# Effects of Extracorporeal Shockwave Therapy on Pain and Mobility in Client-Owned Dogs with Refractory Elbow and Stifle Osteoarthritis: A Randomized Double-Blinded Trial

## TL;DR

This study tested if shockwave therapy could help dogs with severe, treatment-resistant joint arthritis, finding only small and inconsistent improvements in mobility and pain.

## Contribution

The novelty lies in evaluating ESWT in dogs with advanced, treatment-refractory osteoarthritis using both objective and owner-reported measures.

## Key findings

- Improvements were small and mainly limited to selected objective measures.
- Dogs receiving two ESWT sessions showed slightly more consistent changes.
- No substantial or sustained functional improvement was observed in the study population.

## Abstract

This randomized, double-blinded clinical trial evaluated whether one or two sessions of extracorporeal shockwave therapy (ESWT) improve pain and mobility in dogs with advanced, treatment-refractory elbow or stifle osteoarthritis. Both owner-reported assessments and objective outcome measures were used to assess treatment effects. Overall, improvements were small and mainly limited to selected objective measures, with dogs receiving two ESWT sessions showing slightly more consistent changes. However, ESWT did not result in substantial or sustained functional improvement in this severely affected population. Further studies with larger cohorts, optimized treatment protocols, and longer follow-up are needed to better define the role of ESWT in the management of canine osteoarthritis.

Introduction: Extracorporeal shockwave therapy (ESWT) is used as an adjunctive treatment for canine osteoarthritis (OA), but its effects in dogs with treatment-refractory advanced disease remain unclear. This study compared the efficacy of one versus two sessions of focused ESWT administered approximately 28 days apart in dogs with refractory elbow or stifle OA. Methods: In this randomized, double-blinded clinical trial, twenty-four client-owned dogs with treatment-refractory elbow (n = 12) or stifle (n = 12) osteoarthritis received ESWT using an identical per-session protocol (X-Trode, 1000 pulses at 0.14 mJ/mm2; PulseVet-Zomedica, Ann Arbor, MI, USA), once (Group L) or twice (Group E). Orthopedic examination, goniometric and limb circumference measurements, and kinetic gait analysis (peak vertical pressure [PVP], vertical impulse [VI]) were performed on days 0, 28, and 56. Owner questionnaires (Canine Brief Pain Inventory [CBPI], Client Specific Outcome Measures [CSOM]) were collected on days 0, 28, 56, and 84. Data were analyzed using chi-squared tests, t-tests, and mixed effects models in R. Results: Age, weight, BCS, and radiographic osteoarthritis severity did not differ between groups at baseline. Improvement was small and limited to selected parameters. Vertical impulse and limb circumference increased more consistently in Group E, whereas peak vertical pressure increased in both groups, including before ESWT in Group L. No sustained or treatment-associated improvement was detected in symmetry variables or joint range of motion. Owner-reported outcomes showed variable patterns without consistent treatment effects. ESWT was well tolerated, and no major adverse events occurred. Conclusion: ESWT produced modest, inconsistent improvements in dogs with treatment-refractory OA, with slightly more consistent effects following two sessions. Therapeutic efficacy appeared limited in this end-stage population.