Shockwave therapy + PRP thoughts

[DressageHorses4Me]

After having my horse go off and on lame throughout the past two years, with no real answer as to what was going on after extensive testing and blocking, I bit the bullet and had an MRI done. I was hoping for answers and answers I received … just not very good ones. When all is said and done, the horse sustained multiple injuries across the hoof, pastern, and fetlock area prior to my ownership. These old injuries have seemingly compounded themselves finally and are showing up as right front lameness grade of 3/5, flexion positive, no fetlock effusion, and minimal response to hoof testers.

MRI shows mild navicular changes, fluid in the coffin joint, indicating inflammation, significant amount of marked degeneration and micro tearing across throughout the ligaments, including collateral ligaments. Degenerative joint disease in coffin and pastern. No matter what happens, vet says 4-6 months of stall rest with small turnout is next step and is most important. Shockwave therapy was highly suggested, expecting 3-4 treatments, targeting at least 2 areas. PRP was also suggested, in combination with shockwave, to address the collateral ligament damage as the shockwave therapy will not directly address that problem.

Total cost for above treatments: approx. $4000

The horse is an approximately 16 years old, 15 hand quarter horse, gelding, schooling 2nd level. When I ride, he does not appear lame until small circles are introduced in either direction, and a slight “hop” in the right front when lengthening the trot at times. Does not seem displeased working under saddle. The horse receives monthly injections of Legend and Adequan. Horse also has, and had when I purchased, slight arthritis in right hock. Radiographs do not show any changes in last 4-5 years. Wears shoes on all 4 and Equi-Pak pour in pads in front feet.

I am rather unsure of what to do and was curious as to if anyone has had experience with these treatments on older injuries and if so, what were the outcomes (keeping in mind I know each horse is always different). Most of the things I’m finding on shockwave and PRP are focused on newer/fresher injuries.

I want to do right by the horse and feel like I should spend the money to try the therapies but hesitate slightly due to cost and the age of the horse. I would love to continue showing the horse at 1st and hopefully 2nd levels if at all possible. My other option would be to retire the horse.

Any thoughts, comments, opinions, suggestions, experiences, etc. would be super appreciated.

Thanks!

[Highflyer]

What was the vet’s prognosis with the shockwave/ PRP vs. without? I’ve only seen PRP done once in a similar situation and it wasn’t particularly successful. I haven’t seen shockwave recommended for an older injury of that type. I know a couple of people are using Pro-stride (modified IRAP) in similar situations and are cautiously optimistic-- and I think it’s a bit less expensive as well.

That said, if you are looking at a 25% chance of getting the horse competition sound without treatment and only a 50% chance with, I’m not sure I would do it, given the horse’s age and the findings etc. So a lot of it comes down to how much you trust your vet, too.

[theresak]

My horse had a somewhat chronic collateral ligament injury of the fetlock and we discussed shockwave. The vet checked the the machine rep, who indicated we might not see a lot of benefit from using shockwave on a non-acute injury. So we skipped it and did 6 months stall rest, with Osphos at 4 months for some remodeling at the ligament origin site, and a long rehab while still on stall rest.

If you have the time, space, and patience for an extended stall rest, I’d start discussing that with your vet. Honestly, I’d be thinking more like 6+ months stall rest, perhaps transitioning to a pen/paddock in the late summer, with up to a full year of rest + rehab.

I’d be interested to ask if injecting the coffin joint might help calm things down a bit, and if Osphos would help any of the bony changes.

[swgarasu]

Ugh, that sucks.

I had a mysterious forefoot-ish lameness the vet couldn’t quite pinpoint, and he wanted an MRI. I looked into it and it would have cost $3500. I was like “well, that’s a year of board. What are the chances you would prescribe a year off regardless of the findings?” Vet- “Pretty high”.

So we did the year off and I prepped a house for sale and moved twice. Horse came back sound, has been in work for about 3 years, did have hocks done for the first time last spring.
However, she was 11, not 16.

It’s been my experience that most therapies are done to try to get the horse back to work sooner, but that is only one person’s opinion. It also seems people have less luck with bringing horses all the way back once they hit about 15. I think, like us, they are slower to heal and it’s more difficult to fully recover when they get older.

Good luck.

[joiedevie99]

I’d ask the vet much more specifically about likely outcomes with and without additional therapies.

I’d consider giving the horse a year off. 6 months of real stall rest with hand walking daily. Then introduce small paddock turnout, and if that goes well, put the horse out 24/7 for another 6 months. Then re-check him and see what you’ve got.

