At the Table Topic session on shock wave therapy during the 2010 American Association of Equine Practitioners, held Dec. 4-8 in Baltimore, Md., attendees briefly discussed equipment–in particular, focused shock wave equipment. Treatment protocols were discussed in general. Practitioners noted a difference between treating specific injuries versus maintenance of a chronic problem. In treating a new injury veterinarians performed a series of treatments, whereas in the horse with a chronic issue such as lower hock or cervical osteoarthritis, treatment might be done as clinical signs recur or as a scheduled event or prior to specific times of shows.

Much of the forum was spent discussing how shock wave fits into the overall regenerative medicine program. All of the panel members and many attendees use it in combinations with other therapies including platelet-rich plasma (PRP), interleukin-1 receptor antagonist protein (IRAP), and stem cell therapy. The timing of the applications was a bit less consistent between users. There seemed to be some generalized consensus that shock wave therapy can be initiated early in the treatment, and additional therapies such as PRP might be started at the same time with injections following shock wave. There was some discussion about how shock waves seem to dissipate fluid from an acute injury, which can be observed via ultrasound following treatment. In that case practitioners probably want to shock wave before giving injections. Similarly, the potential of inhibition or injury of freshly implanted stem cells would suggest using shock wave before injecting stem cells.

The use of local anesthesia when performing shock wave therapy created much discussion, as there are some tolerance factors of the horse that increase with age and discipline. Veterinarians working on younger horses might need to use local anesthesia more often than they would on mature show horses that are more tolerant of treatment. Attendees discussed how horses with some issues, particularly of the back, seem to respond more when the shock waves are directed at the source of the pain. There might be some diagnostic or at least "confirmatory" value to horses having limited sedation without local anesthesia in those cases.

Areas of interest without clear-cut answers included the application of shock wave therapy for angular limb deformities and osteochondritis dissecans (OCD) lesions. Previous publication showing an inhibitory effect of growth across the physis (growth plate) with a radial pressure wave generator was the basis for some treatments. There was no consensus on how much it contributed to outcome. Similarly, OCD lesions might show some response, particularly in young horses, but there was a lot of anecdotal discussion. No one was excited about the effect of shock wave on large cysts of the medial femoral condyle (the inside of the lower part of the femur)