This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below:
HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Upper Rear Limb » Stifle Lameness » Overview of Stifle Lameness »
  Discussion on Meniscus Injury in 10 yr old 18hd Warmblood
Author Message
New Member:
fittie

Posted on Wednesday, Apr 8, 2009 - 3:33 pm:

Dressage horse with prior very occasional hitch in the right stifle- went dead lame after a bad incident of getting cast in his stall. After ultrasound of the right stifle the medial meniscus looks clearly defined, nice edges, lighter color, the lateral meniscus does not show proper edges, seems to still have fluid in it and is darker in the overall appearance.
Vet is suggesting 3 shockwave treatments in intervals of 3 weeks- followed by rest, small handwalk, sun pen. Prognosis is 50/50 chance of going sound again. She also suggested topical anti-inflammatories. icing if possible.
Are there any other treatments/suggested course of action I could take?
I have a photo of the ultrasound but it's too big to upload here.
Member:
3chip

Posted on Wednesday, Apr 8, 2009 - 11:33 pm:

Shockwave therapy!
It is used to treat a variety of conditions including:

Soft tissue injuries such as flexor tendon strains, suspensory ligament sprains, annular ligament synDrOme/inflammation.
Chronic orthopaedic conditions such as pain associated with arthritis e.g. spavin, caudal foot pain or navicular synDrOme.
Persistent pain associated with active ‘splint’ formation and ‘sore shins’.
Musculoskeletal disorders of the back- vertebral arthrosis, dorsal spinous process impingement or ‘kissing spines’, sacroiliac strains.
A non-invasive treatment for angular limb deformities (crooked limbs) in foals.

Using shock wave therapy to treat an injured racehorse at David Phelan's pre-training yard
To see a video our mobile shock wave machine in use please click here.
(This video requires Apple Quicktime)

It is a non invasive treatment administered by a hand held probe linked to a compressor. This generates a series of ‘shock waves’ at a variable pressure and frequency depending on the injury or condition to be treated. It is a well tolerated treatment most often given as a course of 3 treatments 7 to 14 days apart.

Shock wave therapy has been shown to have several significant effects on healing of musculoskeletal tissues and has also been shown to provide potent analgesia or pain relief. This both encourages healing and provides pain relief during rehabilitation.
Moderator:
DrO

Posted on Thursday, Apr 9, 2009 - 8:37 am:

Welcome Sabina,
What was the diagnosis of the lateral meniscus? Concerning the use of shockwave (ECSWT) in soft tissue injuries the use remains controversial and experimental. I cannot find any peer reviewed published studies (or any studies for that matter) on the use ECSWT on injured meniscus in the literature.

I would not consider the use of shockwave on unknown damage to a meniscus a reasonable alternative to endoscopic evaluation and possible surgical therapy, usually debridement of torn tissues. See the article associated with this discussion for more on this. If endoscopic surgery is not an option I do not know any reason that it might harm the joint. For more on ECSWT see Diseases of Horses » Lameness » Treatment Methods » Extracorporeal Shock Wave Therapy.

Hello 3chip, it is important to realize that despite a flurry of research in the early and mid 2000's and now 5 years more of experience that the beneficial effects of ECSWT on almost all of the conditions you list remains uncertain and in no case do I know where it improves prognosis over more traditional therapy. Yes the potent analgesic effect (done by damaging the sensory nerves) leaves a powerful effect in the viewers mind. But this is temporary effect and not necessarily a good thing. To view the latest research push the "National Library of Medicine" button at the bottom of the article and the latest research will come up. I have been wondering about how quiet the research community has become about the wide spread use of ECSWT.
DrO
New Member:
fittie

Posted on Thursday, Apr 9, 2009 - 11:09 am:

Thank you Dr. O. I have not explored the possibilities of exploratory surgery- but will discuss that. The dr. seems to think that there is a major risk connected with this type of surgery- whereas shockwave is helpful but no risk.
Are there any other topical treatments that might help? The diagnosis of the right later meniscus is not determined as we couldn't see anything other than a swollen mass that did not look like a clean, healthy meniscus. How do you diagnose this condition? I was told shockwave and ultrasound in 3 weeks to see if there is improvement.
Member:
3chip

Posted on Thursday, Apr 9, 2009 - 1:09 pm:

I agree wholeheartedly with you Dr. O. I simply found this discussion of electroshock therapy on the internet. I personally would not use this approach to repair or incite repair of this stifle problem.
Moderator:
DrO

Posted on Friday, Apr 10, 2009 - 6:47 am:

Hello Sabina, we cover both the diagnosis and treatment of meniscal damage and treatment in the article on stifle lameness associated with this discussion. Briefly, arthroscopy is both the current best diagnostic modality and treatment method for soft tissue injury of the stifle.

Other more conservative therapies, most of which are also used in combination with surgery, would consist of those you see for acute (traumatic) forms of arthritis and stall rest. The idea is to get the inflammation out as quick as possible so healing can continue and prevent further chronic arthritis, what we call degenerative joint disease. You can read about these treatments at Diseases of Horses » Lameness » Joint, Bone, Ligament Diseases » Arthritis and DJD: An Overview. You will find a heading "Treatment for Acute Arthritis".
DrO
Home Page | Top of Page | Join Us!
Horseadvice.com is a BBB Accredited Business. Click for the BBB Business Review of this Horse Training in Stokesdale NC