Laser after Depo

[lehughes]

Hi girlfriend!

Hope you are staying warm in Calgary!! It is freezing here today.
I have a 9 yr old lab that is coming for rehab for a biceps tenosynovitis and supraspinatus tendinopathy diagnosed at the vet college with MRI. Cool pictures. I haven't seen the dog for this yet, so haven't had my hands on him.
Conclusions from the report:
Thickening and splitting of the right bicipital tendon. 2. Marked swelling and increased enhancement around the bicipital tendon: indicative of marked bicipital tenosynovitis. The focal areas of decreased signal in this swelling represent hemorrhage, mineralization and/or fibrosis. 3. Suspected lesion in the medial glenohumeral ligament: a partial volume artefact could not be ruled out completely. 4. Thickening and mineralization of the supraspinatus tendon: indicative of supraspinatus tendinopathy. This might be seen in patients with or without clinical signs.

The dog is going to have a depomedrol injection next Wednesday and then is coming for rehab. (not my choice, dog has a primary vet and owner's won't try laser, etc 1st as they are worried if he is not improving fast enough they won't be able to get back into AVC until after the holidays. )
Do I have to wait to laser after a depomedrol injection?
I've never had a case that had the steroid injection, I usually get them 1st and then they improve!

Thanks for the help,
J.

[lehughes]

Good day J!!

So, I went onto pubmed and then also did a simple google search. Then I remembered that I just did a full scale review of Laser use.
All in all I can find nothing… NOTHING that says not to do laser with any steroid injection.
I can find that combo use of laser and steroid injection for scarring, keloid scarring in particular.

It USED to be thought that you might not use a modality after a steroid injection because with the increased blood flow you could wash away the steroid.
BUT that was in the days before we understood about tendonosis and tendon healing and how inflammation is part of the healing process!
So… based on the fact that the Depo will not be healing anything, and this dog needs healing, I’d say you are find to laser as soon as you get the dog in your hands!

And I have not heard of a split of the biceps. Weird!

Best of luck!

Laurie

[David Lane]

I recognize that the treatment choice is beyond your control, but when I read about the planned steroid injection, my 1st thought was "NNNNOOOOOOOOO!!!!!! For the love of all that is good and pure in this world, don't do it!!!".

Ok. I'm better now. Seriously, if they are planning in injecting intratendinously, I consider that malpractice (unless they are specifically hoping to cause the biceps tendon to rupture). If they are just giving it IA, then although it will have a palliative effect, they just made your job harder. Also, depo is chondrotoxic, and (in-vitro research suggests) triamcinolone is not. Therefore, I question the use of depo in any joint that hasn't already reached a point of such advanced arthritis that there is no meaningful cartilage left... which doesn't sound like your case. I will now get off my soap box.

We want tendon healing. To have tendon healing, we need vasodilation and neovascularization. Laser helps with that. Depo hinders it. I am unaware of any research that explores your question directly, but based on what we do know, I would certainly not shy away from laser and in the first month I would even do it more frequently than my normal protocols in hopes of undoing some of the negative consequences of the injection.