[rothmpp]

Is the vet that you are working with the one who would do the shockwave and PRP? If not, I would speak to the vet that would be providing that service to see what they though about the potential for success for your intended use for your horse.

I don’t know if you are in the position to step this horse down and have a second horse but I would be really hesitant to spend $4k on a 16yo horse that is only going 1st/2nd level. Especially without a true picture of whether it will make a substantial difference.

You said he’s a quarter horse - does he have good feet for a quarter horse or the usual tiny feet of years ago?

[DressageHorses4Me]

I so appreciate all the replies, these boards are so helpful. It’s a difficult time.

To hopefully help answer some of the questions that have been asked:

• Yes, the vet (surgeon) that I’m speaking and working with is the one that will be doing the shockwave and PRP. Same one that did the exams and MRI.
• This QH has average sized feet. Not the super tiny ones, I do know of what you speak!
• I can take on another horse but I am very concerned with how to retire this horse. The vet said that he will need to be reassessed after rest to see if he can be turned out to retire, if I elect retirement. He might require extra care if retired, due to the injuries, and I’ll do everything I can to keep him comfortable, even if retired and even though that will most likely mean paying board plus extra medical care for a retired horse. It all depends on where he is in 6 months of what kind of money I’ll need to spend on care, whether retired or working. I’m very afraid he’ll be very expensive to retire, therfore preventing me from having the ability to buy another horse.
• Regarding not doing treatment, the vet said he finds most injuries of this kind don’t heal on their own, even with rest. It’s not out of the question and we can try to rest the horse only and reassess but if I’m looking to bring the horse back into work, he advised selecting at least the shockwave treatment and rest, rest being the most important. He felt the shockwave therapy would be the best “bang for the buck” and the PRP would most address the collateral ligament as the shockwave probably wouldn’t be as effective there.
• I don’t know about Osphos, will have to look that up. Thank you! The vet said injecting the joint with steroids and HA could help with pain but steroids prevent healing so it really wouldn’t be addressing what is happening.
• Vet wasn’t too keen on IRAP for this particular injury because there are just too many variables within IRAP. He felt more confident with PRP for the collateral ligament damage.
• I believe he said he felt fairly confident we could get the horse back to 70%, with 100% being where we are now. He has some hesitation because I would want to continue with dressage. I’ll have to ask if this treatment would lead to an outcome of a sound pleasure horse or a sound 2nd level dressage horse. He said whichever I select, retirement or trying to go back into work, he would put together a customized treatment and care plan.

Thank you all again - the more I discuss this, the more questions I build to ask the vet about and the more I learn … both are great!.

[DressageHorses4Me]

I so appreciate all the replies, these boards are so helpful. It’s a difficult time.

To hopefully help answer some of the questions that have been asked:

• Yes, the vet (surgeon) that I’m speaking and working with is the one that will be doing the shockwave and PRP. Same one that did the exams and MRI.
• This QH has average sized feet. Not the super tiny ones, I do know of what you speak!
• I can take on another horse but I am very concerned with how to retire this horse. The vet said that he will need to be reassessed after rest to see if he can be turned out to retire, if I elect retirement. He might require extra care if retired, due to the injuries, and I’ll do everything I can to keep him comfortable, even if retired and even though that will most likely mean paying board plus extra medical care for a retired horse. It all depends on where he is in 6 months of what kind of money I’ll need to spend on care, whether retired or working. I’m very afraid he’ll be very expensive to retire, therfore preventing me from having the ability to buy another horse.
• Regarding not doing treatment, the vet said he finds most injuries of this kind don’t heal on their own, even with rest. It’s not out of the question and we can try to rest the horse only and reassess but if I’m looking to bring the horse back into work, he advised selecting at least the shockwave treatment and rest, rest being the most important. He felt the shockwave therapy would be the best “bang for the buck” and the PRP would most address the collateral ligament as the shockwave probably wouldn’t be as effective there.
• I don’t know about Osphos, will have to look that up. Thank you! The vet said injecting the joint with steroids and HA could help with pain but steroids prevent healing so it really wouldn’t be addressing what is happening.
• Vet wasn’t too keen on IRAP for this particular injury because there are just too many variables within IRAP. He felt more confident with PRP for the collateral ligament damage.
• I believe he said he felt fairly confident we could get the horse back to 70%, with 100% being where we are now. He has some hesitation because I would want to continue with dressage. I’ll have to ask if this treatment would lead to an outcome of a sound pleasure horse or a sound 2nd level dressage horse. He said whichever I select, retirement or trying to go back into work, he would put together a customized treatment and care plan.

