there was a decrease of degraded collagen and GAG contents. DNA content had not changed in either tendon samples or explants after culturing. CONCLUSIONS ESWT causes a transient stimulation of metabolism in tendinous structures of ponies shortly after treatment. After 6 weeks metabolism has decreased significantly and GAG levels are lower than in untreated control limbs. POTENTIAL RELEVANCE The stimulating short-term effect of ESWT might accelerate the initiation of the healing process in injured tendons. The long-term effect seems less beneficial. Further research should aim at determining the duration of this effect and at assessing its relevance for end-stage tendon quality.
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Affiliation(s)
- G Bosch
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht
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Osseous abnormalities associated with collateral desmopathy of the distal interphalangeal joint. Part 2: Treatment and outcome. Equine Vet J 2010; 41:794-9. [DOI: 10.2746/042516409x452170] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Scott M. Musculoskeletal Injuries in Nonracing Quarter Horses. Vet Clin North Am Equine Pract 2008; 24:133-52. [DOI: 10.1016/j.cveq.2007.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Cleveland RO, Chitnis PV, McClure SR. Acoustic field of a ballistic shock wave therapy device. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1327-35. [PMID: 17467154 DOI: 10.1016/j.ultrasmedbio.2007.02.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 01/30/2007] [Accepted: 02/13/2007] [Indexed: 05/08/2023]
Abstract
Shock wave therapy (SWT) refers to the use of focused shock waves for treatment of musculoskeletal indications including plantar fascitis and dystrophic mineralization of tendons and joint capsules. Measurements were made of a SWT device that uses a ballistic source. The ballistic source consists of a handpiece within which compressed air (1-4 bar) is used to fire a projectile that strikes a metal applicator placed on the skin. The projectile generates stress waves in the applicator that transmit as pressure waves into tissue. The acoustic fields from two applicators were measured: one applicator was 15 mm in diameter and the surface slightly convex and the second was 12 mm in diameter the surface was concave. Measurements were made in a water tank and both applicators generated a similar pressure pulse consisting of a rectangular positive phase (4 micros duration and up to 8 MPa peak pressure) followed by a predominantly negative tail (duration of 20 micros and peak negative pressure of -6 MPa), with many oscillations. The rise times of the waveforms were around 1 micros and were shown to be too long for the pulses to be considered shock waves. Measurements of the field indicated that region of high pressure was restricted to the near-field (20-40 mm) of the source and was consistent with the Rayleigh distance. The measured acoustic field did not display focusing supported by calculations, which demonstrated that the radius of curvature of the concave surface was too large to effect a focusing gain. Other SWT devices use electrohydraulic, electromagnetic and piezoelectric sources that do result in focused shock waves. This difference in the acoustic fields means there is potentially a significant mechanistic difference between a ballistic source and other SWT devices.
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Affiliation(s)
- Robin O Cleveland
- Department of Aerospace and Mechanical Engineering, Boston University, Boston, MA 02215, USA.
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Abed JM, McClure SR, Yaeger MJ, Evans RB. Immunohistochemical evaluation of substance P and calcitonin gene-related peptide in skin and periosteum after extracorporeal shock wave therapy and radial pressure wave therapy in sheep. Am J Vet Res 2007; 68:323-8. [PMID: 17331023 DOI: 10.2460/ajvr.68.3.323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of focused extracorporeal shock wave therapy (ESWT) and radial pressure wave therapy (RPWT) on immunohistochemical staining for substance P and calcitonin gene-related peptide (CGRP) in the skin and periosteum of sheep. ANIMALS 36 sheep. PROCEDURES All 4 limbs of 36 sheep were treated with ESWT, RPWT, or a sham treatment. For 14 days after treatment, at least 2 sheep were euthanized daily and tissue was harvested for histologic evaluation of nerves via staining for substance P and CGRP in the skin and periosteum. RESULTS No effects of ESWT or RPWT were observed on the number of nerves with stain uptake for substance P or CGRP in the skin or periosteum. CONCLUSIONS AND CLINICAL RELEVANCE Substance P- and CGRP-containing nerve fibers are not disrupted by EWST or RPWT. Further studies are needed to identify the mechanism of analgesia observed in association with these treatment modalities.
