Treatment of chronic or recurrent proximal suspensory desmitis using radial pressure wave therapy in the horse.
Authors: Crowe O M, Dyson S J, Wright I M, Schramme M C, Smith R K W
Journal: Equine veterinary journal
Summary
# Radial Pressure Wave Therapy for Proximal Suspensory Desmitis Proximal suspensory desmitis presents a significant clinical challenge due to its poor prognosis with conservative management alone, yet radial pressure wave therapy (RPWT)—already established in human and canine medicine—remained largely unvalidated in equine practice when this study was conducted. Sixty-five horses with chronic or recurrent PSD were treated with three RPWT sessions at fortnightly intervals combined with a structured exercise programme, with clinical and ultrasonographic reassessment occurring 10–12 weeks post-diagnosis to guide subsequent rehabilitation. At the six-month follow-up, 53% of forelimb cases and 41% of hindlimb cases returned to soundness and full work, representing a material improvement over published outcomes with exercise management alone—particularly for hindlimb lameness, where ultrasonographic lesion grade at diagnosis and evidence of lesion resolution proved significant prognostic indicators. For practitioners managing PSD, these findings support incorporating RPWT into a controlled exercise protocol, though the mechanism of tissue healing remains incompletely understood and warrants further investigation using histological and biomechanical analysis. Whilst RPWT shows promise as an adjunctive therapy, outcomes remain variable depending on lesion severity and location, requiring individualised case assessment rather than uniform application.
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Practical Takeaways
- •RPWT combined with structured exercise is a viable treatment option for chronic or recurrent suspensory desmitis, with over 40% of cases returning to full work within 6 months
- •Ultrasonographic assessment at diagnosis helps predict outcome—more severe lesions carry poorer prognosis, so realistic expectations should be set with owners early
- •Hindlimb PSD appears to benefit more from RPWT than forelimb cases based on this data, which may influence treatment recommendations
Key Findings
- •41% of horses with hindlimb PSD and 53% with forelimb PSD returned to full work and were nonlame 6 months after RPWT treatment combined with controlled exercise
- •Ultrasonographic grade at diagnosis significantly affected prognosis in both limbs
- •Ultrasonographic evidence of lesion resolution in hindlimb cases was a significant prognostic indicator
- •RPWT combined with controlled exercise improved prognosis for PSD compared to previously published results of controlled exercise alone