Thank you all again - the more I discuss this, the more questions I build to ask the vet about and the more I learn … both are great!.

[joiedevie99]

If you haven’t done it yet, shoot hoof balance x-rays. If the angles are off, even just some, you are putting unnecessary strain on something that needs to be resting in order to heal.

[TwoRoads]

I will start this with saying that your vet is absolutely the best one to help you make these decisions but…

There are times when I think we forget that horses can have varying levels of soundness just like people. I’m coming off a long term injury with surgery and all. I’ve been told that there was enough damage that I can’t do everything I used to do, but I should continue to do the things I can because activity and muscle strength are very important to long term health. So I will eventually be able to jog again, but no more long distance running. Riding is still painful but I should still work to getting back in the saddle.

So for your 16 year old guy, which isn’t all that young, I don’t know that you need to decide between retirement and trying treatments to make him 100% sound. Dressage is muscle training, or physical therapy in some ways for horses. If you back off your training some, say training to 1st level work on big circles the horse still gets to move but you avoid the things that hurt. And movement is so important to a horse’s health, not just joint and muscle health but digestive and mental.

For sure don’t ride your horse if they are in a lot of pain and don’t enjoy it. But if you can do light work you’ll be more likely to keep them from going downhill faster, getting stiff and not wanting to move on their own thus making them more stiff. Hard work causes stress and can lead to injuries, but rarely would a dr recommend to a human patient absolute rest for some mild discomfort during certain activities. They’d still try to get them up and moving and doing what they can do without a high amount of pain.

[flyracing]

All older horses have changes in their fiber patterns of the collateral ligaments on MRI. It can be very challenging to determine if that is the actual source of pain. I assume a blocked to a PDN (the foot), but did they also try blocking the coffin joint? Have you tried injecting the coffin joint since the lameness started? The MRI you describe often responds well to injecting the coffin joint and a dose of osphos. I don’t like giving older horses too much time off either. It makes them harder to bring back.

[Scribbler]

At the moment, you say the horse only appears off on small circles, and occasionally lengthening the trot? In other words, if you were only doing light trail riding on him, he might not appear injured at all?

I have to say, for a 16 year old first level dressage quarter horse, who is just schooling 2nd year movements, $4000 is a lot to pay when your best outcome is a first level 17 year old quarter horse, completely out of shape, with ongoing arthritis issues, who will never be fully sound. I think it might just be best to start stepping down his work load, find him pasture retirement or a long-term free lease to a recreational rider who wants a well-trained horse. When I watch the outcomes of stall rest on horses that have complicated injuries, or tendon tears, it often doesn’t work out that well. They re-tear the injuries, or the lack of exercise causes other parts of the body to start failing. I realize stall rest is the recommendation for lots of injuries, but it has the same dangers as bed rest for person: you can lost strength all over.

I’ve seen lots of horses with arthritis improve in long-term pasture life, because they keep moving and keep things looser.

I’d be hesitant to put $4000 worth of treatment into a questionable prognosis, when that could be money towards a nice young horse.

[joiedevie99]

Now I’m confused. I thought the horse was 3/5 lame and she was worried about being able to retire him without major maintenance? Or is he only off on small circles and otherwise comfortable?

[Daisyesq]

I think you should do the stall rest, and definitely ask about Osphos. (Stall rest will even heal other parts of his body that are probably hurting, but those parts did not get the MRI pointed at it).

If your horse has major medical insurance, then also get the Shockwave and PRP. It is intended to improve the “quality” of the healing, not just the speed. (according to my vet, who of course wants to justify the treatment)

[DressageHorses4Me]

[QUOTE=joiedevie99;9007832]
Now I’m confused. I thought the horse was 3/5 lame and she was worried about being able to retire him without major maintenance? Or is he only off on small circles and otherwise comfortable?[/QUOTE]

3/5 lame during flexion test, trotting off on pavement. Under saddle in arena, he goes fine, is happy in work, and is not visibly lame nor can rider feel anything off until working smaller circles and occasionally it is slightly evident in trot lengthenings. Sorry, can see how that could be confusing.

[rothmpp]

FWIW, I had a horse that was 3/5 lame on a flexion test that was sound as could be under a reasonable work load.

Had you ever done xrays or an MRI as part of your pre-purchase on this horse? I am not underestimating the findings on the MRI - but without a baseline to start from it’s hard to know what that leg looked like 10 years ago. I went round and round with my vet about films that we took on a horse that was fine one day and 3/5 the next. He took rads and declared it was nothing but arthritis. I had a very hard time accepting that was all that it was as he had been totally fine the day before. I went with a middle of the road time off one round of HA injection in the joint and never had a problem again.

