TM
Healing today. Curing tomorrow.
VersaTron Use in Young Horses: Healing common conditioning and
training injuries with high-energy focused shock wave technology
As summer approaches, it is time to start conditioning the yearlings. Optimizing the training at this stage is crucial to the
performance of the horse through the years to come and to the value of the horse in the immediate future. There are a variety of
training injuries that are commonly seen during the initial training stages and it is equally important to address these injuries
appropriately and quickly.
While horses of any age need to be pushed in order to increase performance, there are frequent injuries associated with the stress
of conditioning, which need to be aggressively treated. Certainly the types of injuries are dependent upon the breed and activity of
the horse. The following is a list of common issues seen across a variety of disciplines including horse racing, hunter/jumpers,
dressage, reiners, etc.
•
Osteochondritis Dissecans (OCD) and Subchondral Bone Cysts
•
Suspensory Ligament Desmitis
•
Bucked Shins / Stress Fractures / Splints
•
Fetlock Problems / Green Osselets
High-energy, focused, Extracorporeal Shock Wave Technology (ESWT) is a safe, efficacious and timely option for
managing these conditions.
ESWT Technology
Safety is first and foremost the concern associated with any treatment, and even more so in young patients. During the last
10+ years of shock wave use for musculoskeletal conditions, the safety of the technology continues to be reaffirmed. Specifically,
VersaTron® high-energy shock wave technology has been proven to be safe and effective when used at the proper energy settings,
even in young horses. Numerous studies conclude that ESWT utilizing VersaTron is a safe treatment and that no damage occurs at
the appropriate settings.1-6
OCD & Subchondral Bone Cysts
OCD is a common issue seen in yearlings and can be a difficult condition to treat. Arthroscopic debridement and other surgical
options can be successful, but even minimally invasive techniques are associated with recovery periods and the potential for
complications and additional structural injury. VersaTron shock wave treatments may provide a non-invasive alternative to
successfully heal OCD lesions. A common contributing cause of OCD of any joint in any species is the loss of blood supply to the
bone and cartilage. Shock wave technology has been proven to stimulate expression of angiogenic growth factors and induce
neovascularization, thereby leading to regression of bone lesions as seen in histological evaluations and MRI screenings.7,8
Dr. Robert Cook (Woodford Equine, Versailles, KY) has reported excellent results for OCD applications with efficacy rates
estimated to be at 90% for treatment in yearlings.9 Prognosis is also excellent for bone cysts in growing horses.10
Suspensory Ligaments
Suspensory ligament injuries are perhaps one of the most common injuries seen in equine medicine today and veterinarians report
that it is the most common use for the VersaTron high-energy shock wave device.11 Focused, high-energy ESWT heals these
injuries more rapidly and with better efficacy than alternative modalities.5 Dr. Larry Metheney (Phoenix, AZ) reports that shock
wave treatment increases blood flow to areas of the lower limb such as the suspensory ligaments that have a limited blood
supply, thereby decreasing healing times.10 In addition, early and sustained release of various growth factors including Proliferating
Cell Nuclear Antigen (PCNA) following shock wave treatment leads to tissue regeneration and repair.7 ESWT significantly improves
collagen fiber alignment during the repair process, which can help to prevent injury relapse.12
To optimize treatment of a suspensory
ligament injury with ESWT, the injury
must be treated at two areas; the area
of the suspensory proximal and distal
to the location where the suspensory
divides into the medial and lateral
branches. Dr. Metheney considers the
outcomes for ESWT for this application
to be excellent with the appropriate
treatment protocol (see Figure 1). 10
Figure 1. VersaTron Protocol for Suspensory Ligament Injuries
Entry
Window
Probe
Energy Setting
Number of
Shocks
Treatment
Interval
Proximal Suspensory Ligament (proximal 1/3 of ligament)
Palmardorsal
Medial and lateral
R20 or R35
R05
E4 to E6
500
10 days to 3 weeks
E4 to E6
500 each side
10 days to 3 weeks
Distal Suspensory Ligament
Medial and
lateral branches
R05
E4 to E6
800 each branch
10 days to 3 weeks
TM
Healing today. Curing tomorrow.