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Affiliation(s)
- Janan M Abed
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
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Benson BM, Byron CR, Pondenis H, Stewart AA. The effects of radial shock waves on the metabolism of equine cartilage explantsin vitro. N Z Vet J 2007; 55:40-4. [PMID: 17339915 DOI: 10.1080/00480169.2007.36733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM To investigate, in vitro, the effects of radial shock waves on the release of nitric oxide (NO) and synthesis of prostaglandin E2 (PGE2) and glycosaminoglycan (GAG), and liberation of GAG, from equine articular cartilage explants. METHODS Equine cartilage from normal metacarpophalangeal and metatarsophalangeal joints was exposed to radial shock waves at various impulse doses and then maintained as explants in culture for 48 h. Shock waves were delivered at 1,876 Torr pressure and a frequency of 10 Hz. Treatment groups consisted of a negative control group, or application of 500, 2,000, or 4,000 impulses by use of either a convex handpiece (Group A) or concave handpiece (Group B). Synthesis of GAG was measured using incorporation of 35S-labelled sodium sulphate. Additionally, the synthesis of NO and PGE2, and content of GAG of the explants and media were determined. RESULTS No significant effects (p>0.05) of radial shock-wave treatment were evident on the synthesis of NO or PGE2, or release of GAG by cartilage explants. However, radial shock waves decreased synthesis of GAG measured 48 h after exposure for all treatment groups other than the 500-impulse Group-A explants (p<0.05). CONCLUSIONS Radial shock waves impact the metabolism of GAG in chondrocytes in equine articular cartilage. Further studies will be required to fully investigate the impact of this effect on the health of joints, and to elucidate the clinical impact.
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Affiliation(s)
- B M Benson
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, 1008 W. Hazelwood Drive, Urbana, IL 61802, USA
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Dahlberg JA, McClure SR, Evans RB, Reinertson EL. Force platform evaluation of lameness severity following extracorporeal shock wave therapy in horses with unilateral forelimb lameness. J Am Vet Med Assoc 2006; 229:100-3. [PMID: 16817722 DOI: 10.2460/javma.229.1.100] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To measure alterations in lameness severity that occur following use of extracorporeal shock wave therapy (ESWT) in horses with naturally occurring unilateral forelimb lameness. DESIGN Nonrandomized clinical trial. ANIMALS 9 horses with unilateral forelimb lameness. PROCEDURES Force platform gait analysis was performed prior to administration of any treatments (baseline) and after use of local anesthesia to eliminate the lameness. Extracorporeal shock wave therapy was then administered, and gait analysis was repeated 8 hours later and then daily for 7 days. RESULTS Compared with the baseline value, peak vertical force was significantly increased 8 hours and 2 days after ESWT, and peak vertical force on day 2 was not significantly different from force measured after use of local anesthesia to eliminate the lameness. Similarly, vertical impulse was significantly increased, compared with the baseline value, 8 hours and 2 days after ESWT, but at all times, it was significantly lower than vertical impulse measured after use of local anesthesia. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that in horses with naturally occurring lameness, use of ESWT results in a period of acute improvement in lameness severity that typically persists for 2 days. Thus, in horses undergoing ESWT, exercise should be controlled for a minimum of 2 days after treatment to prevent further injury.
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Affiliation(s)
- Jessica A Dahlberg
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
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Bischofberger AS, Ringer SK, Geyer H, Imboden I, Ueltschi G, Lischer CJ. Histomorphologic evaluation of extracorporeal shock wave therapy of the fourth metatarsal bone and the origin of the suspensory ligament in horses without lameness. Am J Vet Res 2006; 67:577-82. [PMID: 16579748 DOI: 10.2460/ajvr.67.4.577] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine via histologic examination and scintigraphy the effect of focused extracorporeal shock wave therapy (ESWT) on normal bone and the bone-ligament interface in horses. ANIMALS 6 horses without lameness. PROCEDURE Origins of the suspensory ligament at the metacarpus (35-mm probe depth) and fourth metatarsal bone (5-mm probe depth) were treated twice (days 0 and 16) with 2,000 shocks (energy flux density, 0.15 mJ/mm2). One forelimb and 1 hind limb were randomly treated, and the contralateral limbs served as nontreated controls. Bone scans were performed on days -1 (before ESWT), 3, 16, and 19. Histomorphologic studies of control and treated tissues were performed on day 30. RESULTS ESWT significantly increased the number of osteoblasts but caused no damage to associated soft tissue structures and did not induce cortical microfractures. A significant correlation between osteoblast numbers and radiopharmaceutical uptake was noticed on lateral views of the hind limb on days 3 and 16 and on caudal views of the forelimb on day 3. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that ESWT has the potential to increase osteoblast numbers in horses. The correlation between increased osteoblast numbers and radio-pharmaceutical uptake 3 days and 16 days after the first ESWT suggested that stimulation of osteogenesis occurred soon after ESWT. No damage to bone or the bone-ligament interface should occur at the settings used in this study, and ESWT can therefore be administered safely in horses.