Correct me if I’m not following correctly - but the issue with your horse is that he had been intermittently lame, but is usually fine except for some small circles and lengthenings. I agree with the poster that said, maybe you’ll need to step the horse down. I would be very surprised if the above is an accurate description that you could not either step him down or retire him comfortably. Without requiring a ton of medical management.

[keh]

I don’t understand how a horse who’s going fine & happy in work will be expensive to manage in retirement. It sounds as if he’s maxed out & has some hitches in his giddyup which will prevent him from progressing. These issues may have always been there & the advanced work could’ve exasperated them. It’s a heartbreaking situation & you have my sympathy. I would retire him now & start over. The vet is hesitant (my guess) is because dressage gets progressively harder on them. Can you rest him & lease something to learn on or take lessons on a schoolmaster?

[DressageHorses4Me]

My concern about retirement is my vet said even if retired, the injuries are still there and will need to be addressed at some point. It is likely he will have some pain that will need to be managed as he ages and these injuries become bigger issues. I was mostly curious as to if anyone had experienced a similar situation and how they dealt with the horse in retirement. Would it be beneficial to do the shockwave and PRP therapies, even if I retire him, as it might keep him more comfortable as he ages and off of pain medication later in his life as we will have healed some things (hopefully).

No, I did not do x-rays or MRI as part of pre-purchase. I doubt I’d ever do an MRI for pre-purchase … I’m not quite in that price range of horse I had about 4 years of vet records from his prior owners and in his pre-purchase exam, he was fine except for the slight arthritis in the right hock. I’ve had x-rays done of that hock every other year or so so I do have baselines there. Just never had a reason to suspect anything was wrong with the right front until now and I’ve owned him for 5 years.

I find myself going from one decision to a different one each day as I work through the options in my mind … all day long. Yesterday, I was sold on doing the shockwave and PRP with the rest. I hear such great outcomes most of the time. Felt that would be the best. Today, I’m thinking more of the stepping down in work, or really just not continuing to step up, after some rest, and not doing the shockwave and PRP. See if I can accept where we are and enjoy him for a few more years at perhaps a slower pace. Or, find someone in my area that is looking for exactly what he has to offer and I look for a new horse. Either way, he’ll be getting 4-6 months of rest and I’ll find a trainer that has lesson horses available during my horse’s rest period.

Thank you all for giving me things to think about, past experiences, and treatment ideas. Really appreciate it!

[Cowgirl]

[QUOTE=DressageHorses4Me;9009283]
My concern about retirement is my vet said even if retired, the injuries are still there and will need to be addressed at some point. It is likely he will have some pain that will need to be managed as he ages and these injuries become bigger issues. I was mostly curious as to if anyone had experienced a similar situation and how they dealt with the horse in retirement. Would it be beneficial to do the shockwave and PRP therapies, even if I retire him, as it might keep him more comfortable as he ages and off of pain medication later in his life as we will have healed some things (hopefully).[/QUOTE]

I did surgery (to remove a chip fracture from the extensor process of the coffin joint in one foot), IRAP, Osphos, a round of Adequan, isoxuprine for many months, diet change, rehab facility for 9 months, bought a cold laser, etc., for a 15 year old horse about a year and a month ago, and she is now 100% sound and forward like she is a five year old again. The surgery did not go entirely as planned (the chip was bigger than it imaged due to the location and could not be removed arthroscopically), but it all worked out and her foot is pain free now. My expenses were pretty significant, but it was worth it to me to do it. Even if she had not come back totally sound due to arthritis (which they did not see during the surgery) she still would have ended up more comfortable without the chip fragment. Even if you don’t want to compete or even ride the horse, giving them a shot at being pain free is worth it and $4,000 spread over the maybe 10 plus years your horse has left to live is not significant.

Before I got into it though, I’d maybe want a second opinion from a lameness specialist. I’d also want to know what the maintenance would entail (i.e. would you have to be doing shockwave annually?

[Kareen]

I’ve had way better results using induction (I believe available in the US as magnawave?) and found the price-performance ratio to be a lot more feasible. I’ve had the unit for two years now and couldn’t imagine working without it now. We need a lot less meds in our orthopedic cases now and I’ve seen some super progress in otherwise very frustrating issues such as recurrent suspensory issues or tendon lacerations. In sore backs even one or two treatments tend to bring a significant difference for the better. Haven’t since used shockwave or PRP Maybe you can find someone with a unit in your area. It’s definitely worth a try!