Shockwave Therapy

What is Shock Wave Therapy?

Nuclear Scintigraphy

Nuclear Scintigraphy or Bone Scanning, is the most commonly performed equine nuclear medicine procedure because it offers high sensitivity for detecting early disease. In addition, it allows veterinarians to evaluate the entire equine skeleton (or a region) making it an ideal tool for diagnosing difficult or multi-factorial lameness. Nuclear scintigraphy is an imaging modality that emphasizes physiologic processes – it is the physiologic evaluation of bone metabolism. It is especially useful in detecting bone inflammation when a lameness is difficult to diagnose or when the complaint is that the horse is not performing up to his/her athletic expectations. A bone scan is tremendously more sensitive than radiographs in detecting lameness related to bone inflammation. At Virginia Equine Imaging, we provide state of the art nuclear medicine services complete with motion correction software.

Frequently Asked Questions About Nuclear Scintigraphy:

When Should I consider nuclear scintigraphy for my horse?
In general, the indication for bone scanning is to identify and describe physiologic information that cannot be discerned by other imaging methods. For instance:
• Competition horse not performing up to athletic expectations.
• Severe lameness of unknown origin.
• Difficult multiple limb lameness.
• Suspected fracture with no radiographic evidence.
• Lameness localized to a general area with no radiographic or ultrasonographic abnormalities apparent.
• Horse suffers from a lesion that induces a lot of bone metabolism such as: stress fractures, ligamentous avulsions, sclerosis, osteomyelitis, etc.


How is the bone scan performed?
Upon arrival at the clinic, the patient is injected intravenously with a short acting radio-isotope, Tc 99 MDP, linked to bone tracer agent. If appropriate, the horse is next exercised on the lunge pad in order to evaluate the lameness. Following the evaluation, the patient is stabled in a secure stall for approximately two hours while the radio-isotope circulates systemically throughout the horse’s body. The horse is next tranquilized (standing sedation) and imaged with the gamma camera. Areas of bony inflammation are indicated in the computerized pictures as areas of increased uptake and described as focal or diffuse and mild, moderate or intense.

How long does the procedure take?
Depending on whether a hindend, frontend or a full body bone scan is performed, the procedure usually takes place several hours after the radio-isotope has been injected. Therefore, the bone scan images are often not read by the doctors until the late evening or early the following morning. After reviewing the images, the doctors devise the best plan for more extensively working up the lameness including: additional nerve blocks, intra-articular injections, digital radiographs, ultrasound, etc. Prior to the work-up and therapeutic treatment, the owner will be contacted to discuss the bone scan findings and further diagnostic options.

As a lameness specialty practice, we treat lameness due to arthritis more than any other pathology. There are many therapeutic options available today including the gold standard – intra-articular steroids with hyaluronic acid – and other supplemental treatments such as shock wave therapy, systemic injectables such as Legend and Adequan, and oral nutraceutical products such as glucosamine, chondroitin sulphate, and hyaluronic acid. Even with this arsenal of therapeutics, we still sometimes find osteoarthritis a frustrating management issue.

Recently, a new therapeutic option has become available which involves gene therapy. The technique is called IRAP – or Interleukin-1 Receptor Antagonist Protein. In order to understand how IRAP therapy works, it is necessary to understand the basics of osteoarthritis and joint pathology.

What causes osteoarthritis? Osteoarthritis can occur for a variety of reasons, including acute trauma, joint sepsis and soft tissue injury; however it is most commonly caused by some initial insult to a joint followed by daily wear and tear from performance use. Regardless of the cause, a cycle of events continues the inflammatory process, resulting in continual degradation of the cartilage matrix. Until now, the goal in managing osteoarthritis has been breaking this cycle of inflammation with the use of steroids and hyaluronic acid. While steroids can be very successful in reducing inflammation in a joint and thus slowing the degradation of cartilage, it is a short-term fix and they do little to protect actual joint tissues. That's where IRAP therapy comes in. There are a number of inflammatory proteins that play a role in increasing the degradation of cartilage and decreasing the production of cartilage matrix. One of the most important proteins in this process is called Interleukin -1, (IL-1). IL-1 binds to receptors on the surface of tissues within a joint. In an attempt to decrease inflammation in the body, another protein is produced called IL-1 receptor antagonist (IRAP), which blocks the binding of IL-1, therefore reducing its deleterious effects.

What IRAP therapy does is to “harvest” anti-inflammatory mediators that are then injected into an affected joint. What does the procedure involve? Blood is drawn aseptically from the horse into a syringe containing prepared beads that induce an inflammatory response while being incubated for 24 hours. The blood is then spun and separated, and the serum which contains these anti-inflammatory proteins is put into individual dose syringes which can then be frozen for future use. The intra-articular treatments are administered every 7 to 10 days for three treatments. Results are typically seen by the second treatment. IRAP can also be used as maintenance therapy throughout a competition season to reduce the amount of steroid use. IRAP therapy is not for every horse. There are some factors that make a horse a less successful candidate; however the therapy shows great promise for horses that have become refractory to traditional management of osteoarthritis. Ask if your horse is a candidate for IRAP therapy at your next appointment!

