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Taking the pain out of forelimb lameness

Diagnosing and treating forelimb lameness in canine patients can be challenging. However, shockwave therapy, may make treatments easier, particularly now that these treatments can be performed without sedation or anesthesia. Cases can present as either a chronic symptom or an acute injury, which several pathologies could cause. Differentials include biceps tendinopathy, supraspinatus tendinopathy, medial shoulder instability, and elbow osteoarthritis.

Patients rarely demonstrate overt pain on forelimb palpation, and although the dog’s age and medical history can help steer veterinarians in one direction or another, advanced diagnostics, such as ultrasound, CT, and MRI, are often required for a definitive diagnosis10

Since these diagnostics can be cost-prohibitive for the owner and may not be available at all clinics. Due to this, veterinarians and owners will often choose to treat certain conditions empirically. 

In the past, treatment options included activity restriction, joint supplements, NSAID or pain medication, laser therapy, rehabilitation, joint injections, and arthroscopic surgery. However, there are limited studies documenting the efficacy of these treatments, and many of the options come with their own set of hurdles. 

Electrohydraulic shockwave therapy is one exception, with more than 20 years of clinical, published research proving its efficacy in treating veterinary patients. Until recently, shockwave therapy frequently required small animal patients to be lightly sedated due to discomfort associated with the high-energy sound waves the technology generates. However, a new handpiece released by PulseVet Technologies, the X-Trode, allows the same energy to be deposited to a greater focal area. This new technology takes the sting out of treatment and diminishes the need for sedation in small animals.

The energy is applied non-invasively and deposited in the tissue around the site of injury. The physical stimulus to the cells causes the release of anti-inflammatory, angiogenic, and osteogenic proteins, such as TNF, VEG-f, PCNAA, eNOs, and BMP. This biological response causes a cascade of healing effects that modulates inflammation, improves vasodilation and neovascularization, increases osteogenesis, and improves the fiber alignment in tendon and ligament repair. 1,2,3,4 

A treatment takes less than 5 minutes, for a total of 1-3 sessions about 2-3 weeks apart, can be performed without sedation, has little to no side effects, and the research shows  that ESWT is effective in treating difficult forelimb lameness cases7,8,9.

In a study performed by Leeman et al. at Seattle Veterinary Specialists (2016), 87% of dogs with biceps or supraspinatus tendinopathies had a good or excellent outcome after 1 to 3 shockwave treatments, especially in those with moderate to severe lesions7. The median follow-up time was 95 months. Shockwave therapy was performed in all the patients without complications. 

Willem Becker, DVM, DACVS-SA and Michael Kowaleski, DVM, BS, DACVS, at Tufts University found that 100% of dogs with shoulder lameness had short-term improvement or resolution after 3 shockwave treatments, and 64% of those dogs had long-term improvement or symptom resolution8

At the University of Tennessee, dogs presenting with osteoarthritis of the elbows either received 2 shockwave treatments or were in a sham group. The dogs in the shockwave group showed significant improvement in Peak Braking, Peak Propulsion and increased 4.5% in Peak Vertical Force compared to a decrease of 2.6% in the sham group9.

Shockwave is an effective, non-invasive treatment option that decreases inflammation, aids in pain relief, improves tissue and bone healing, and should be considered for forelimb lameness cases. 1,2,3,4

Written by Jennifer Vitucci, DVM, CCRT

  1. Kersh,KD, McClure,SR, Evans,RB. The evaluation of extracorporeal shock wave therapy on collagenase induced superficial digital flexor tendonitis. Vet Comp Orthop Traumatol 2006;19:99–105
  2. Chen, YJ, Wang, CJ, Yang, KD, et al. Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-β1 and IGF-I expression. J Orthop Res 2004;22:854–861
  3. Wang, CJ, Wang, FS, Yang, KD. Biological mechanism of musculoskeletal shockwaves. International Society for Musculoskeletal Shockwave Therapy—ISMST 2004;1:5–es 11
  4. Ogden, J.A., Toth-Kischkat, A. and Schultheiss, R. Principles of shockwave therapy. Clinical Orthopaedics 2001;387:8-17.
  5. Farkas, B., Kvell, K., Czompoly T., et all. Increased chondrocyte death after steroid and local anesthetic combination. Clinical Orthopaedics and Related Research 2010; 468:3112-3120.
  6. Cook, J., Kenter, K., Fox, D. Arthroscopic biceps tenodesis: technique and results in six dogs. Journal of the American Animal Hospital Association 2005; 41:121-127.
  7. Leeman, J., Perry, J., Carr, A., et al. Extracorporeal shockwave therapy and therapeutic exercise for supraspinatus and biceps tendinopathies in 29 dogs. Veterinary Record 2016; 1-8.
  8. Becker, W., Kowaleski, M., McCarthy, R, et al. Extracorporeal shockwave therapy for shoulder lameness in dogs. Journal of the American Animal Hospital Association 2015; 51:1.
  9. Millis, DL, Drum, M, Whitlock D. Treatment of elbow arthritis with extracorporeal shock wave therapy. IAVRPT Symposium, 2010.
  10. Wall, C., Cook, C. and Cook, J. Diagnostic sensitivity of radiography, ultrasonography, and magnetic resonance imaging for detecting shoulder osteochondrosis/osteochondritis dissecans in dogs. Veterinary Radiology & Ultrasound 2015; 56:3-11.

 

 

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