Back from vets and the reason Jenny's been stopping is....

[ann-jen]

....she's damaged her suspensory ligament in her right hind.

I know this should probably be in the NL or the vets section, but if anyone had been following our poor form in here recently I thought I'd just up date you as we now have the reason.

Basically the last 2 shows we've been to, she's very uncharacteristically been eliminated for stopping. In a very back to front way I had her back and saddle checked first as she wasn't lame and these have been problems for her in the past. When that didn't seem to make any difference I arranged an appointment for a vet check.
She has never been lame and the only thing out of the ordinary has been the stopping and if I'm really critical that she's been a bit quieter to jump than normal.
Anyway predicatably she trotted up sound and was also sound following a flexion test. When the vet watched me ride her he noticed that she didn't track up quite so well on her right hind. On examination he noticed there was a very slight thickening at the base of her hock, so he scanned and x-rayed it. There was nothing on her x-rays but there was thickening of the suspensory ligament where it inserts onto the hock. He thought there had been some changes going on in there for a while and if anything the ligament was already healing. I think I've been very lucky that the damage wasn't more hefty as I'm sure the prognosis would of been a lot worse if it had. Basically he thinks I just need to stop jumping her for 6 months while it settles down. I thought it was going to be box rest or at least no riding but he said as she's not lame and so fit that I can continue to hack her out and do a bit of flatwork with her. She has to go back in 2 months to repeat the scan to check how its progressing but he seemed to think there was no reason why she shouldn't be able to go back to jumping as normal once its all settled - just that its going to take a long time.
Its much better news than I was expecting - as the eternal pessimist I was expecting this to be the end of Jen's jumping career. It is going to drive me insane not jumping for 6 months but if she's going to come right at the end of it it'll all be worth it. The only trouble is Jen is not the ideal hack

I think I'm going to have to box her to places for off road riding as she's not a quiet ride on the roads by any stretch. Don't know what I'm going to do with my weekends now we're not out competing. Will have to start counting down the days....

 

[ihatework]

Sounds like proximal suspensory desmitis (PSD), have a search on this site as a few people have been through it!
Did your vet offer shockwave therapy?

 

[Ludi-doodi]

Well that's good news, as you say it could have been a lot worse!

Hope you got back OK after Manor Grange the other week, I didn't realise until you left that you'd been on your own, I'd have said hello earlier if I'd known! All the best for the next 2 months and the next scans show a great improvement!

 

[ann-jen]

No he did say we could inject steroids into the ligament to settle the inflammation and that I would be able to restart jumping/competing sooner but he would recommend just prolonged rest to allow it to settle on its own. At the end of the day Jenny is a pet as well as a competition animal and so I would rather take the long term view and have a horse I can compete in 5 years time than one that I can get on and compete in a few months and then bu**er the ligament for good in the long term.
He didn't mention shockwave therapy - but I think its a very mild case so maybe he didn't think it would be necessary to do anything else.
I will definitely do a search on here - it's always good to see other peoples experiences and perhaps get some moral support.

 

[ann-jen]

Thanks - I hope she's back fighting fit soon too - although all I've done is hack her round the farm since Manor Grange and I think she is enjoying being a lady of leisure - I think I might miss the jumping more than her

I'm always at shows on my own - its a real luxury if I do get a friend to come - or the best scenario - once or twice my instructor has been at the same show and even warmed me up a couple of times - a real luxury to have someone to put the jumps up and down. My vet did say I might be able to still do a bit of dressage on her but I thought I'd stick with hacking until the 2nd scan and if its looking good then do a bit of dressage over the winter til I can start jumping in the spring.

 

[Gamebird]

Best of luck, at least you know she wasn't just being naughty. Hope to see you out again soon.

 

[ann-jen]

Thank you - hopefully might see you out and about next year (god that sounds like such a long time).
I knew there was definitely something wrong with her I just couldn't work out what. Jen is the sort of horse that you can put on a horrible approach and on a dodgy stride and she'll still jump for you - the number of times she's stopped in the last month or so are more than the number of times in the whole of the 6 years I've owned her prior to this. Its just not "normal abnormal" behaviour for her if you know what I mean. In fact I think if this ligament has been twingeing her for a while she's been very good to continue as well as she has for so long up til now. Bless her.

 

[dieseldog]

Poor Jen, but at least you know now.

I think you should ask your vet if it is PSD as the rehab he has suggested to you for it isn't the standard treatment. It doesn't ususally heal by itself.

 

[HammieHamlet]

glad you have found out where the problem is.

