RESUMO
BACKGROUND: Radiographs are a common diagnostic tool utilised during pre-purchase examinations, yet differences surround their interpretation among equine veterinarians. OBJECTIVES: (1) To determine veterinarians' subjective impressions of a spectrum of radiographic abnormalities regarding suitability for purchase; (2) To determine how veterinarians' years in practice, primary discipline or board certification status influence their subjective impression of radiographic abnormalities, and (3) To determine how horses' discipline, current level of work (working at intended level vs. future prospect) and buyer intent (sell vs. retain ownership) influence veterinarians' subsequent recommendation. STUDY DESIGN: Worldwide electronic survey of veterinary professionals. METHODS: Four radiographic series of navicular bones, tarsi, and stifles, representing varying degrees of pathological change (normal, mild, moderate and marked) were presented. Respondents (n = 211) graded their level of concern from 1 (no concern) to 10 (very concerned) based on the radiographs and case scenarios presented. RESULTS: Overall, as the grade of pathological change increased for each anatomical location, so did the level of veterinarian concern, but a wide range of answers were submitted for all grades of pathology. Board certified practitioners had a higher level of concern over marked radiographic changes of the navicular bone for both western performance and English sport horses as well as prospect horses (mean = 7.2 vs. 6.1; P = 0.009; 95% CI for difference = [0.3, 2.0]). Board certified respondents had a lower level of concern over marked radiographic changes of the tarsus regardless of the performance status of the horse (mean = 7.1 vs. 8.0; P = 0.008; 95% CI for difference = [-1.5, -0.2]). Western performance horse practitioners had a lower level of concern over mild radiographic changes of the tarsus regardless of the performance status of the horse (mean = 3.3 vs. 4.2; P = 0.009; 95% CI for difference = [-1.6, -0.2]). MAIN LIMITATIONS: Only one example of each pathological grade per anatomical region was presented. CONCLUSIONS: On survey radiographs, the perceived clinical relevance of radiographic abnormalities among equine practitioners differs widely, making purchase recommendations highly variable.
RESUMO
Over the past three decades, electrohydraulic extracorporeal shock wave therapy (ESWT) as a treatment modality for equine orthopaedic disorders has sparked exponential interest among practitioners, but its clinical applications are quickly evolving and a current review highlighting modernised equine clinical use is lacking. The objective of this review is to summarise the most current ESWT technology, evidence for its use, proposed mechanisms of action and clinical applications in horses while also highlighting the areas requiring further investigation. The three ways to generate a shock wave are through electrohydraulic, electromagnetic or piezoelectric mechanisms, but over the last decade, electrohydraulic systems have predominated due to the ability to focus and control a therapeutic waveform. Shock waves' primary physical effect is believed to be via mechanotransduction leading to cellular activation and downstream signalling. Experimentally, ESWT's effects on osseous, connective tissue and wound healing via various mechanisms of action have been reported both in the human and veterinary literature. Clinical trials have investigated ESWT's orthopaedic application including osteoarthritis, thoracolumbar pain, navicular syndrome, tendinopathy and proximal suspensory desmopathy, with its concomitant use with biologics representing an area of active research. Direct ESWT protocol comparisons in terms of long-term efficacy with variables of energy, depth and exposed tissue types are still lacking with evidence-based recommendations being largely anecdotal. Technical advancements to facilitate the safe and judicious use of ESWT include human and equine hearing protection, light sedation and/or patient restraint. Efforts to ensure the safe and judicious use of ESWT and its analgesic effects are ongoing.
