Klinische Studie zur Behandlung häufiger Erkrankungen des Bewegungsappartes des Pferdes mittels fokussierter extrakorporaler Stoßwellentherapie (ESWT)

Urhahne, Petra Focussed Extracorporeal Shock Wave Therapy (ESWT) for treatment of common diseases in equine orthopaedics In the present study the results of focussed extracorporeal shock wave therapy on 65 treated horses with the following four diseases are represented: navicular disease, chronic proximal suspensory ligament desmitis, chronic proximal sesamoiditis and bone spavin. Only horses which had shown lameness over a period of at least two months were included in the study. The focus of this study was to assess the influence of focussed extracorporeal shock wave therapy on the clinical symptoms and on radiological und ultrasonographic findings as well as to determine if treatment could restore full athletic function during the time of observation. The focussed shock waves were produced using a conventional veterinary shock wave generator based on the electrohydraulic principle. Treatments were conducted two to four times in intervals of three to four weeks. For each treatment of horses with navicular disease 2000 impulses were applied, for the treatment of the other diseases 1500 impulses were applied with a maximum energy flux density of 0,15 mJ/mm². No other treatments were allowed during the time of observation. After each shock wave treatment the horses had two days of rest before a controlled exercise program was started. Clinical examinations to document treatment success were conducted at least four times. The first examination was conducted shortly after the first shock wave application (until two moths later), the second one three months after the beginning of treatment, the next one half a year after commencement of treatment, and the last clinical examination was carried out up to thirty months after the first treatment. Within the framework of these clinical examinations x-rays and ultrasound pictures were taken too. A significant initial improvement of lameness was observed in all four orthopaedic diseases, shown by an improvement in the lameness of at minimum one lameness-degree in 78 % to 100 % of the treated horses in the first two months after therapy started. After three months 50 % (six horses) of the twelve horses with navicular disease, 77 % (26 horses) of the 34 patients with chronic proximal suspensory ligament desmitis, 70 % (seven horses) of the ten horses with chronic proximal sesamoiditis and 44 % (four horses) of the nine spavin diagnosed horses were free of lameness. The examination of the patients half a year after the first treatment 33 % (four horses) of the navicular disease horses, 79 % (27 horses) with proximal suspensory ligament desmitis, 70 % (seven horses) with sesamoiditis and 33 % of the spavin diagnosed horses were free of lameness. Six to thirty months after the first ESWT-treatment 42 % (five horses) of the horses with navicular disease, 79 % of the patients with chronic proximal suspensory ligament desmitis, 60 % (six horses) of the horses with chronic proximal sesamoiditis and 33 % (three horses) of the spavin-diagnosed horses were still sound. No relevant side effects were noticed in treated horses. The sonographic examination of the thirty-four horses with chronic proximal suspensory ligament desmitis showed a complete restoration in function in 77 % of all treated patients after a maximum of six months after begin of ESWT. When pre- and post-treatment x-rays were compared to one another no significant changes were seen. The results of this study were compared to the results of other, previously conducted studies in which shock wave therapy was utilised in horses suffering from the same orthopaedic diseases as occurred in this study, as well as to results of conventional treatments of the named diseases. Although the studies yielded varying results, all studies were able to show a significant improvement of lameness after shock wave therapy. The results of the present study demonstrate that focussed extracorporeal shock wave therapy seems to be an effective treatment in the four described chronic orthopaedic diseases of the horse with no considerable side effects, and especially effective for the treatment of chronic proximal suspensory ligament desmitis und chronic proximal sesamoiditis.