A group of very interactive veterinarians gathered for the table topic discussion on shock wave therapy at the 2012 American Association of Equine Practitioners Annual Meeting, held Dec. 1-5 in Anaheim, Calif. Susan Johns, DVM, CVA, of Virginia Equine Imaging, and Scott McClure, DVM, PhD, Dipl. ACVS, associate professor of equine surgery at Iowa State University College of Veterinary Medicine, moderated. They first discussed shock waves’ mechanisms of action, noting that veterinarians still don’t completely understand how a physical pressure wave causes cells to produce stimulatory cytokines (“messenger molecules” by which immune system cells signal and instruct one another), but a number of outcomes (e.g., neovascularization, or blood vessel formation) have been shown. Attendees also discussed the types of shock wave equipment available at the convention trade show and their differences.

At this time it is clear shock wave therapy is an important part of the treatment regimen for a number of common lameness problems. In particular, veterinarians discussed its use with proximal suspensory desmitis (inflammation of the upper suspensory ligament) and weighed in on the types of cases they prefer to use shock waves with and the types of treatments they use. In the modern era veterinarians have a number of treatment options for this condition, including biologic therapies, and the group talked about what and why they start with a specific protocol for treatment. There was good discussion, for example, about where biologics such as platelet-rich plasma and stem cells fit into treating suspensory desmitis and how the timing of those treatments and shock wave therapy go together. There were a number of opinions, but it does appear the group overall would use shock wave with a biologic therapy initially on a severe desmitis case and follow that with additional shock wave treatment and a rehabilitation program.

There are few contraindications for the treatment, and the practitioners were interested in sharing ideas about frequency and spacing of treatments to maximize the therapy’s value. There was little consensus, but many ideas exchanged.

This table topic was moderated by Susan Johns, DVM, CVA, of Virginia Equine Imaging, and Scott McClure, DVM, PhD, Dipl. ACVS, associate professor of equine surgery at Iowa State University College of Veterinary Medicine.