Effects of extracorporeal shock wave therapy and radial pressure wave therapy on elasticity and microstructure of equine cortical bone

OBJECTIVE: To measure changes in the modulus of elasticity (E) and describe histologic findings after extracorporeal shock wave therapy and radial pressure wave therapy on equine cortical bone specimens. SAMPLE POPULATION: 16 bone specimens from the proximodorsal cortex of an equine third metacarpal or metatarsal bone. PROCEDURE: Baseline E was determined by the density (p) and unidirectional ultrasound transmission velocity (C) of each specimen according to the equation E = pC2. Eight specimens were treated with 500 pulses of 0.15 mJ/mm2 of extracorporeal shock wave therapy, and 8 specimens were treated with 500 pulses of 0.16 mJ/mm2of radial pressure wave therapy. After treatment, C was determined again. Four treatment sessions resulted in 2,000 pulses and 5 C measurements. The p of each sample was measured again. Mean post-treatment E was calculated for each group. Nondecalcified sections of all specimens were stained with toluidine blue or basic fuchsin for histologic evaluation. RESULTS: Overall treatment group effect was not significant for C or E. Final E was not different from baseline values for extracorporeal shock wave therapy and radial pressure wave therapy. No histologic changes could be attributed to either treatment modality. CONCLUSIONS AND CLINICAL RELEVANCE: Extracorporeal shock wave therapy and radial pressure wave therapy did not affect the material properties of equine bone at the energy and pulse values used in this study.     

Extracorporal shock wave therapy in veterinary medicine.]

This article gives a general overview on a new therapy in equine orthopedics. In human medicine extracorporal shock wave therapy (ESWT) is used for lithotripsy of stones of the urologic system and also in orthopedics. In equine medicine the therapy is almost exclusively applied for the treatment of orthopedic problems. The main indications are proximal suspensory desmitis (PSD), lesions of tendons and ligaments, osteoporotic changes and spavin. In this paper the mode of action of shock waves and the different shock wave devices are discussed. Also, some information about an ongoing clinical trial at the Animal Hospital University of Zürich is given.     

Extracorporeal shock wave therapy: Theory and equipment

Shock waves were employed for many years for the management of uroliths in people, but in the 1990s use was extended to musculoskeletal diseases. Much is known about the physics of shock waves and shock wave generators. Less is known about the mechanisms of action of shock waves in musculoskeletal diseases in people or horses. This chapter describes the shock wave itself, how shock waves are generated, and what is known about shock waves and interactions with musculoskeletal tissues.     

Effects of extracorporeal shock wave therapy on bone

Extracorporeal shock waves have been used for 30 years to fragment uroliths for nonsurgical treatment for urolithiasis in humans. Applied to bone, shock waves delivered at the appropriate energy and pulse number, can stimulate osteogenesis. In Europe, shock waves are routinely used to treat nonunions in humans despite poor understanding of the mechanism of action. Shock wave therapy has also been used clinically in horses. Preliminary experimental studies indicate that shock wave therapy does not damage soft tissue in the distal aspect of the equine limb and can stimulate osteogenesis throughout the depth of the near cortex of the metacarpus and metatarsus.     

Evaluation of analgesia resulting from extracorporeal shock wave therapy and radial pressure wave therapy in the limbs of horses and sheep

OBJECTIVE: To identify the duration and potential mechanisms of analgesia following extracorporeal shock wave therapy (ESWT) and radial pressure wave therapy (RPWT) in limbs of horses and sheep. ANIMALS: 6 horses and 30 sheep. PROCEDURE: An electrical stimulus was used to identify the nociceptive threshold for each horse daily for 3 days before treatment (baseline) with ESWT or RPWT, 8 hours after treatment, and at 24-hour intervals for 7 days after treatment. Testing was conducted for the treatment field (midmetacarpus or midmetatarsus) and nerve field (medial and lateral forelimb heel bulbs) distal to a treatment site that included the nerve on the abaxial surface of the proximal sesamoid bone. All 4 limbs of 30 sheep were treated with ESWT, RPWT, or a sham treatment. Two sheep were euthanatized daily and tissue harvested for histologic evaluation of nerves, and concentrations of substance P and calcitonin gene-related peptide were measured in the skin and periosteum. RESULTS: Values did not differ significantly between baseline and after treatment for the treatment field or nerve field sensation. There was a large difference in the slope when data for horses were plotted for the first 3 days after treatment, compared with the slope for days 4 to 7 after treatment. No differences were found in neuropeptide concentrations after treatment of the sheep, but there was an inflammatory response in the treated nerves. CONCLUSIONS AND CLINICAL RELEVANCE: A small cutaneous analgesic effect may exist at the treatment site for approximately 3 days after ESWT or RPWT in horses.     

