Message from Porter...
As MEDS continues to develop and
finds its niche within the equine
community, it is evident that there
is a big demand for advanced
musculoskeletal imaging. Over
50% of the cases seen by MEDS
involve lameness evaluations along
with high-definition imaging. The
following case reports give some
example of the work MEDS is
Proximal Suspensory Desmitis (PSD) of
Student Case Study #1
By: Heather Caplan, Class of 2006
A 9 year old Arab gelding used as an endurance horse was evaluated for
lameness. He has been intermittently lame in the front end for the last year.
Usually, the lameness begins after he has been at work for a long period 20+
miles. On palpation the gelding was reactive to palpation of the right front
forelimb in the area of the proximal suspensory ligament (SL) and a thickening
was appreciated of the distal aspect of the lateral splint bone. Initial examination
included radiographs and ultrasound of the McIII region.
proximal aspect of
lateral splint bone.
In addition, there
were several small
mineralized r -- z
structures in the r l
region of the
origin of the SL.
of the proximal
LONGITUDINALVIEWOF THE RFAND LF PROXIMAL SUSPENSORY
s u s p e n s o r y LIGAMENT. NOTE THE HYPERECHOIC AREAS CONSISTENT WITH
noted multiple MINERALIZATION AND/OR SPLINT BONE IMPINGEMENT.
areas of apparent
mineralized ligament and an enlarged cross-sectional area when compared to
the opposite limb. The gelding was diagnosed with chronic proximal suspensory
desmitis associated with the periostitis of the lateral splint bone.
Proximal suspensory desmitis (PSD) is a common injury in the forelimbs of
athletic horses and may occur unilaterally or bilaterally. PSD may result
lameness that varies from mild to moderate and is rarely severe unless the
lesion is extensive.
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Extracorporeal Shock Wave Therapy
and Equine Orthopedic Disease
Student Case Study #2
By: Rena Borucki, Class of 2006
Shock waves are high amplitude, high energy, short build-up acoustic waves
which have been the treatment of choice for nephrolithiasis in humans for
over 20 years. Recently, it has become a common therapeutic option for the
treatment of orthopedic conditions in equines, including metacarpal stress
fractures, navicular syndrome, osteoarthritis, tendonitis, and desmitis.
Historically, these conditions require prolonged periods of stall rest with few
other treatment options available. Tendon and ligament injuries are slow to
heal due to their poor blood supply and slow cellular repair mechanisms.
Today, there are new therapies extracorporeall shock wave therapy (ESWT)
and stem cell injections) available that may significantly increase the rate of
healing and provide analgesia to the injured area.
Shock waves travel
through tissue and are
deflected at sites of
similar to the process
which allows ultrasound
to produce an image.
When the wave is
reflected and refracted, it
forces the tissue interface
to be altered in order
to absorb the kinetic
LONGITUDINAL AND CROSS-SECTIONAL VIEW
OF THE SUPERFICIAL DIGITAL FLEXOR (SLIGHTLY energy. The primary
OBLIQUE VIEW). NOTE THE DISTINCT "CORE LESION" benefits of ESWT appear
THAT WAS APPROXIMATELY 20% OF THE CROSS- to be an increased rate
SECTIONAL AREA of healing and transitory
anesthesia at the site,
but the physiology behind these results remains to be elucidated. Present
hypotheses include acceleration of neovascularization, secretion of local
growth factors, increased cellular division and tissue regeneration at
border zones. Osteogenesis may be due to the production of transforming
growth factor B1 (TGF-B1) and osteoclacin which alter osteoblast activity,
neovascularization, and NO synthase activity.
Each probe (R05, R20, R45, and R80 VersaTron@) generates a wave capable
of penetrating to a given depth, allowing the shock wave to be focused
on injuries at various tissue depths. The energy level of the wave and
the number of pulses can also be set to maximize the therapeutic efficacy
while minimizing the risk of injury. Depending on the injury, it is typically
recommended to provide 3 treatments at 2-3 week intervals. In order to
assess clinical improvement, an ultrasound exam with digital image capture
is performed prior to the first treatment and several weeks after the last
shock wave treatment.
CROSS-SECTIONAL VIEWS OF THE RF AND LF PROXIMAL
SUSPENSORY LIGAMENTS. EVIDENCE OF BILATERAL, CHRONIC
SUSPENSORY DESMITIS (CORE LESIONS).
LONGITUDINAL VIEW OF THE MEDIAL AND LATERAL BRANCH OF
THE SUSPENSORY LIGAMENT AT THE INSERTION SITE. EVIDENCE OF
DESMITIS AND ENTHESOPHYTE FORMATION WITHIN THE LATERAL
LONGITUDINAL AND CROSS-SECTIONAL VIEW OF THE FLEXOR
TENDONS. EMPHASIS ON THE DIFFUSE DESMITIS OF THE
SUPERFICIAL DIGITAL FLEXOR TENDON.
Mobile Equine Diagnostic Service
Veterinary Medical Center
P.O. Box 100136
Gainesville, FL 32610-0136
(352) 392-4700 ext. 4036
UFVMC Friends ofMEDS
University of Florida Veterinary Medical Center
In 2004, the University of Florida's College of Veterinary Medicine unveiled plans to create a unique medical
diagnostic and treatment system that could be put to use by any equine or food animal veterinarian in
Florida. This system would mobilize the cutting-edge technology and the extensive medical expertise
found at UF's Veterinary Medical Center and put it within the reach of veterinarians in the field. The new
service would give veterinarians new resources, new tools, and new allies in their mission to improve
Today, the Mobile Equine Diagnostic Service (MEDS) is a reality, and it is creating new treatment options
for animal patients everywhere. MEDS works for your veterinarian, using digital and satellite technology
to put the resources of the University of Florida and the experience of the Veterinary Medical Center
faculty at his or her command. Thanks to the state-of-the-art MEDS truck, digital radiography, ultrasound,
endoscopy, specialist consultations and more can now be utilized anywhere from urban veterinary
hospitals to the most remote pastures of Florida.
Dr. Porter and MEDS are dedicated to keeping this service available and affordable for those who need
it. The ingenuity and cooperation of veterinarians like yours has made MEDS possible, but it needs your
support to succeed and expand. MEDS, the MEDS truck, and the veterinarians, specialists, students,
and nurses who make it work, are all supported entirely by the care they provide and by donations from
friends, animal lovers, and people who want to help make veterinary medicine better. We like to call these
people "Friends of MEDS."
For more info regarding how to make a charitable donation to the Friends of MEDS Fund please contact:
Dr. Michael B. Porter @ 352-392-4700 ext 4036 or Karen Hickok, Development Office, College of Veterinary
Medicine, 352-392-4700 ext 5213