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  Discussion on Post Extracorporeal Shock Wave Series Rehab Protocol??
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Member:
Lovnlife

Posted on Thursday, May 5, 2005 - 12:22 am:

My gelding just received (last week)the third and for now final Shock Wave treatment for what is presumed to be tendon and/or ligament damage/disease in the area of his DIP joint. He has been rested in a small pen where he can move around to exercise the tendons/ligaments but not run around with the herd, for 6 months, and has remained lame (grade 3). Full vet school/hospital workup, with blocks and radiographs point to the soft tissue in the DIP joint diagnosis, which could only be confirmed with MRI, which I didn't do because it is soooo expensive and no matter what, it seemed rest was the treatment anyway. Now, after 6 months rest and no improvement, we have tried the shock wave treatment, and amazingly, after the second treatment, the horse looks better and I would say is improved one grade in his lameness. I am hopeful for more recovery, but don't know when, and what kind of rehab to now start doing. The person who did the treatments said, if he seems to be responding, get him back to exercise. What would you suggest in terms of a protocol?
Moderator:
DrO

Posted on Thursday, May 5, 2005 - 10:50 am:

Did the fellow operating the SW also tell you the shockwaves temporarily (several weeks) deaden the nerves so may cover ongoing lameness? See the article on Shockwave in the Treatment topic for more on this. This is a well established effect and I would not let a immediate improvement change my recovery schedule. There are cases of DIP collateral ligament damage that did not improve with paddock rest and did with stall rest and hand walking. Prognosis is guarded after this much time however the best treatment while lame remains the same: rest. My question is he getting enough rest?
DrO
Member:
Lovnlife

Posted on Saturday, May 7, 2005 - 12:11 pm:

I thought I posted a response, but for some reason it didn't show up. In any event, thanks, Dr. O for your time and input. Yes, I was told of analgesia effects, but for days rather than weeks. I will take it very slowly and controlled. Thanks again for your time and for a great web site for horse owners!
Moderator:
DrO

Posted on Sunday, May 8, 2005 - 9:28 am:

This report found significant loss of nerve conduction for over one month a digital nerve:

Am J Vet Res. 2004 Dec;65(12):1714-8.
Determination of functional and morphologic changes in palmar digital nerves after nonfocused extracorporeal shock wave treatment in horses.

Bolt DM, Burba DJ, Hubert JD, Strain GM, Hosgood GL, Henk WG, Cho DY.

Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA.

OBJECTIVE: To determine functional and morphologic changes in palmar digital nerves after nonfocused extracorporeal shock wave (ESW) treatment in horses. ANIMALS: 6 horses. PROCEDURES: The medial and lateral palmar digital nerves of the left forelimb were treated with nonfocused ESWs. The medial palmar digital nerve of the right forelimb served as a nontreated control nerve. At 3, 7, and 35 days after treatment, respectively, 2 horses each were anesthetized and nerves were surgically exposed. Sensory nerve conduction velocities (SNCVs) of treated and control nerves were recorded, after which palmar digital neurectomies were performed. Morphologic changes in nerves were assessed via transmission electron microscopy. RESULTS: Significantly lower SNCV in treated medial and lateral nerves, compared with control nerves, was found 3 and 7 days after treatment. A significantly lower SNCV was detected in treated medial but not lateral nerves 35 days after treatment. Transmission electron microscopy of treated nerves revealed disruption of the myelin sheath with no evidence of damage to Schwann cell bodies or axons, 3, 7, and 35 days after treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Nonfocused ESW treatment of the metacarpophalangeal area resulted in lower SNCV in palmar digital nerves. This effect likely contributes to the post-treatment analgesia observed in horses and may result in altered peripheral pain perception. Horses with preexisting lesions may be at greater risk of sustaining catastrophic injuries when exercised after treatment.
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