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  Discussion on Update on research on Shock Wave Therapy?
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Member:
Canderso

Posted on Tuesday, Jun 13, 2006 - 8:07 am:

Dr O,
My 13 year old gelding has been quite lame (hocks) for about 2 months now. Stall rest, reduced work, etc, have all led to very little change. My vet came out to take a look and reminded me that radiographs taken 3 years ago already showed fairly advanced OCD. Bailey's hocks are also chronically swollen (soft and puffy).

We had hoped that Bailey's hocks would fuse - apparently they have not.

We started Bailey on 1 gram of bute per day 10 days ago -no change. Next step is to up the bute to 2 grams per day to see if there is any change. I suspect it will not make any difference, so am investigating next steps.

My vet has already said the joints are 'messy enough' to pretty much rule out injection. He suggests next step is shock wave treatment, presumably to get the fusing process going again.

I read this section and notice last posts were 2003. At that time you were pretty cautious about using Shock Wave for (a) joints or(b) OCD. (hmmm. I have a double whammy here!)

Has there been any further research or is there new knowledge around the use of shock wave therapy?

Thanks for any help you can give.
Moderator:
DrO

Posted on Tuesday, Jun 13, 2006 - 10:19 am:

Hello CherylA,
If there is boggy swelling it suggests that the joints affected, it would include the tibiotarsal with the swelling, are not those where fusion will help. I am also uncertain about the judgement that just because they look messy not injecting the hocks is a wise decision. Lastly 12 or 13 is pretty late onset for OCD related lameness.

The research showing the effects of shock wave therapy (ECSWT) and DJD including are still iffy. Counter-intuitively, shockwave may slow fusion, if that is your purpose. The best work that I have seen showed a decrease in the biochemical markers of inflammation in the joint fluid when compared to other treatments for induced acute arthritis (Evaluation of extracorporeal shock wave therapy for osteoarthritis. Proc 50th Annu Meet Am Assoc Equine Pract 2004;261–263 Frisbie DD, Kawcak CE, McIlwraith CW. ). The use of ECSWT in dogs with hip arthritis did show some improvement in range of motion tests but it was not statistically significant compared to the control dogs and the owners reported no improvement. Currently the use of ECSWT in arthritis is experimental and of uncertain benefit.

In short it seems like you are getting confusing information from the little I know more about your horses lameness. Perhaps getting a second opinion on those radiographs, from a radiologist and orthopedic specialist, would help clear things up a bit.
DrO
Member:
Canderso

Posted on Wednesday, Jun 14, 2006 - 3:56 pm:

Thanks for speedy reply!

Sorry for the confusion. I was trying to be as succinct as possible and guess I left out the wrong stuff! Note I am the one presuming the reasons behind the shock wave treatment - I did not ask the question directly. I am pretty sure my vet also believes the swelling is another 'issue' in the joint over and above the OCD and/or fusing.

Bailey has had problems with OCD for a very long time. Frankly the local vets are shocked he is as sound as he has been thus far.... We have managed him veerrrry carefully to minimize lameness episodes - including shoeing, managed turn out, extensive use of topical painkillers (capsaicin products)and glucosamine chondritin supplements, extreme paranoia about footing and finally, limitations on use.

So no, I agree this is not a late onset of OCD related lameness - it has been around for sometime already. We have just been lucky.

Thanks for the update on ECSWT. Interesting that there is thinking it may slow fusion.

When you say ' a decrease in the biochemical markers of inflammation in the joint fluid', do you mean ECSWT reduced inflammation in the joint?

In the meantime, I will ask my vet some more questions...

Thanks again
Cheryl
Moderator:
DrO

Posted on Wednesday, Jun 14, 2006 - 9:08 pm:

In short yes, the only detailed study indicates a decrease in inflammation and though no one else has said it, if this is true I say it will slow down fusion.
DrO
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