One of the first case series completed was in a group of horses with bone spavin where 59 of 74 horses (80 percent) improved at least one lameness grade. In vivo studies have shown increased bone formation and healing of nonunions and neovascularization of bone-tendon junctions. In the horse, multiple applications have been tried. A number of results of the treatment have been identified. Neovascularization following ESW therapy has been shown in tissues ranging from bone to myocardium. Up regulation of cytokines has been demonstrated in a number of tissues and more recently shown through gene expressions. These findings are great strides towards identifying the initiating mechanism which appears to be a cellular response to the physical shock wave stimulating the cell. The mechanisms by which ESWs provide a therapeutic outcome are minimally understood. Investigations into multiple other areas have led to the FDA approval of ESWs for heel spurs and tennis elbow and other FDA trials are underway. Multiple studies have documented the effectiveness of ESWs for treating hypertrophic nonunions in people. Subsequently, the original musculoskeletal applications were associated with stimulation of nonunion fractures to heal. The original use of shock waves to fragment uroliths was expanded to orthopedic applications when, following a safety study, the density of a portion of the pelvis within the treatment area increased. This creates a pressure wave, but the parameters of the wave are different, however they continue to be confused and incorrectly lumped together. The waveforms have different energy levels and different depths of penetration. It is important not to assume that the results of using one wave form will be similar to the other. The discussion here will focus on ESWs. There are differences between extracorporeal shock waves (ESWs) and radial pressure waves (RPWs). Radial pressure waves are created by a pneumatically driven device to strike the surface. This mechanism allows the energy in the wave to aim at a specific point within the tissue. In all three mechanisms, the pressure wave is brought to a focal point by lenses or a parabolic reflector. The pressure wave can be instituted by vaporization of fluid across a spark gap (electrohydraulic), expansion of piezoelectric crystals (piezoelectric), or pushing a membrane with opposite electrical current (electromagnetic). There are multiple ways to generate a shock wave. McClure, DVM, PhD, Diplomate ACVS, Diplomate ACVSMRĪ shock wave is an acoustic (pressure) wave with very high amplitude and rapid rise time.
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