Shock wave therapy for tendon and bone injuries in horses and dogs

Abstract

OBJECTIVE: To describe the proposed mechanism of action of shock wave therapy and discuss treatment considerations and guidelines for use in equine and canine practice. ANIMALS: Client-owned animals with owner consent. METHODS: Shock wave therapy is proposed to stimulate healing by generating forces that cause cells to undergo microtrauma and release anti-inflammatory cytokines and growth factors into the treated tissues. While the 4 types of shock wave therapies are discussed, electrohydraulic and piezoelectric are described in detail, as they are most utilized in veterinary medicine for the treatment of tendon and ligament injuries, osteoarthritis, and nonunion fractures. The dose that is applied per patient is relative to the selected settings of depth, energy level, and number of pulses delivered. It is important to recognize that the highest energy deposition and greatest biological effects are seen at anatomic regions of differing tissue types such as bone and soft tissue interfaces; thus, shock wave is particularly useful at areas of enthesopathy. RESULTS: Because of the mechanism of action, the use of anti-inflammatory medications and/or cryotherapy around shock wave treatment times should be avoided. Additionally, because of the potent analgesic effects of shock wave for the first 48 hours after treatment, rest is recommended to prevent any further damage to the tissues. Competition rules surrounding the use of shock wave must also be followed and discussed with owners. CLINICAL RELEVANCE: Shock wave therapy is an accessible and useful modality for the treatment of tendon and ligament injuries, osteoarthritis, and nonunion fractures.