I think it depends on what you are treating. From my understanding, therapeutic ultrasound is good for tendons, but not much good for suspensory ligaments as the ligament is so deeply buried in the leg the ultrasound waves have trouble getting through at a decently therapeutic level. Shockwave, on the other hand, can get very effectively to the damage on a suspensory.
Our recent suspensory injury involved two rounds of shockwave therapy. The vet's view was that it certainly would help speed up recovery, but didn't take the place of doing all the rehab work... Seems to have worked for us.
FWIW, the lameness vet we use is topnotch, and he seems to primarily use shockwave. This is what I did with my guy earlier this year--he had a bruised tendon, no heat or lameness, but a definite lump on the tendon, and after shockwave it disappeared. Plus it cut the rehab from a month off and a month of light work to 2 days off, 10 days of walking under tack and 10 days of jogging. So it was expen$ive but worth it.
Bodie had 3 or 4 shockwave treatments after tearing his laterla collateral ligament. the 1st 2 treatments brought him back to sound but then he escaped and ran like a banshee! so back to the drawing board after that! $300 a pop in 2006! I tried it on my hand. Very intense treatment. Bodie required sedation!
Just finished my horses third shockwave session a few days ago. He had three spaced two weeks apart as well as an ultrasound prior to each session in order to see if any healing was taking place (mainly b/c I begged my vet out of curiosity...too early to see dramatic changes). My horse was really crippled before the first treatment but got progressively better and was pretty much sound after the second. It's been two days since his last treatment so I had him trot down a long side and he is 100% sound. Looks awesome. Of course we still have a long road ahead since the ultrasound still shows the injury but already the legion is very, very reduced. I would not hesitate to do shockwave again although I'm considering doing PRP on this horse as well since it worked so well on my other guy.
My vet also shockwaved my ankle for me since I've been having issues and it really does help. It was super sore the day after (and it does hurt while they do it so I understand why most horses need to be sedated) but it feels so much better now.
I think it would have cost about $1200 for all three treatments but my vet does work on my horses in exchange for my help house sitting/around the barn so I'm not 100% sure on that. As far as I'm concerned I'll never mess around with any other treatments. Shockwave and PRP have worked miracles on my horses.
Keep in mind that shockwave therapy deadens the nerves for a matter of time. Just because they look sound doesn't mean they are sound.
Correct which is why it's so important to continue to ultrasound after the end of the treatment to monitor the legion. It's actually kind of maddening since they LOOK sound but you still can't do anything with them. It does speed up the process though. My guy's ultrasounds look like hes been on stall rest for 5 months+ by how much he has healed (based on my experience with my other horses) but he's only been off for 2.5 months.
My horse had 2 shockwave treatments spaced 6 weeks apart to help break up bone chips sitting in his tendon (deep flexor I think??) and scar tissue in his damaged annular ligament. Basically he fractured his sesamoid, the pieces made their way into the tendon where they settled and aggravated him, and the jacked edge of the sesamoid caused damage to his annular ligament. So, he was pretty much 3 legged lame, totally miserable, and in pain before the shockwave. We did shockwave #1 and he was about 75% better, waited 6 weeks to make sure we were going to stay that much better, and then did shockwave #2. He wasn't 100% sound immediately, but after a few weeks he was. That was about 1.5 yrs ago, and although his fetlock will always be enlarged, he is sound and cleared for jumping *knocking on wood 80 million times*.