Joint Therapies
description
Transcript of Joint Therapies
To locate the source of the lameness
Joint injury Tendon or ligament injury Hoof pain Bone pain (fracture) Muscle pain Neurological disease (EPM) Mechanical
Excessive force and loading Stiffens bone- denser but less elastic From heavy work, hoof imbalances, poor
surfaces, Can be an accumulation of loading or a single
event Blunt or sharp trauma to the joint Infection Defects in the joint
Chips, fragments, OCD Poor conformation/deformities Poor cartilage structure
inflammation of the joint
Chronic inflammation will cause release of cytokines that degrade cartilage and collagen.
Cartilage becomes less able to absorb shock Continued exercise increases trauma to joint Synovial membrane scars and enlarges, fluid
amounts increase, viscosity decreases. Osteophytes form, subchondral bone loss
Subchondral bone sclerosis osteocyte death loss of blood supply microcracks in subchondral bone chips of bone at the edges cartilage and bone collapse
fracture
PAINPAIN
Pain comes from both inside the joint and outside the joint Intraarticular: synovial and cartilage
attachments Extraarticular: Increased pressure in the
marrow speculated as well as inflammatory cytokines or in ligaments surrounding the joint capsule.
Non medical therapies
Cold therapy 30 minutes for up to 72 hrs for acute injury
Liniments, poultice Limit motion- hand walk, limit turnout if
“new” keep in light regular exercise if “chronic”
Bandage to reduce swelling Corrective trimming/shoeing
Systemic medical therapies Adequan ® Legend®
Glucosamine HCL best glucosamine injectable N- Acetyl glucosamine less reliable in inhibiting degredation Glucosamine SO4 more easily incorporated but less stable
than HCl
NSAIDS Bute Banamine ®
Surpass cream ® topical Equioxx ®
Joint injections
SteroidsHyaluronic acid (HA)Adequan®®
Remove physical causes of inflammation Chip removal, OCD surgery. Infection- flush joint, antibiotics. Reduce exercise level.
Acupuncture Chiropractic Nutrition Herbal Homeopathy
Look for products that contain: Glucosamine HCL
5000mg per servingserving or lower amounts combined with chondroitin sulfate (e.g. Cosequin)
Best for minor/early lesions- decreases progression
Mixed reviews on success Takes 4-8 weeks for effect.
Chondroitin sulfate low MW better- Takes 2-4 months for effect, continued benefit after
discontinued. Decreases inflammation
Oral Hyaluronic acid MSM Omega 3 fatty acids (fish oil best) EPA
and DHA Enhance Animal Wellness
Combination Supplements Platinum performance ortho con series Cosequin ASU
Look for name brand products that have a history of quality products and good quality control Examples:
Cosequin Platinum performance Enhance animal wellness Michael Plumbs horse journal tests products
randomly for ingredient content and publishes the good and bad.
Shock Wave Unknown how it works Anecdotally helps with hock arthritis, navicular
pain
IRAP (Interleukin 1 receptor antagonist) Orthokine® made by Arthrex®
Made from horse’s serum. Inhibits IL-1 in people. May also stimulate anti-inflammatory interleukins
(IL-4, 10) and growth factors (FGF TGFβ). Successfully used in Europe in 30,000 patients
Used with horses with joints that do not respond to steroids
Potentially good for Cushing’s horses which can’t tolerate steroids.
Appears to be safe, non reactive, significantly improved lameness scores 5-8 weeks post injection (not tested beyond that date- may be longer.)
Can freeze serum for later use, and use in multiple joints.
Platelet Rich plasma (PRP) therapy Made from the horse’s own plasma. Platelets have growth factors stored in them
which are released when activated over a number of days.
Growth factors help speed tendon and ligament repair- helps joints by helping the supporting structures.
Used for difficult wound repairs Possible indication for navicular disease or
other bursal issues.
Stem cell therapyFat and bone marrow both have stem cells
and growth factors.
Fat- Vet Stem® system- great concept, recent study shows effectiveness.
Bone marrow aspirate- works well with ligaments
A Cell (ligament repair) A collagen scaffold material. Best for severe tendon ligament injuries Is reactive to tissues.
Grafts for bone cysts PRP+ bone scaffold Bone Marrow+ bone scaffold Cartilage grafts- promising Bone grafts- poor results
Joint fusionFor lower hock and pastern joints
Surgical fusion Laser
Chemical fusion MIA Alcohol
Foals need to have light exercise- encourages normal cartilage development in the first year of life.
Good shoeing and trimming practices distribute forces properly across the joint
Good nutrition Controlled growth of young horses don’t
overfeed. Balance of micronutrients including:
Copper, Zinc, Manganese, Selenium, monitor Su and Fe in water.
Use name brand Feeds- Nutrena ®, Purina
®, etc. Don’t mix and match supplements!
Legend®, Adequan®
Supplements- Cosequin ASU®, omega 3 FA (Enhance Animal Wellness ®) Platinum Performance
Good riding surface Regular exercise Good conditioning Don’t overstress joints too often
(tight circles, long rides etc). Help minor lamenesses before they
get worse
Ledgewood Equine Veterinary Clinic
David Trachtenberg, DVM
1o impact- vertical force• First collision of hoof with surface. Force gets
dissipated by joints.
2o impact – horizontal breaking• Increase in force second collision of body with
leg
Support • Most of second collision; puts maximal force on
limb
Breakover • decrease in force, strain applied in toe. Up to
2.5x body weight- most likely time that injury occurs.
Post Breakover- Tendon forces rotation of hoof/ joints