Aplicação de ondas de choque extracorporais em lesões músculo-esqueléticas de cavalos: descrição de casos clínicos
Data
2019-10-16
Autores
Aguiar, Mafalda Cunha Pereira Monteiro de
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Resumo
A terapia com ondas de choque extracorporais foi inicialmente desenvolvida na década de 80 em medicina humana. O sucesso alcançado levou então à aprovação das ondas de choque em cavalos no tratamento de lesões ortopédicas, e nos últimos anos, a sua aplicação tem vindo a crescer, nomeadamente no tratamento de lesões músculo-esqueléticas. As ondas de choque viajam através de fluídos e tecidos moles e os seus efeitos ocorrem em locais com diferentes impedâncias acústicas, tal como a interface osso-tecido. Ao encontrarem esta zona de junção, libertam energia cinética causando alterações nos tecidos. As ondas de choque podem ser diferenciadas em focais: electro-hidráulicas, piezoelétricas, eletromagnéticas; e radiais, sendo as primeiras mais indicadas para fins terapêuticos. Apesar do seu mecanismo de ação não ser ainda claro, sabe-se que as ondas de choque permitem a reconstituição dos tecidos lesados ao estimularem os osteoblastos e fibroblastos, promovendo efeitos condroprotetores, de neovascularização, anti-inflamatórios e supõe-se que também, efeitos analgésicos. O objetivo desta dissertação foi aprofundar os conhecimentos sobre a terapia de ondas de choque extracorporais, fazendo o paralelismo entre a prática clínica e a literatura, através da exposição de vários casos clínicos tratados com esta terapêutica. Deste trabalho faz parte um relato de atividades e casuística observada, uma revisão bibliográfica do tema, seguindo-se a apresentação de 4 casos clínicos com diferentes lesões, observados no Hospital Veterinário da Universidade do Tennessee e tratados com ondas de choque electro-hidráulicas, piezoelétricas ou mesmo ambas. Foi avaliada a progressão clínica destes animais, sendo possível verificar os efeitos benéficos desta terapia em doenças como a desmite proximal do ligamento suspensor do boleto, a desmite dos ramos do ligamento suspensor do boleto e a osteoartrite das facetas cervicais. A desmite do ligamento sesamoideu reto pode ser uma vertente a explorar, visto neste trabalho se terem verificado resultados positivos no animal em estudo. Em suma, a terapia com ondas de choque extracorporais constitui uma terapêutica a ter em atenção na medicina de equinos, no entanto, é necessário realizar mais estudos para melhor compreensão do mecanismo de ação e efeitos desta terapia nas várias afeções músculoesqueléticas em cavalos.
The extracorporeal shock waves therapy was initially developed in human medicine. The success achieved in human medicine led to the approval of the shockwave in horses and is now a cutting-edge therapy for the treatment of various musculoskeletal injuries. Shockwaves travel through fluids and soft tissues and their effects occur at locations with different acoustic impedances, such as the bone-tissue interface. When they encounter this junction zone, shock waves release kinetic energy, which will lead to tissue changes. Shock waves can be differenciated into focal: electrohydraulic, piezoelectric, electromagnetic; and radial, being the first ones most suitable for medical treatment purposes. Although their mechanism of action is unclear, it is known that shockwaves allow the reconstruction of damaged tissues by stimulating osteoblasts and fibroblasts, as well as promoting chondroprotective, neovascularization and anti-inflammatory effects. It is supposed also to have analgesic effects. The aim of this dissertation was to deepen the knowledge about extracorporeal shockwave therapy, making the parallel between the clinical practice and the literature, through the exposure of some clinical cases treated with this therapeutic modality. This work includes an activity report, the bibliographic review of the subject, followed by the presentation of 4 clinical cases of different pathologies observed at the University of Tennessee Veterinary Hospital, treated with electrohydraulic, piezoelectric shock waves or even both. It was evaluated the clinical progression of these animals, and the beneficial effects of this therapy on diseases such as the proximal suspensory desmitis, desmitis of the branches of the suspensory ligament and cervical facial osteoarthritis. Desmitis of the straight sesamoidean ligament can be an aspect to explore, since positive results have been found in the animal under study. In summary, extracorporeal shockwave therapy is a new therapeutic modality to be taken into consideration in equine medicine, however, further studies are needed to better understand the mechanism of action and effects of this therapy on various musculoskeletal disorders in horses.
The extracorporeal shock waves therapy was initially developed in human medicine. The success achieved in human medicine led to the approval of the shockwave in horses and is now a cutting-edge therapy for the treatment of various musculoskeletal injuries. Shockwaves travel through fluids and soft tissues and their effects occur at locations with different acoustic impedances, such as the bone-tissue interface. When they encounter this junction zone, shock waves release kinetic energy, which will lead to tissue changes. Shock waves can be differenciated into focal: electrohydraulic, piezoelectric, electromagnetic; and radial, being the first ones most suitable for medical treatment purposes. Although their mechanism of action is unclear, it is known that shockwaves allow the reconstruction of damaged tissues by stimulating osteoblasts and fibroblasts, as well as promoting chondroprotective, neovascularization and anti-inflammatory effects. It is supposed also to have analgesic effects. The aim of this dissertation was to deepen the knowledge about extracorporeal shockwave therapy, making the parallel between the clinical practice and the literature, through the exposure of some clinical cases treated with this therapeutic modality. This work includes an activity report, the bibliographic review of the subject, followed by the presentation of 4 clinical cases of different pathologies observed at the University of Tennessee Veterinary Hospital, treated with electrohydraulic, piezoelectric shock waves or even both. It was evaluated the clinical progression of these animals, and the beneficial effects of this therapy on diseases such as the proximal suspensory desmitis, desmitis of the branches of the suspensory ligament and cervical facial osteoarthritis. Desmitis of the straight sesamoidean ligament can be an aspect to explore, since positive results have been found in the animal under study. In summary, extracorporeal shockwave therapy is a new therapeutic modality to be taken into consideration in equine medicine, however, further studies are needed to better understand the mechanism of action and effects of this therapy on various musculoskeletal disorders in horses.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
ondas de choque extracorporais , lesões músculo-esqueléticas , cavalo