Immunohistochemical evaluation of substance P and calcitonin gene-related peptide in skin and periosteum after extracorporeal shock wave therapy and radial pressure wave therapy in sheep

OBJECTIVE: To evaluate the effect of focused extracorporeal shock wave therapy (ESWT) and radial pressure wave therapy (RPWT) on immunohistochemical staining for substance P and calcitonin gene-related peptide (CGRP) in the skin and periosteum of sheep. ANIMALS: 36 sheep. PROCEDURES: All 4 limbs of 36 sheep were treated with ESWT, RPWT, or a sham treatment. For 14 days after treatment, at least 2 sheep were euthanized daily and tissue was harvested for histologic evaluation of nerves via staining for substance P and CGRP in the skin and periosteum. RESULTS: No effects of ESWT or RPWT were observed on the number of nerves with stain uptake for substance P or CGRP in the skin or periosteum. CONCLUSIONS AND CLINICAL RELEVANCE: Substance P- and CGRP-containing nerve fibers are not disrupted by EWST or RPWT. Further studies are needed to identify the mechanism of analgesia observed in association with these treatment modalities.     

Endotoxic Shock

Endotoxic shock is a complex phenomenon resulting from systemic release of inflammatory mediators. Endotoxin interacts with inflammatory cells, platelets, and vascular endothelium. Cytokines, such as tumor necrosis factor and interleukins, and lipid mediators (platelet activating factor, thromboxane, prostacyclin, leukotrienes) are released. These primary mediators act synergistically to cause many of the harmful effects associated with endotoxemia. Multiple secondary mediators are released in response to the primary mediators, compounding the damage. The end result is the species-specific clinical syndrome recognized as endotoxemia.     

Effect of focused and radial extracorporeal shock wave therapy on equine bone microdamage

OBJECTIVES : To determine whether bone microcracks are altered after application of focused and radial extracorporeal shock wave therapy (ESWT) to the equine distal limb. STUDY DESIGN : An ex vivo experimental model. SAMPLE POPULATION : A contralateral limb specimen was obtained from 11 Thoroughbred racehorses with a unilateral catastrophic injury. Distal limb specimens were also obtained from 5 non-racing horses. METHODS : Three separate skin-covered bone segments were obtained from the mid-diaphysis of the metacarpus (MC3) or metatarsus (MT3). Focused (9,000 shockwaves, 0.15 mJ/mm2, 4 Hz) and radial (9,000 shockwaves, 0.175 mJ/mm2, 4 Hz) ESWT treatments were randomized to the proximal and distal segments and the middle segment was used as a treatment control for pre-existing microcracks. After treatment, bone specimens were bulk-stained with basic fuchsin and microcracks were quantified in transverse calcified bone sections. RESULTS : ESWT had small but significant effects on microcracks. Microcrack density (Cr.Dn) and microcrack surface density (Cr.S.Dn) were increased after focused ESWT, whereas Cr.Le was increased after radial ESWT. In racing Thoroughbreds, Cr.Le increased with increased number of races undertaken. Cr.Dn and Cr.S.Dn were not significantly influenced by the number of races undertaken. CONCLUSION : ESWT has small but significant effects on bone microcracking ex vivo. CLINICAL RELEVANCE : These preliminary data suggest that ESWT has the potential to increase bone microcracking in equine distal limb bone in vivo. Such effects may be more pronounced in Thoroughbreds that are actively being raced, because in vivo microcracking increases with increased number of races undertaken.     

热休克蛋白的研究进展

热休克蛋白(Heatshock proteins,HSP),是生物受到环境中物理、化学、生物、精神等刺激时产生应激反馈而合成的蛋白质。作为进化保守的蛋白家族之一,普遍存在于各种生物体中,并在生物体内发挥着重要的生理功能。HSP因具有丰富强大的分子伴侣、抗应激、调节细胞凋亡、抗氧化、参与机体免疫等生物学功能,决定了其广泛的用途。大量的试验表明,近年来HSP在相关领域的应用研究已获得了重要的突破与进展,特别是在疾病免疫和药物开发中的应用研究。文中在阐明HSP分子调控的基础上,综述了近年来热休克蛋白家族(HSP90、HSP70、HSP60和小分子HSP)在功能和应用方面的研究进展,为进一步完善对HSP的研究提供一定的参考。     

