Sports Medicine

Lameness diagnosis begins with a thorough clinical examination of your horse's musculoskeletal system. We are well equipped to evaluate horses in hand and under tack on a variety of surfaces to optimize the examination process. Selected diagnostics and treatments are then chosen on an individual basis.
 
Diagnostic Technology
 
Specialized In-House Therapies
Once the location, nature and extent of the problem is determined, we will recommend a course of treatment with the goal of healing your horse and allowing him or her to return to regular activity. Specialized in-house therapies include:
 
  • Extra Corporeal Shockwave Therapy - A noninvasive technique that generates high-intensity pressure waves pulsed to specific areas of injury to reduce inflammation, stimulate blood flow, provide pain relief, and enhance healing. It is typically used to treat suspensory desmitis, tendinitis, navicular disease, vertebral spinal pain and to encourage correction of angular limb deformities.
 
  • Interleukin 1 Receptor Antagonist (IRAP) Treatment - Interleukin-1 is an inflammatory mediator that stimulates degenerative processes in the body. To act, this molecule (called a cytokine) must interact with a receptor, in essence switching on a pathway that releases damaging enzymes. Interleukin-1 receptor antagonist protein (IRAP) is another molecule that fits in that same receptor; however, instead of activating the process, it blocks it. By drawing the horse's blood and incubating it in a specialized collection system, this protein can be isolated and concentrated. It can then be injected into arthritic joints in an effort to block some of the major inflammatory pathways and stop the degenerative process. The principles behind the use of IRAP are well established in arthritis models, but not enough work has been done to prove definitive advantage in the treatment of tendon or ligament injuries. It is ready 24 hours after drawing the blood and is injected into the arthritic joint(s) once a week for 3-4 treatments, and often monthly thereafter. This treatment will not (nor will any other) reverse damage already done and is best used in the early stages of the disease process.
 
  • Platelet Rich Plasma Therapy (PRP) - Platelets are cell-like elements in the bloodstream that are classically associated with blood clot formation. They also contain tiny granules full of a multitude of growth factors that promote everything from cellular proliferation to angiogenesis (formation of new blood vessels) to epithelialization (covering of an open wound with healthy new skin). Centrifugation or specialized collection kits are used to concentrate the platelets into the horse's own plasma (the clear element of the blood) creating "platelet-rich plasma". Upon injection the platelets are activated and the granules open releasing the growth factors into the target tissue. These growth factors attract cells responsible for everything from matrix/tissue production to the cleanup of damaged tissue and cellular debris. The advantages of PrP include the diverse range of growth factors delivered, ease of production and potential for immediate use. The main disadvantage is that tendons and ligaments have very few innate cells and PrP does not provide an immediate source of cells. That said, it combines very well with the cellular therapies discussed below.
 
  • Prostride Injections - ProStride is the commercial name for a high concentration combination of interleukin-1 receptor antagonist protein (IRAP) and platelet rich plasma (PrP). IRAP targets inflammation by blocking the major degradation pathways of osteoarthritis. PrP is a rich source of growth factors that initiate and accelerate the body’s natural healing process. ProStride is a treatment that lets us combat harmful inflammation and engage the body’s natural healing mechanisms without the deleterious effects of steroids.
 
Stem Cell Therapy
 
  • Bone Marrow Derived Stemcells - Involves collection of bone marrow from the sternum as a source of stemcells that are then cultured to the number of desired stemcells over a 3 week period for subsequent injection.
 
  • Culture Expanded Stem Cells - Tendons and ligaments take so long to heal because they have so little blood supply and so few cells. They are almost entirely a collagenous extracellular matrix. Instead of relying on the few cells that are already there, bone marrow injection provides a source of cells for local repair. While bone marrow comprises many different cell types, our primary target is its stem cell population. Stem cells are undifferentiated cells isolated from fat or bone marrow, and can be injected into a lesion to provide an immediate source of cells for the healing process. Stem cells exist in a more primordial state than the rest of the body's cells. They have the unique ability to differentiate into (become) cells that produce almost any type of tissue in the body. Bone marrow-derived stem cells seem to have the greatest potential for tendon and ligament injuries because they are already "programmed" to become connective tissue-type cells. Bone marrow is harvested fairly easily from different sites in the body; most commonly the sternum and the point of the hip. Once obtained, it is either injected as is or is centrifuged in an effort to inject a smaller volume with a higher concentration of stem cells. A typical injection contains 10,000 - 100,000 cells. Importantly, centrifugation does not increase the actual number of cells being injected, just the concentration. While it has not been proven that more cells are necessarily better, most stem cell research showing measurable improvements in healing parameters has been done with cell numbers in the millions. The benefits (relative to culture-expended cells; see below) are the ability to obtain and inject the cells immediately and decreased cost. Clinical studies have reported success, but robust investigations comparing treated horses to a control group are lacking.
 
  • Fat Derived Stemcells - Involves collection of subcutaneous fat from the croup region as a source of a wide variety of stemcells that are then extracted from the fat and returned for injection 2 days later.
 
  • PulpCyte Stemcells - PulpCyte is an allogeneic (from another horse; non-immunogenic) stem cell preparation. It contains proteins and mesenchymal stem cells. Stem cells are used in the treatment of a variety of musculoskeletal injuries, predominantly ligament, tendon and joint lesions. PulpCyte stem cells are available for use within 24hrs.
 
Often the key to solving your horse's lameness is through a methodical approach, involving the step-by-step elimination of possible causes. Our equine veterinarians have a wealth of experience with diagnosing and treating lameness, and have established protocols that help them accurately determine the root of your horse's problem as efficiently as possible.
 
Pre-Purchase Examinations
A horse is a significant investment. For that reason, we consider a thorough pre-purchase exam conducted by one of our highly skilled veterinarians an integral part of your decision-making process. The aim of the pre-purchase examination is to identify and assess factors that could affect the horse's suitability for its intended purpose. Although the pre-purchase examination does not guarantee the future soundness of your horse, it enables us to identify certain medical conditions or lameness at the time of the examination.
 
The full pre-purchase exam, which includes a written report:
 
  • Conformation evaluation
  • Palpation of all four limbs
  • Lameness evaluation on hard and soft ground
  • Flexion of all four limbs
  • Blood Work
  • CBC, Chem, Coggins Test
  • Ophthalmic exam
  • Cardiovascular exam
  • Respiratory system exam
  • Reproductive system exam (if applicable)
  • Lunging and under saddle (as appropriate)
  • Radiographs of the front feet (65 degree navicular, Skyline navicular, 45 degree P3, Straight lateral and Dorsal palmar)
  • Radiographs of all four fetlocks (45 degree dorsal palmar, Lateral oblique, Medial oblique, Straight lateral and Flexed lateral)
  • Radiographs of the hocks (Dorsal plantar, Lateral oblique, Medial oblique and Straight lateral)
  • Radiographs of the stifles (Straight lateral and Posterior anterior and oblique)
 
Additional services such as drug screens, endoscopic exams, and sonographic exams are not included the standard pre-purchase examination, but can in added for an additional fee. We are happy to customize our examination to address your concerns and expectations.
 
A pre-purchase examination is an invaluable tool in helping you with your final decision. The cost of the exam is small when compared to the cost of caring for a horse that is unable to meet your expectations. For more information or to schedule a pre-purchase examination, please call us at (609) 397-0078.