Extracorporeal Shockwave Therapy
Extracorporeal Shockwave Therapy
Extracorporeal Shockwave Therapy
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<strong>Extracorporeal</strong><br />
<strong>Shockwave</strong> <strong>Therapy</strong><br />
Principles and technic, application and<br />
comparison with other therapies<br />
R. Brems, C. Siedler,<br />
Equine Clinic, Wolfesing, Germany<br />
Geneva 2001
Definition<br />
● Shock-waves (= acoustic waves)<br />
● Pulsating pressure waves<br />
● Extremely short pressure rise<br />
● High peak pressure<br />
Geneva 2001
ESW of low energy density:<br />
< 0.1 mJ/mm 2<br />
ESW of high energy density:<br />
0.2 -0.5 mJ/mm 2<br />
Geneva 2001
Principles of <strong>Shockwave</strong>s<br />
● <strong>Shockwave</strong>generator<br />
Elektromagnetic system<br />
Elektrohydraulic system<br />
Piezoelectric system<br />
● Liquid medium of transmission<br />
● Ultrasound / radio focus-system<br />
● Coupling cushion<br />
Geneva 2001
Ultrasound Guided<br />
<strong>Extracorporeal</strong> <strong>Shockwave</strong><br />
<strong>Therapy</strong> (7.5 MHz)<br />
Geneva 2001
Preparation - <strong>Therapy</strong> -<br />
Post Treatment Care<br />
● Sedation<br />
● Shaving, ultrasound gel<br />
● 1-3 treatments<br />
● 5-20 days treatment intervalls<br />
● Energy density: 0.2-0.5 mJ/mm 2<br />
● Hand-walking; no stall-rest<br />
Geneva 2001
Indications for ESWT<br />
● Insertiondesmitis<br />
● Tendinitis / Desmitis<br />
● Calcifications in tendons and ligaments<br />
● Arthrosis<br />
● Osteoporosis<br />
Geneva 2001
High Suspensory Desmitis<br />
(n=124)<br />
● 67 horses - lameness-free or almost<br />
sound (54%)<br />
● 37 horses - improved (30%)<br />
● 20 horses - unchanged (16%)<br />
Geneva 2001
Other Forms of Desmitis<br />
(n=85)<br />
● 48 horses - lameness-free or almost<br />
sound (56%)<br />
● 12 horses - improved (14%)<br />
● 25 horses - unchanged (30%)<br />
Geneva 2001
Horses<br />
ESWT of Different Forms of<br />
90<br />
80<br />
70<br />
60<br />
50<br />
40<br />
30<br />
20<br />
10<br />
0<br />
Total<br />
Desmitis (n=85)<br />
Sesam. Lig.<br />
Inf. Check Lig.<br />
Annular Lig.<br />
Others<br />
Total<br />
no lameness<br />
improvement<br />
unchanged<br />
Geneva 2001
Other Indications<br />
(n=114)<br />
● 33 horses - lameness-free or almost<br />
sound (29%)<br />
● 49 horses - improved (43%)<br />
● 32 horses - unchanged (28%)<br />
Geneva 2001
Horses<br />
120<br />
100<br />
80<br />
60<br />
40<br />
20<br />
0<br />
ESWT of Other Indications<br />
Total<br />
Sesamoid.<br />
Calcifi.<br />
(n=114)<br />
Arthrosis<br />
Others<br />
Total<br />
no lameness<br />
improvement<br />
unchanged<br />
Geneva 2001
Advantages<br />
● Minimal invasive - No surgery<br />
● Low risk method<br />
● Requires no general anaesthesia<br />
● No hospitalisation required<br />
● Cosmetic<br />
● Successful therapy - even in case of<br />
unfavourable prognosis<br />
Geneva 2001
Disadvantages<br />
● No long-term results available<br />
● Side effects (hematoma /<br />
inflammation)<br />
● Costs<br />
● No wonders; not healing everything, ...<br />
Geneva 2001
Horses<br />
140<br />
120<br />
100<br />
80<br />
60<br />
40<br />
20<br />
0<br />
ESWT of HSD (n=124)<br />
Total<br />
Total<br />
no lameness<br />
Geneva 2001<br />
improvement<br />
unchanged
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