Bucked Shins / Stress Fractures / Splints
These forelimb injuries are common problems among race horses and are caused by the extreme stress generally put on young
bones that are not yet fully conditioned. The degree of lameness, pain, and swelling is dependent upon the severity of the case, but
at any level, these injuries can delay training and potentially impact the future success of the horse. High energy focused shock
wave treatment speeds the recovery from these injuries, thereby decreasing the resting period and returning the horse to a sound
state sooner. In an investigation of the mechanism of action of ESWT by Wang, et al, the results showed higher bone strength and
bone mass in the ESWT treatment group vs. the control group.7 The protocol to treat these conditions is somewhat dependent
upon the area affected; however Figure 2 lists general recommendations. Bucked shins and splints are often healed with one
treatment, acute fractures with 1-2 treatments and old fractures with 3-4 treatments.10
Green Osselets
Figure 2. VersaTron Protocol for Bucked Shins / Stress Fractures / Splints
This condition of the joint capsule in
the fetlock is another issue that is very
Bucked Shins:
common as a result of the severe
Entry
Probe
Energy Setting
Number of
Treatment
Window
Shocks
Interval
stress put on the forelimbs of many
Dorsal, medial, and
R05
E6
1000 per cannon
Uncomplicated
breeds during training. The hot, soft,
lateral aspects of
cases respond to
inflammation associated with green
cannon bone from
one treatment
osselets can lead to permanent
carpus to fetlock
damage of the cartilage and joint
Stress Fractures:
capsule so it is critical to address the
Entry
Probe
Energy Setting
Number of
Treatment
symptoms immediately and prevent
Window
Shocks
Interval
resulting new bone formation and
Depends
on
area
Depends
on
depth
of
E4
to
E6
1000-3000
dependRepeat
every 3 to 4
spurs. Recent theory categorizes this
affected
intended target
ing on size of lesion
weeks
condition as a cartilage injury that
Acute fractures generally 1 to 2 treatments, while old fractures may require 3 to 4 treatments.
causes proliferation of the joint capsule
Splints:
and is therefore of arthritic nature. A
Entry
Probe
Energy Setting
Number of
Treatment
report from the Colorado State
Window
Shocks
Interval
University Orthopaedic Research
Dorsal, medial, and
R05
E6
1000 per cannon
Uncomplicated
Center previously demonstrated the
lateral aspects of
cases respond to
significantly positive effects of ESWT
cannon bone from
one treatment
carpus to fetlock
vs. polysulfated glycosaminoglycan for
improving lameness and the clinical
signs of pain associated with induced
osteoarthrittis of the carpal joints. Additionally, a significant reduction in synovial fluid total protein was seen with ESWT.6 Further
publication has documented the positive acute results for shock wave and long-term results of 24 months and beyond for arthritic
conditions.13
Dr. Metheney, reported a recent case in which he was able to successfully treat green osselets without the use of a joint injection.
The 2 yr old was diagnosed with green osselets in addition to a small chip in the ankle at the proximal end of P1. Based on
previous success with shock wave for tendon applications, the owner requested shock wave instead of an injection. The patient
did “very very well” states Metheney. Dr. Metheney suggests that the horse be cooled down for 5-10 days prior to treatment and
NSAIDS should not be used. He recommends administering 1-3 treatments of 1000 shocks with the R05 VersaTrode.14
With the ten years of proven safety and efficacy, VersaTron ESWT has become the trusted technology of choice for many
veterinarians and its indications for use continue to expand through scientific research and practical applications. When used as
directed, VersaTron ESWT is a safe and reliable treatment for common injuries seen in young horses as a result of conditioning
and training.
TM
Healing today. Curing tomorrow.
References:
1. Wang CJ, et al. Treatment for Osteonecrosis of the Femoral Head: Comparison of
Extracorporeal Shock Waves with Core Decompression and Bone-Grafting. J Bone Joint Surg Am.
2005;87:2380-2387.
2. Wang CJ, Chen HS, Chen CE, Yang, KD. Treatment of Nonunions of Long Bone Fractures With
Shock Waves. Clin Orthop. 2001;387:95-101.
3. Schaden W, Fischer A, Sailler A. Extracorporeal Shock Wave Therapy of Nonunion or Delayed
Osseous Union. Clin Orthop. 2001;387:90-94
4. Answers on Shock Wave Therapy. Grayson-Jockey Club Research Today. 2004;21:1-3.
5. Bonner, L. The Wave of the Future? Equus. May 2003; 307.
6. Orthopaedic Bioengineering Laboratory 2002-2003 Report. Evaluation of Extracorporeal
Shock Wave Therapy for Osteoarthritis. Orthopaedic Research Center, Colorado State University.
2003:94-95.
7. Wang CJ, Wang, FS, Yang, KD. Biological Mechanism of Musculoskeletal Shockwaves.
International society for musculoskeletal shockwave therapy – ISMST Newsletter. Volume 1. Issue I.
8. Wang CJ, et al. Treatment for Osteonecrosis of the Femoral Head: Comparison of
Extracorporeal Shock Waves with Core Decompression and Bone-Grafting. J Bone Joint Surg Am.
2005;87:2380-2387. 9. SANUWAVE Data on File. Interview with Robert Cook, DVM. May 2008
10. Metheney, LA. Extracorporeal Shock Wave Therapy and the Equine Patient: A Practitioner’s
Guide to Methods of Extracorporeal Shock Wave Therapy. SANUWAVE Data on File. November
2004.
11. SANUWAVE Data on File. Customer Survey 2008.
12. Alves, ALG, et al. Effects of extracorporeal shock wave treatment on equine tendon healing.
International society for musculoskeletal shockwave therapy – ISMST Newsletter. Volume 1. Issue I.
13. Revenaugh MS. Extracorporeal shock wave therapy for treatment of osteoarthritis in the horse:
clinical applications. Vet Clin North Am Equine Pract. 2005;2:609-25.
14. SANUWAVE data on file. Interview with Larry Metheney, DVM. May 2008.
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