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What the Equine Practitioner Needs to Know About the Biochemical Manipulation of Equine Joint Disease
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A recent survey suggested that 60% of lameness problems are related to OA , stressing the importance of advancements of both medical and surgical treatment options. This section reviews medical options currently used for treating joint disease, emphasizing recent and/or future perspectives. The section after this will address these surgical options.
The aim of treatments for acute synovitis, with or without accompanying capsulitis, is to return the joint to normal as quickly as possible. In addition to bringing relief to the patient and allowing it to return to normal work, suppression of synovitis and capsulitis is important in order to prevent the products of inflammation from compromising the articular cartilage and leading to osteoarthritis (processes previously described). In addition to the potential deleterious effects of synovitis on articular cartilage, it is important to provide pain relief and minimize the potential microinstability associated with excessive synovial effusion. It has also been shown experimentally in the rabbit that joint inflammation weakens intra-articular ligaments in addition to affecting the cartilage.
In all traumatic entities in the joint, the goal in addition to returning the joint to normal as quickly as possible- is to prevent the occurrence or reduce the severity of osteoarthritis. In other words, there are two goals; 1) reduce pain (lameness), and 2) minimize progression of joint deterioration. While this section addresses medical treatments, it is important to note that timely removal of osteochondral chip fragments, timely and appropriate reduction of fixation of large intraarticular fractures, accurate diagnosis of ligamentous and meniscal injuries with arthroscopy and the appropriate treatment of osteochondritis dissecans entities are all critical treatments to prevent OA. The remainder of this sections deals with treatments where progress, knowledge, or new treatments have been developed in the past 10 years.
Physical Therapy and Shock Wave Therapy
Swimming and underwater treadmills are popular rehabilitation tools following arthroscopic surgery for joint injury and also, to a lesser degree, rehabilitation of non-surgical injuries. Underwater treadmills have become increasing available and decrease the weight-bearing while potentially providing a massaging effect on the limbs and preventing fibrosis of the joint capsule. Controlled work with some evidence basis for the relative usefulness of these modalities would be an excellent contribution to our knowledge. [...]
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