Evaluating treatment options for equine tendon, ligament and joint disease - DVM
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Evaluating treatment options for equine tendon, ligament and joint disease


Making informed decisions

Education, familiarity and experience all factor into the treatment choices that veterinarians make every day. They're certainly at work in the way an individual clinician chooses to treat a torn tendon, a strained ligament or an arthritic joint. Essentially you use what you were taught to use, what you have tried and had success with and what you are comfortable with.

But this doesn't ensure that the appropriate or best treatment, out of the many available, is used on each case. Many of the treatments in these instances have been available just long enough, however, for us to take a closer, more scientific look and to evaluate their successes and failures. A look at what we now know about these ways of dealing with specific injuries will provide a better basis on which to make a clinical decision.

Photo 3: Horses working at speed or jumping uneven surfaces are more prone to tendon and ligament damage. Treatments such as PRP, Tildren and stem-cell use can significantly improve healing.
This evaluation will make it easier for practitioners to recognize strengths and weaknesses of individual drugs and procedures and to educate their clients on choices made.

Allowing sufficient rest

Even with all the treatments available, there is one part of almost all equine soft-tissue injury protocols that is universally accepted: "Rest must be an integral part of any potentially successful tendon or ligament-treatment program," says Dr. Mark Revenaugh of the Equine Performance Institute of Mulino, Ore.

Some practitioners believe rest may be the most important part. Dr. Rodger Smith, of the Department of Veterinary Clinical Sciences at the Royal Veterinary College, University of London, states, "a multitude of treatments have been advocated for the management of tendon over-strain injuries, but there is little evidence in any species that any is more effective than a prolonged period of rehabilitation with carefully controlled exercise."

Attempting any other treatments without incorporating adequate rest into the protocol generally is unrewarding.

There are a number of topical creams (such as diclofenac liposomal cream) and rubs for treating tendon and ligament inflammation. A reduction in edema and in the damaging secondary cellular effects of inflammation can lessen initial injury and shorten recovery time. These products are relatively inexpensive, easy to use and apply, and most have a proven effectiveness.

If damage to the tendon or ligament is severe and involves fiber disruption, the action of these topicals is limited to reducing inflammation, so an accelerated healing time will not be as likely as with various other, more aggressive, treatments.

Diclofenac liposomal cream has been shown to decrease the histological progression of osteoarthritis when applied to joints and provides better pain relief and anti-inflammatory response than standard anti-inflammatory drug choices (phenylbutazone).

Shock-wave therapy

It has been almost 10 years since Extracorporeal Shock Wave Therapy (ESWT) was first used in horses. This technique uses a machine (extracorporeal; from outside the body) to produce high-intensity shock or pressure waves that are directed, often with ultrasound, to a specific site within injured tissue.

After initially being pointed at any and all injuries in the horse, ESWT has found success treating conditions varying from suspensory ligament desmitis, navicular disease and bucked shins, to bowed tendons, saucer, sesamoid and stress fractures, and some conditions of the equine spine.

The exact manner in which ESWT works remains largely unknown, and whether it primarily produces pain relief or stimulates healing is still in debate.

Researchers at the Institute of Biomedical Engineering at the National Yang-Ming University in Taiwan investigated ESWT on rat Achilles-tendon preparations and documented cellular evidence of shock-wave treatment.

They found "positive stimulatory effects," including up-regulation of proliferating cell nuclear antigen, collagen types I and III, transforming growth factor and increases in nitric-oxide production. They concluded "ESWT can stimulate tenocyte proliferation and collagen synthesis."

In the cases and areas where ESWT is effective, it is very beneficial, but in many other instances has little better than a 50/50 chance of success. ESWT seems to be most effective on front-leg suspensory desmitis but for hind-leg suspensory problems and for navicular disease it works about half the time.

In joint therapy, ESWT has been shown to improve clinical lameness and synovitis but does not improve the progression of arthritis.

The analgesia produced by this modality may lead to joint damage if the treated animal becomes more animated and active during its recovery.


Source: DVM360 MAGAZINE,
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