♘امیرحسین♞
♘ مدیریت انجمن اسب ایران ♞
The average equine extracorporeal shock wave therapy (ESWT) patient has been examined multiple veterinarians before arriving for ESWT treatment, said Alan Donnell, DVM, of Pilot Point, Texas at the third annual Shock Wave Therapy Symposium, held this year on Dec. 3 in Denver, Colo. Donnell treats Quarter Horses and Arabians and travels to 33 major performance shows throughout the year.
Donnell revealed some of what he has learned in treating horses over the past several years:
* Correct Diagnosis: In treatment of athletic injuries, if you're not treating the correct area, then there's obviously great failure in treatment. He stresses blocking, radiography, and ultrasound to try and find the source of the lameness problem.
* Number of Shocks: "I've learned we don't have to use 3,000 shocks on these horses," said Donnell. "It's better that we decrease the number, that way the clients are able to afford the treatment. I see a lot of the same clinical results with a decreased number of shocks. For a small percentage of clients, cost doesn't matter…whatever fits the individual veterinarian and gets the clinical results is what we're striving to attain."
* Response: Horses that do not respond to conventional therapies but respond to ESWT typically will do so after 2-3 weeks.
* Indications:
o ESWT is a very legitimate treatment in distal hock disease. "It is not a panacea, but is a good ancillary treatment in treating lower hock lameness," said Donnell.
o Curb: 95% of acute cases of curb can be brought down by two shock wave therapy treatments, in his experience.
o Chronic Heel Pain: He has treated chronic heel pain with 800-1,000 shocks every four days. This can be expensive, but can be a successful treatment.
o Post-operative Treatment: ESWT applied over an incision site on a joint has shown to be beneficial for horses that have had bone chip removals.
o Ligament Damage: Often times there is damage to the distal sesamoidian ligament and branches of the suspensory ligament, and giving 400-800 shocks has aided in horses' recoveries and have decreased the amount of scar tissue at the incision site.
o Check Ligament Surgery Recovery--ESWT has also been helpful in reducing scarring from cutting the horse's check ligament;
o Chronic Wounds--ESWT has been shown to reduce inflammation in chronic open wounds and in places that have been sutured. The therapy appears to help the skin migrate over the damaged areas. "We're getting some good response and are curious to see what would happen in large muscle lacerations," he said.
o Fractured Splint Bones--He has shocked right over acute or non-union fractures in the horse with some success.
o Ringbone--If caught early, ESWT can slow ringbone, but it isn't very effective as a treatment.
o Sacroiliac pain--Shock wave therapy has been used successfully in treating sacroiliac joints, according to the literature, but Donnell hasn't had much luck with the modality and sore backs.
o Success has also been achieved in treatment of distal suspensory ligament disease, and navicular disease with ESWT.
* Desensitization--there is short-term desensitization, but long-term therapeutic effects of ESWT.
In Europe, the primary emphasis of ESWT is human treatment and research, and much of that human information can be extrapolated to help the horse. Use of ESWT is only approved in non-union fractures, tennis elbow, and heel bursitis in humans in the United States.
Donnell pointed out that many practitioners are probably using focused ESWT on different equine injuries and their experiences are underreported. He and the other presenters at the symposium hope that the exchange of information will foster sharing of clinical experience and thus a better understanding of the modality's indications and contraindications. "As we try it on different things, we're going to find out shock wave therapy is beneficial to different things beyond what is published," he added.
Donnell revealed some of what he has learned in treating horses over the past several years:
* Correct Diagnosis: In treatment of athletic injuries, if you're not treating the correct area, then there's obviously great failure in treatment. He stresses blocking, radiography, and ultrasound to try and find the source of the lameness problem.
* Number of Shocks: "I've learned we don't have to use 3,000 shocks on these horses," said Donnell. "It's better that we decrease the number, that way the clients are able to afford the treatment. I see a lot of the same clinical results with a decreased number of shocks. For a small percentage of clients, cost doesn't matter…whatever fits the individual veterinarian and gets the clinical results is what we're striving to attain."
* Response: Horses that do not respond to conventional therapies but respond to ESWT typically will do so after 2-3 weeks.
* Indications:
o ESWT is a very legitimate treatment in distal hock disease. "It is not a panacea, but is a good ancillary treatment in treating lower hock lameness," said Donnell.
o Curb: 95% of acute cases of curb can be brought down by two shock wave therapy treatments, in his experience.
o Chronic Heel Pain: He has treated chronic heel pain with 800-1,000 shocks every four days. This can be expensive, but can be a successful treatment.
o Post-operative Treatment: ESWT applied over an incision site on a joint has shown to be beneficial for horses that have had bone chip removals.
o Ligament Damage: Often times there is damage to the distal sesamoidian ligament and branches of the suspensory ligament, and giving 400-800 shocks has aided in horses' recoveries and have decreased the amount of scar tissue at the incision site.
o Check Ligament Surgery Recovery--ESWT has also been helpful in reducing scarring from cutting the horse's check ligament;
o Chronic Wounds--ESWT has been shown to reduce inflammation in chronic open wounds and in places that have been sutured. The therapy appears to help the skin migrate over the damaged areas. "We're getting some good response and are curious to see what would happen in large muscle lacerations," he said.
o Fractured Splint Bones--He has shocked right over acute or non-union fractures in the horse with some success.
o Ringbone--If caught early, ESWT can slow ringbone, but it isn't very effective as a treatment.
o Sacroiliac pain--Shock wave therapy has been used successfully in treating sacroiliac joints, according to the literature, but Donnell hasn't had much luck with the modality and sore backs.
o Success has also been achieved in treatment of distal suspensory ligament disease, and navicular disease with ESWT.
* Desensitization--there is short-term desensitization, but long-term therapeutic effects of ESWT.
In Europe, the primary emphasis of ESWT is human treatment and research, and much of that human information can be extrapolated to help the horse. Use of ESWT is only approved in non-union fractures, tennis elbow, and heel bursitis in humans in the United States.
Donnell pointed out that many practitioners are probably using focused ESWT on different equine injuries and their experiences are underreported. He and the other presenters at the symposium hope that the exchange of information will foster sharing of clinical experience and thus a better understanding of the modality's indications and contraindications. "As we try it on different things, we're going to find out shock wave therapy is beneficial to different things beyond what is published," he added.