Osteochondrosis (OC) Back to work - PulseVet · Osteochondrosis (OC) Tips for diagnosing and treating OC Reese Hand, DVM, DACVS Equine Sports Medicine & Surgery, Weatherford , Texas

Leadership in Veterinary Regenerative Technology

Back to workTips for diagnosing and treating

equine back conditionsKent Allen, DVM

Virginia Equine Imaging, Virginia

Brought to you by:

High-energy, focused sound wave healing - Extracorporeal Shock Wave Technology (ESWT)

For more information, visit PulseVet.com

Leadership in Veterinary Regenerative Technology

For more information, visit PulseVet.com

Osteochondrosis (OC)Tips for diagnosing and treating OC

Reese Hand, DVM, DACVSEquine Sports Medicine & Surgery, Weatherford , Texas

Brought to you by:

High-energy, focused sound wave healing - Extracorporeal Shock Wave Technology (ESWT)

For more information, visit PulseVet.com

Makers of:

SOUND ADVICE FROM FELLOW PRACTITIONERS

Diagnosing and recognizing back pain/conditions• Obtain a complete performance history (behavioral changes as noted from trainer/owner, evidence of pain) and

consider the horse’s health history (previous exams/conditions to rule out other musculoskeletal problems)• Start with a Standing Visual Inspection/Physical Exam for horses presenting with lameness/performance evaluation:

− Evaluate for symmetric or asymmetric muscle atrophy and axial/abaxial vertebral misalignment − Palpate slowly from front to back: press down with f ingertips over the dorsal spinous processes to determine

sensitivity – horses will react when experiencing pain• Moving Evaluation:

− Inspect horse movement in straight line and in both directions of a circle over f irm surface − View the horse under saddle – varying weight over the saddle region is essential in linking back pain and

performance. A weighted surcingle (50lb) may provide a more effective evaluation and helps with a horse that bucks

• Differentiate between bone and soft tissue inflammation (with diagnostic support from nuclear scintigraphy and digital radiography) Dorsal articular processes (DAP) are reviewed for abnormalities in size, shape and opacity. The more common spinous process impingement (SPI) are evaluated for lesions most often observed from T10 to T18, but not exclusively

• The reality about treating back conditions is: − Methocarbamol/Phenylbutazone will not f ix a back condition − Rest does not help a chronic sore back heal (in fact, rest further loosens the epaxial muscles) − Hocks do not cause back pain and injections are not needed prior to treating the back − “Kissing Spines” or Dorsal Spinous Processes Impingement (DSPI) does not have to lead to career end

Utilizing shock wave therapy for treating backs• May be used exclusively or as part of multi-modal treatment plan following diagnosis of SPI or DAP osteoarthritis• High-energy, focused sound waves penetrate to heal (up to 110 mm)• Shown to release proteins (cytokines) that reduce inflammation and proliferate growth factors (VEGF, eNOS, IGF1,

PCNA, BMP - result in neovascularization and increased bone growth)• Down-regulates TNF-alpha and IL-10 so mature chondrocytes (cells) are protected

Treatment recommendations for shock wave healing• Preparation: Wipe the treatment area with alcohol and apply ultrasound gel to the trode or area (Clip prior, if possible) • 2,000 shocks at highest energy setting:

− SPI is treated with 35 mm trode. Move the trode on midline for dorsal spinous processes − Reach the DAP and lumbar vertebrae (L1 – L6) with 35 mm or 80 mm trode at a slightly oblique angle

• Advise client to give the horse 2 days off and then gradually return to work over 3-5 days. Repeat treatment in 4-8 months

• Retrospective review of patients treated: 74 horses with radiograph-review following shock wave treatment. 89% had a positive outcome with ~60% improving for 4-6+ months following treatment*

©2011 PulseVet Technologies* 2010 AAEP Proceedings.

Vol. 56, 384-388

“Retrospective documentation of focused shock wave healing for thoracolumbar pain has demonstrated a significant improvement after just one treatment. More than 80% of horses are sound and back to work in weeks,” — Kent Allen, DVM Virginia Equine Imaging

©2017 PulseVet Technologies