Mesotherapy

Dr. M. Pistor originated the technique of mesotherapy in France in 1952. Today, it is commonly practiced in France, where more than 15,000 practitioners utilize mesotherapy for the care of their human patients. Mesotherapy is also practiced in many other countries around the world, including: Belgium, Columbia, Argentina, and throughout Europe. This technique was introduced into the United States by veterinarian, Dr. Jean Marie Denoix, for the equine patient at the Veterinary Thoracolumbar Spine (Back) Seminar presented at Virginia Equine Imaging in the Spring of 2002.

Mesotherapy is a treatment that stimulates the mesoderm, the middle layer of the skin, which will, in turn relieve a wide variety of symptoms and ailments. The treatment is used to stimulate the Giant fibers. The technique involves the injection of substances to stimulate the mesoderm for various biological purposes. The mesotherapy injections involve extremely small needles that penetrate the interdermal layer of the skin only a very small depth, which is typically four to six millimeters. The number of treatments needed depends on many variables including the condition, the abnormal physiology causing the condition, as well as the chronicity of the problem. A minimum of one to two sessions of mesotherapy is performed generally to assess the horse’s response. Mesotherapy is effective for a multitude of conditions because it helps reverse the physiology of that condition, and stop the pain spasm cycle. At our clinic, we have used this technique on a number of horses with conditions such as chronic back pain and degenerative arthritis of the back and cervical vertebrae (neck).

Diagnostic Thermography

Thermography is the pictorial representation of the surface temperature of an object. It is a non-invasive technique that measures emitted heat. The circulatory pattern and relative blood flow dictate the thermal pattern, which is the basis for thermographic interpretation. This ability to noninvasibly assess inflammatory change makes thermography an ideal imaging tool to aid in the diagnosis of certain lameness conditions in the horse. In addition, thermography is an excellent adjunct to clinical examination as well as being complementary to other imaging techniques such as radiology, ultrasonography and nuclear scintigraphy.

There are at least three ways in which thermography can be used in an equine veterinary practice. The first is as a diagnostic tool or a physiologic imaging method, where a difference of one degree between two anatomically symmetric regions indicates a region of inflammation. The second method is to enhance the physical examination. In these cases, thermography is used to identify changes in heat and to locate areas of suspicion. Thermography cameras are approximately 10 times more sensitive than the human hand in determining temperature difference; therefore, this method helps the veterinarian identify asymmetry between the horse’s anatomical structures. The third method of using thermography is as a preventative measure to enhance training. Thermographic changes occur two weeks before many clinical changes; thus, thermography can be used in a training program to identify subclinical problems so that conditioning alterations can be made to avoid injuries.

SPECIFIC APPLICATIONS:

• CONDITIONS OF THE FOOT
• JOINT DISEASES
• LONG BONE INJURIES
• TENDON INJURIES
• LIGAMENT INJURIES
• MUSCLE INJURIES
• VERTEBRAL COLUMN INJURIES (LUXATIONS, SUBLUXATIONS, FRACTURES)

MRI                                                
                               
The Magnetic Resonance Imaging (MRI) system in collaboration with the Marion duPont Equine Medical Center has been functioning since April 1, 2004. Since that time, nearly 200 horses have been examined predominantly for foot problems. Magnetic resonance imaging provides images with unmatched tissue contrast and anatomic definition, thus offering numerous diagnostic advantages over other imaging technologies. MRI displays anatomic and physiologic detail in both bony and soft tissue structures through a series of tomographic slices using magnetic properties of the horse’ tissues. The MRI has provided the diagnosis in many cases when other imaging modalities failed to clearly identify the lameness. This is especially true for soft tissue injuries around joints, and in the areas difficult to palpate or image by other means such as radiographs or ultrasound. MRI is the only method presently available that can assess all tissues during a single examination.

The equipment at the Marion duPont Equine Medical Center is a standing open MRI system, which allows the patients to stand under mild sedation, so distal extremities can be scanned in a weight-bearing state. This enables our doctors to more precisely pinpoint your horse’s source of pain. In order to obtain images, a receiving coil is placed closely along the horse’s anatomic region of interest to collect emitted signal. The patient’s legs are positioned within the center of a strong magnetic field generated by the MRI system. The sequences are selected, and a radiofrequency signal is collected to create the image. The typical MR exam of an equine patient yields 300-500 high-detailed images to review.

MRI should be considered as a diagnostic tool when the site of pain or injury can be localized, but the problem cannot be distinguished by other forms of imaging such as radiographs, ultrasound or thermography. For instance, if your horse has been diagnosed with navicular disease, but has been unresponsive to therapy, the MRI may be the next logical approach. The MR exam because it can more precisely evaluate soft tissue and bone within the hoof capsule provides a more concise diagnosis such as navicular bursitis, impar ligament desmitis, or supensory ligament desmitis of the navicular bone. It is particularly useful for lameness localized to the foot. Importantly, MRI is capable of demonstrating cortical erosions along the flexor surface of the navicular bone, and adhesions to the adjacent deep digital flexor tendon. The use of MRI in equine veterinary medicine allows more timely intervention, and an improved prognosis and long-term outcome for equine athletes.

MRI has become one of the most important diagnostic tools in equine lameness. For further information concerning specifics of the procedure or in order to make an appointment please consult our website.

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