Im going through something similar with my horse at the moment - for the past year he just hasnt been right, and has totally lost confidence jumping. He used to jump anything from anywhere, yet now will stop at a 2ft6 X pole if the striding isnt right. Have had people tell me that its because Ive got another horse, therefore riding him differently etc - I know that's complete rubbish, as he is a totally genuine horse that used to jump for fun and have so much confidence.

Ive spent a lot of time and money on osteos/ vets etc, and today I have been told that he has nerve blocked positive to the right hind foot, yet the X ray shows nothing - so therefore soft tissue damage?? The vet was also talking about suspendory ligament damage..... Hmmm...

Like you, Im just going to take things easy over the next 6 months, no jumping at all. Its such a worry, but best to let nature take its course in this situation. Hopefully we may be able to get out next season!!

Good luck with your one

 

[alisonpook]

Sorry to sound a little negative biut we had a horse with hind limb co proximal suspensory desmitis several years ago and the standard treatment at the time was rest. He did not respond. Treatment options have moved on since then and I think that it is now often thought that rest alone will not cure certain cases and that a more proactive treatment is now recommended. Hind limbs may also need a different approach to front limbs. Would suggest you have a look at Jet-set's posts and also the vet with the Welsh Section D - sorry can't remember her name. They have both been through this and may well have valuable advice. All the best for a successful recovery.

 

[star]

sounds like he's saying it's PSD and i would therefore question his management of it. even mild PSD doesn't get better with rest alone. i did my final year elective on it, read every case study the RVC has ever seen!

 

[_jetset_]

I am sure if you look back at some of my posts you will find some excellent references to PSD, but firstly I would check with the vet that this is what she has as usually you cannot 'see' any inflammation when it is a PSD injury. The ligament is right behind the hock, which is why it is so difficult to detect

Star is an excellent reference as I am pretty sure she did her thesis on PSD (please correct me if I am wrong) and has been a real source of information for me. Also, try this site, it's an excellent starting point for researching the condition and was a mine of information for me: http://behindthebit.blogspot.com/2008/03/proximal-suspensory-desmitis-common.html

If you want to ask me any questions about Grace's treatment, injury, recovery etc etc, please feel free to PM me!!! I know I got a lot of information from other people on here who had been through the same thing, and that helped me so much!

 

[_jetset_]

[ QUOTE ]
sounds like he's saying it's PSD and i would therefore question his management of it. even mild PSD doesn't get better with rest alone. i did my final year elective on it, read every case study the RVC has ever seen!

[/ QUOTE ]

We crossed posts... I hope you didn't mind me mentioning your thesis

 

[sikaran]

Pleased you know what it is now, and it also sounds like a good prognosis. Hopefully I'll see you out and about dressaging again soon!

S x

 

[star]

[ QUOTE ]
[ QUOTE ]
sounds like he's saying it's PSD and i would therefore question his management of it. even mild PSD doesn't get better with rest alone. i did my final year elective on it, read every case study the RVC has ever seen!

[/ QUOTE ]

We crossed posts... I hope you didn't mind me mentioning your thesis

[/ QUOTE ]

no probs. i think there's a lot of people on here a mine of info on it now! When Dan was diagnosed I posted on here and no-one had heard of it. That was back in 2002. Shows how times change!

 

[ann-jen]

Thanks to everyone who has replied. I've started to research things a bit but think its going to take me ages to sift through the huge amount of info there seems to be on the subject. As I understand it so far - shockwave treatment is of more use in early cases and from what my vet was telling me Jenny's has been quite long standing and niggling away for a while. I'm willing to give anything a go that might help. I wondered if anyone could give me an idea of whats involved. I understand its a bit painful for the horse and usually done under sedation but things like frequency of treatments and duration would be a help. I am contemplating ringing Edinburgh for advice to see if they think Jenny's case would be suitable or if there is anything I could be doing for her myself (I am a vet myself after all

even if I do only work with small animals at the moment!)
I'm not sure surgery is right for Jenny either - she's not actually lame so I don't think a neurectomy would be indicated in her case unless things progressed further.

As far as the diagnosis/treatment suggested is concerned. He doesn't want me to completely rest Jenny because he said although a lot of people advocate this he finds that the ligament heals shortened and giving it a little bit of exercise would likely make a better result long term. I can ring him to clarify things today - but I'm sure we are definitely talking about PSD here. There was definitely changes on the scan though - mainly thickening of the ligament compared to her other hindleg I think as opposed to the "black holes" you see when there is bleeding into the ligament. When he told me the diagnosis I was obviously quite upset and said that I thought the prognosis was pretty poor for this but he seemed very positive that it would settle with enough time. I think I need to talk to a few more people and just digest a bit more of the information and make a more informed decision based on that.
I'll give Edinburgh a ring today and let you know what they said.

