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Lameness - Diagnostic Tests

Lameness - Diagnostic Tests

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Published by S. Bala Dahiya
American Association of Equine Practitioners
American Association of Equine Practitioners

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Published by: S. Bala Dahiya on Jul 20, 2014
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07/20/2014

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Extracorporeal Shock Wave Therapy in Horses: What We Know
by y Scott !" #c$l%re& D'#& (hD& Diplomate A$'S
 
 " shock wave is an aco!stic &press!re' wave with very high amplit!$e an$ rapi$ rise time( The original !se of shock waves to fragment !roliths was expan$e$ to orthope$ic applications when# following a safety st!$y# the $ensity of a portion of the pelvis within the treatment area increase$( S!bse)!ently# the original m!sc!loskeletal applications were associate$ with stim!lation of non!nion fract!res to heal( *!ltiple st!$ies have $oc!mente$ the effectiveness of extracorporeal shock wave therapy &ESWT' in treating hypertrophic non!nions( +nvestigations into m!ltiple other areas have le$ to the F," approval of ESWT for heal sp!rs an$ recently tenniselbow( There are m!ltiple ways to generate a shock wave( The press!re wave can be instit!te$ by vapori-ation of fl!i$ across a spark gap &electrohy$ra!lic'# expansion of pie-oelectric crystals &pie-oelectric'# or p!shing a membrane with opposite electrical c!rrent &electromagnetic'( +n all three mechanisms# the press!re wave is bro!ght to a focal point by lenses or a parabolic reflector( This mechanism allows the energy in the wave to aim at a specific point within the tiss!e( "n alternative mechanism# ra$ial press!re waves# has been $evelope$( This !tili-es a pne!matically $riven $evice to strike the s!rface( This creates a press!re wave# b!t the parameters of the wave are $ifferent from that of a shock wave( The mechanisms by which ESWT provi$es a therape!tic o!tcome are minimally !n$erstoo$( +n vitro st!$ies have shown that shock wave can stim!late the pro$!ction of cytokines by cells an$ increase cell!lar $ivision( +n vivo st!$ies have shown increase$ bone formation an$ healing of non!nions an$ neovasc!lari-ation of bone.ten$on /!nctions( +n the horse# m!ltiple applications have been trie$( 0ne of the first case series complete$ was in a gro!p of horses with bone spavin where 12 of 34 horses &567' improve$ at least one lamenessgra$e( ,ata from bone.healing st!$ies wo!l$ in$icate ESWT wo!l$ be beneficial in treating stressfract!res in horses( While m!ltiple !sers of this technology report goo$ o!tcomes in stim!lating stress fract!res to heal# there have been no p!blishe$ reports( Similarly# m!ltiple veterinarians have reporte$ s!ccess in stim!lating s!spensory $esmitis to heal an$ $ecrease lameness( The first clinical reports from two separate !niversities in$icate$ seven of eight an$ five of six horses improve$ following treatment( " controlle$ st!$y with collagenase.in$!ce$ s!spensory $esmitis fo!n$ that the $efects fille$ in faster as $etermine$ by !ltrasonography( So far there is $ata s!pporting the !se of ESWT for s!spensory $esmitis# bone spavin# stress fract!res an$ navic!lar syn$rome( There are also m!ltiple $isc!ssions as to the !se of ESWT for ten$onitis# s!bchon$ral bone cysts an$ for sore backs( With time# more controlle$ st!$ies will be complete$ for a more thoro!gh an$ ob/ective assessment of o!tcome( While the positives of this therapy are being eval!ate$# the negatives m!st be consi$ere$( *ost importantly there is a perio$ of analgesia following treatment( H!mans treate$ with ESWT report an initial $ecrease in pain in the area treate$# lasting !p to a week# then some ret!rn of the original pain that gra$!ally $ecreases as the !n$erlying problem heals( +n a st!$y f!n$e$ by the 8rayson Fo!n$ation at +owa State University# we fo!n$ that in the horse# a perio$ of analgesia appears to be present for abo!t fo!r $ays after treatment( The analgesia is not profo!n$ like a local anesthetic# b!t there is a $ecrease in pain perception( The exact mechanism is not known( There is some inflammation in the nerves in the treatment fiel$( 9esearchers at o!isiana State University have fo!n$ a $ecrease in sensory nerve con$!ction velocity following ra$ial shock wave treatment(
 
*!ltiple racing /!ris$ictions have instit!te$ or are consi$ering reg!lations concerning when a horse can compete after being treate$( *ost are in the neighborhoo$ of seven $ays( The FE+ has $etermine$ that ESWT sho!l$ not be !se$ for five $ays prior to competition( This sho!l$ allow theanalgesia to regress( "$$itionally# the in$ications for shock wave therapy wo!l$ in$icate most horses sho!l$ be on a $ecrease$ level of activity while healing( The $ata in$icate that there are benefits associate$ with ESWT( "$$itional controlle$ st!$ies are in$icate$ to f!lly eval!ate this new therape!tic mo$ality( ,r( *cl!re is assistant professor at the +owa State University ollege of ;eterinary *e$icine an$has been a member of the ""E< since =22>
poste$: 1?=2?@66>( ast !p$ate$: 1?=2?@66>(
)lex Test
by Davi* W" !amey& D'#
 
David W. Ramey, DVMYou’ve decided to sell your horse and the potential buyer has sent a veterinarian to our farm to perform a purchase exam. As you stand beamin !ith satisfaction next to !ho you hope !ill be the ne! o!ner, the veterinarian pic"s up your horse’s left front le. #endin it at the "nee, he holds it for about $% seconds, returns it to the round and as"s that the horse be &oed do!n your asphalt drive. 'n astonishment,you !atch as the horse moves off most decidedly lame. What happened(What you have !itnessed is a phenomenon not necessarily of the veterinarian’s creation, but somethin that can sometimes occur follo!in a procedure called a forelimb flexion test. 'n a forelimb flexion test, various &oints and soft tissue structures of the lo!er limb are stretched and)or compressed for a brief period of time by bendin the limb. After!ard, the horse is immediately trotted off and observed for sins of lameness. *orelimb flexion tests !ere described in +!edish veterinary literature as early as -/. 0hey appear to have become an interal part of the evaluation of the horse intended for sale. 'n performin the tests, a veterinarian !ill li"ely pic" up the horse’s le and bend it, !ith the bendin force centerin around the fetloc" &oint. 1e or she !ill hold the le for a period of /% seconds to $% seconds, and then let o, as"in the horse to trot off immediately. 0he test is not unli"e !ht you miht experience if someone as"ed you to sit in a crouch for sixty seconds and then run riht off. 2sually, you can run off &ust fine, but occasionally, you miht experience some soreness or pain in the &oint that results in some initial stiffness !hen you first try to run. You may be normal or the soreness could sinal a problem 3such as a bad "nee4.

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