Electrohydraulic Shockwave for Treatment of Forelimb Superficial Digital Flexor Tendinitis and Proximal Suspensory Desmitis in Horses.
Authors: Khairoun Ahmed, Hawkins Jan F, Moore George E, Lescun Timothy B, Adams Stephen B
Journal: Journal of equine veterinary science
Summary
# Editorial Summary: Electrohydraulic Shockwave Therapy for Equine Tendon and Ligament Injuries Superficial digital flexor tendinitis and proximal suspensory desmitis represent persistent sources of performance-limiting lameness in horses, driving ongoing investigation into optimised treatment protocols beyond conventional rest and medication strategies. This retrospective analysis of 11 years' clinical records (2010–2021) compared outcomes in horses receiving three or more electrohydraulic shockwave treatments against those completing fewer than three treatments, with lameness scoring and ultrasound assessment at multiple timepoints to evaluate both immediate and sustained responses. Clinical lameness scores improved significantly in both conditions when comparing baseline to the third treatment in the multi-treatment group (PSD P<0.0001, SDFT P=0.016), though corresponding ultrasound changes remained statistically insignificant—suggesting functional improvement may precede tissue remodelling visualisation. Extended follow-up proved the determining factor for positive outcomes (P=0.001 regardless of treatment frequency), with chronicity of injury acting as a negative predictor of recovery (P=0.028), whilst no meaningful difference emerged between short and long-term prognosis between the two groups. For practitioners, this indicates that electrohydraulic shockwave therapy produces measurable clinical benefit in acute to moderate-chronicity cases, though the protocol of three treatments offers no outcome advantage over fewer applications when monitored over extended periods—suggesting individualised treatment planning based on injury duration rather than arbitrary session thresholds may optimise both efficacy and cost-effectiveness.
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Practical Takeaways
- •ESWT shows clinical benefit for SDFT and PSD with improved lameness scores, but ultrasound lesions may not fully resolve—manage expectations regarding tissue healing on imaging
- •Treatment frequency (≥3 vs <3 sessions) did not significantly affect outcomes; focus on adequate follow-up time and patient recovery rather than number of sessions
- •Chronic injuries respond less favorably to ESWT; earlier intervention may improve prognosis
Key Findings
- •Lameness scores significantly improved between first and third ESWT treatments in both PSD (P<0.0001) and SDFT (P=0.016) horses in the ≥3 treatment group
- •Ultrasound findings showed no significant difference at the end of the third treatment for either PSD (P=0.062) or SDFT (P=0.125)
- •Time to follow-up (months) was the only significant predictor of positive outcome (P=0.001), with no difference between horses receiving ≥3 versus <3 treatments
- •Chronicity of injury was negatively associated with lameness improvement (P=0.028)