Focused extracorporeal shock wave therapy in an isolated calcification in the equine ligamentum nuchae--case report

In recent years extracorporeal shock wave therapy (ESWT) is used in veterinary medicine especially in equine orthopedics. Different ESWT generators are commonly used in equine medicine with varying energy density and depth of penetration. The presented case report described the treatment of a ligamentum nuchae calcification with focused extracorporeal shock wave therapy with SONOCUR Plus generator combined with SONOLINE Prima ultrasound. Negligible adverse effects, the non-invasive character of the treatment, the time-saving therapy, and the positive results make the focused extracorporeal shock wave therapy to an useful application.     

Extracorporeal shock wave therapy for treatment of osteoarthritis in the horse: clinical applications.

Veterinarians have begun using extracorporeal shock wave therapy (ESWT) for treatment of osteoarthritis (OA) in horses, although relatively little information has been published about its efficacy or mechanism of action. As a clinician, it can be difficult to know if and when ESWT should be recommended. Case studies in which ESWT is used to treat advanced OA in horses are discussed. ESWTseems to be a valuable adjunct for management of equine OA. It is the purpose of this article to discuss indications and techniques as well as to share clinical experiences using ESWT in the treatment of OA in the horse.     

Osseous lesion of the calcaneus following the use of shock wave therapy in a horse

An 8-year-old Dutch warmblood gelding was presented with a mechanical lameness (2/10) because of the presence of a soft tissue injury on the top of the right tuber calcanei. Plain radiographs of the tarsus demonstrated the presence of soft tissue swelling caudal to the right tuber calcanei, without osseous involvement, and ultrasonography revealed excessive scar tissue within and around the superficial digital flexor tendon. Extra-corporeal shock wave therapy was applied on the right hock to decrease the amount of scar tissue. One month after the therapy the lameness was greater (3/10) and a marginal increase in the size of the swelling was found. Periosteal new bone formation associated with an ill-defined radiolucent area and two bony fragments were detected radiographically at the caudo-proximal aspect of the right tuber calcanei. A blister containing oil of croton, camphor, pine and thyme, turpentine and cantharides was applied on the right calcaneus. Twenty days after blister application, the size of the swelling had been reduced by 50% and the degree of lameness had also been decreased (1/10). On clinical re-evaluation 6 months after treatment, the degree of lameness was stable (1/10) and flexion test of the limb was negative.     

Treatment of chronic or recurrent proximal suspensory desmitis using radial pressure wave therapy in the horse

REASONS FOR PERFORMING STUDY: Proximal suspensory desmitis (PSD) is diagnosed with increasing frequency in horses and radial pressure wave therapy (RPWT) is a widely used therapy for painful orthopaedic conditions in man and dogs. There are, however, few published data as to the outcome of its use in PSD. OBJECTIVE: To evaluate the use of RPWT in the treatment of chronic or recurrent PSD in the horse, an injury which carries a poor prognosis for return to athletic function with conservative management alone. HYPOTHESIS: RPWT and controlled exercise improves the prognosis of chronic or recurrent PSD in the horse when compared to previously published results of controlled exercise alone. METHODS: The use of RPWT in the management of chronic or recurrent proximal suspensory desmitis (PSD) was evaluated in 65 horses. Diagnosis was based on response to local analgesia, ultrasonography and radiography. Horses were classified according to severity of ultrasonographic lesions, whether fore- or hindlimbs were affected, and duration of lameness prior to diagnosis. Horses were treated 3 times at 2-week intervals and followed a controlled exercise programme; they were reassessed clinically and ultrasonographically 10-12 weeks after diagnosis, when further exercise recommendations were made dependent upon the animal's progress. RESULTS: Forty-one percent of horses with hindlimb lameness and 53% with forelimb lameness were nonlame and returned to full work 6 months after diagnosis. The prognosis was significantly affected by the ultrasonographic grade at the time of diagnosis and by ultrasonographic evidence of resolution of the lesion in hindlimb cases. CONCLUSIONS: These findings, when compared to previously published results of treatment using controlled exercise alone, suggest that RPWT improves the prognosis for PSD in the hindlimb. POTENTIAL RELEVANCE: RPWT is a useful treatment modality for chronic or recurrent PSD when combined with controlled exercise. Further studies are required on the effect of RPWT employing histology and biomechanics in order to fully evaluate its use on equine tissues.