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Waldern NM, Weishaupt MA, Imboden I, Wiestner T, Lischer CJ. Evaluation of skin sensitivity after shock wave treatment in horses. Am J Vet Res 2005; 66:2095-100. [PMID: 16379653 DOI: 10.2460/ajvr.2005.66.2095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of shock wave treatment on cutaneous nerve function, compared with the effects of local nerve block and sedation. ANIMALS 18 clinically sound Swiss Warmbloods. PROCEDURE Horses were randomly allocated to 3 groups and received different amounts and types of shock waves (extracorporeal shock wave treatment [ESWT] or radial pressure wave treatment [RPWT]). Horses were sedated with xylazine and levomethadone. Shock waves were applied to the lateral palmar digital nerve at the level of the proximal sesamoid bones on 1 forelimb. Skin sensitivity was evaluated by means of an electrical stimulus at the coronary band before and 5 minutes after sedation and at 4, 24, and 48 hours after application of ESWT or RPWT. On the contralateral forelimb, skin sensitivity was tested before and 10 minutes after an abaxial sesamoid nerve block. RESULTS No significant changes in skin sensitivity were detected, regardless of the shock wave protocol applied. Mean reaction thresholds after sedation were more than twice the baseline thresholds. After the abaxial sesamoid block, no reaction was recorded in any of the horses. CONCLUSIONS AND CLINICAL RELEVANCE Application of ESWT or RPWT to the palmar digital nerve had no effect on cutaneous sensation distal to the treated region for at least 2 days after application. The analgesic effect of sedation on reaction to electrical stimuli was distinct but varied among horses.
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Affiliation(s)
- Nina M Waldern
- Equine Hospital, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
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Brown KE, Nickels FA, Caron JP, Mullineaux DR, Clayton HM. Investigation of the Immediate Analgesic Effects of Extracorporeal Shock Wave Therapy for Treatment of Navicular Disease in Horses. Vet Surg 2005; 34:554-8. [PMID: 16343141 DOI: 10.1111/j.1532-950x.2005.00087.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To measure the acute analgesic properties of extracorporeal shock wave therapy (ESWT) in horses with navicular disease using objective ground reaction forces (GRF). STUDY DESIGN Prospective study. ANIMALS Nine client-owned horses with unilateral forelimb lameness caused by navicular disease. METHODS Horses were trotted at 3 m/s over a force plate to record pre-treatment GRF of the lame and contra-lateral forelimbs. After ESWT of the lame limb, applied with a radial unit to each of the frog and heel bulb areas with 1500 pulses at 4 bar and 10 Hz, GRF measurements were repeated at 15 minutes and 24-hour intervals for 7 days. From the 5 trials recorded at each time, peak vertical force (PVF) was calculated and averaged. Data were compared between limbs and over time using a 2-way repeated-measures ANOVA. RESULTS Mean (+/-SD) PVF was significantly different between lame (day 1; 4339+/-626 N) and contra-lateral (day 1; 5236+/-515 N) limbs pre-treatment (P<.05). After ESWT treatment, this difference remained unchanged at 15 minutes and from days 1 to 7. To confirm navicular disease, palmar digital analgesia significantly reduced the lameness (lame 5144+/-430 N; contralateral 5082+/-586 N; P>.05). CONCLUSIONS Single ESWT treatment applied in this manner does not influence lameness in horses with navicular disease. CLINICAL RELEVANCE Although many equine regulatory commissions currently ban the use of ESWT before competition, our results suggest that such regulations may be unfounded. Further research is required to determine the long-term analgesic properties of this frequently used treatment modality in equine athletes.
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Affiliation(s)
- Keith E Brown
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA.
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