South Shore Equine Clinic & Diagnostic Center
Equine Veterinary Services South Shore Boston Massachusetts

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Extracorporeal Shockwave Therapy (ECSWT)

Extracorporeal Shockwave Therapy (ECSWT) is useful in the treatment of injuries to bone, tendon and bone-ligament interfaces such as high suspensory and collateral ligament injuries.

ECSWT is currently the standard therapy (lithotripsy) for humans with urolithiasis, as well as gallstones, pancreatic stones, and salivary stones.  Over the past ten years it has been applied in orthopedics in both veterinary and human medicine (plantar fasciitis, epicondylitis).  The effects of ECSWT are not only disintegration of mineral deposits, but also pain relief, stimulation of bone remodeling (fractures of dorsal canon bone, active ringbone), and neovascularization of bone ligament interfaces (proximal suspensory desmitis, collateral ligament desmitis). 

Shockwaves are mechanical (acoustic) pressure pulses.  The time from maximum pressure pulse to negative pressure pulse and return to normal atmospheric pressure is less than 10 µs.  Different mechanisms of producing shockwaves are available depending on the physical type of shock wave generation.  For clinical applications it is necessary to focus the shock wave pulse on the area of interest.

In the equine patient, ECSWT has been used for about 10 years and proven to be effective in accelerating healing of bone, tendon, and ligament injuries. In cases of suspensory desmitis, typical lay up time has decreased significantly from a minimum of 6 months, prior to the use of ECSWT.  Now horses are able to be maintained with approximately 4 weeks of rest, then walking, and soon after walk – trot.  It allows a steady rehabilitation program to be implemented.  The effects of ECSWT are neovascularization of the ligament.  The increased blood flow to the area helps to minimize mineralization of the ligament as well as limit any periosteal reaction.  Similar results have been observed with regard to tendon injuries; however few controlled studies have been performed thus far.

ECSWT has also been applied to cases of osteoarthritis of the distal intertarsal and tarsometatarsal joint with 80% success in achieving at least one grade of improvement with associated lameness.  The exact mechanism of improvement is unknown but hypotheses include the stimulation of subchondral bone remodeling, changes in intramedullary pressure and analgesic effects of shockwave.

Experimental data support the use of ECSWT in healing stress fractures of the equine dorsal metacarpus/metatarsus, commonly seen in race horses.  The biggest concern with dealing with these is determining when it is safe for the horse to return to work.  There is a seven day withdrawal period for horses being treated on the race track and in the show circuit.   Analgesia as a result of the shock wave treatment may lead to horses being worked before the bone is adequately healed.   Repeat radiology plus nuclear scintigraphy may assist in determining when the bone is fully healed.   In conclusion, ECSWT  is becoming  a standard for treatment of ligamentous – bone injuries.

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