This article gives a general overview on a new therapy in equine orthopedics. In human medicine extracorporal shock wave therapy (ESWT) is used for lithotripsy of stones of the urologic system and also in orthopedics. In equine medicine the therapy is almost exclusively applied for the treatment of orthopedic problems. The main indications are proximal suspensory desmitis (PSD), lesions of tendons and ligaments, osteoporotic changes and spavin. In this paper the mode of action of shock waves and the different shock wave devices are discussed. Also, some information about an ongoing clinical trial at the Animal Hospital University of Zürich is given.