 

[_jetset_]

Ok... here goes

Grace's was an acute injury (therefore the one that the shockwave is most succesful in treating). She was not lame, even on flexions, and it was only when she was on a really tight circle on the lunge and being asked to really move forwards it could be seen, it was that miniscule. In fact, my own vet missed it, so I went to a specialist for a second opinion and that is where it was discovered.

Therefore, my first real piece of advice is get a 'specialist' to look at the scans, even if you do not get her referred. I am not sure who the closest person to you would be, I dealt with Peter Scholefield in Halifax and if he had not been available, my next port of call would be Sue Dyson.

On Grace's scan there was no 'hole' or lesion as they like to call it, just when compared to her right hind ligament it was slightly swollen which had altered the fibre patterns of the ligament. It is such a narrow channel, that even the smallest amount of inflammation can cause something to be strange.

Peter recommended 6-8 weeks of complete box rest (and I mean complete) with four sessions of shockwave therapy a week apart, and two sessions of injections into the ligament itself every other week. At 8 weeks I was to start walking her in hand for 10 minutes on an even surface, and gradually increase it. When we were at 30 mins I was to go back for a follow up scan.

I am pretty sure that both Sue Dyson and Andy Bathe advise complete box rest (the real experts in this field... again, someone correct me if wrong, but from vet journals I have read this is what I have deduced) therefore I would consider following this. As others have said, a PSD injury is not like any other ligament injury, and does not heal with rest alone unfortunately. However, the rest seems to be a necessary part of the healing when used alongside other methods such as the shockwave.

With regards to it being painful, I cannot imagine it is particularly pleasant, but it is done under mild sedation and does not take too long. I would be in and out within an hour when I took Grace over to Halifax, and she is no worse for her experience

It is not a 'cheap' treatment, I think in total my shockwave came to just over £1,500 with the injections etc etc. I then chose to have the neurectomy and faciatomy because although the ligament had reduced well with the shockwave and rest, there was still some slight swelling in one area and we were looking at a further 6-8 weeks of box rest (by this point we had done four months) without a definite positive result.

 

[ann-jen]

Thanks ever so much for all that info. At the moment I'm waiting for my vet to ring me back - he is very experienced and has a very good reputation in the area - hence me going to him rather than muddling on myself. I just want to clarify with him regarding the diagnosis/prognosis before ringing Edinburgh etc because I don't want to step on his toes and just to be sure what I'm dealing with so I don't look like a numpty if I've got this wrong.

 

[dieseldog]

If Jen has had it for a while Shockwave probably won't work and the operation might be your only option. If she has it in one leg she more than likely will get it in the other so if you do decide to do the operation it might be worth doing both legs at the same time. When my horse had it done it was £1,300 for one leg and £1,500 for two legs. I had both done as she had changes starting in the other leg, although she wasn't lame on it yet. My horse was done at Willesley - but they are miles from you.

 

[saskia295]

Oh no

that's such a shame but I'm glad the vet's prognosis is so positive

Looks like some serious dressage practice for you over the winter then to be coming out on form next year! Wishing Jen a speedy recovery.

 

[ann-jen]

Thanks guys.
I've just spoken to Edinburgh and I have to say they tend to agree with my vets approach. He said basically because she's not lame then it isn't 100% that the problem is PSD and it would of required nerve blocks to prove that is the cause. My vet didn't do nerve blocks because as Jenny isn't lame it wouldn't show anything. The vet at Edinburgh said from a diagnostic point of view I would have to keep Jenny in full work until she became obviously lame in order to nerve block her and prove the diagnosis although obviously it wouldn't be in mine or Jenny's interests to do that! So for that reason he agrees that I should keep her in low grade amounts of work until Jenny has her 2nd scan and then build up the flatwork from there with a view to start jumping again in 6 mths. He said that shockwave wouldn't be appropriate in Jenny's case partly because we can't confirm the diagnosis through nerve blocking and partly because its a bit more of a chronic case. He said if the worst case scenario was that the ligament continued to degenerate and Jenny became lame that she would be a good candidate for denerving and felt there would be a good prognosis for her following that. As I discussed with my vet yesterday we felt that Jenny's injury was possibly traumatic rather than a repetitive strain type problem which also affects the prognosis/treatment options.
So I have some more food for thought but also feel a bit less panicy about keeping her in work.