Bilaterl Hindlimb PSD and surgery - help!

[Cripple101]

Hi all

Just after some advice regarding the N&F surgery for hind PSD.

My 5 year old was diagnosed in April after being NQR for a few months, and eventually going lame. He blocked to both hind high suspensories and ultrasound showed some thickening but no lesions, left worse than right. They were treated with cortisone and a course of shockwave, and things were looking good while he was in walk work in July, so we started a slow work increase. Unfortunately there's been a recurrence of the toe dragging and him feeling not quite right in the last week or so, and vet has confirmed he's gone lame again, but this time right hind worse. We blocked again to be sure and it's come up to the high suspensory again, but even his left hind is reactive on flexion, so it doesn't look like we're making any progress.

Vet thinks I need to seriously consider surgery at this point, as it doesn't look like he's coping with even light work as is. My head is in a complete spin even thinking about it. Vet is going to call me next week for a chat about it once I've had time to think.

So, questions;

Am I correct in the thinking that the surgery will not solve the problem, merely relieve compartment syndrome and the pain from the suspensory? In this case, what is the liklihood that the suspensory will continue to be damaged, ultimately resulting in a complete breakdown of the ligament?

Does anyone know anything about long term prospects after the surgery? A lot of people seem to really rave about it, but are only a year out from it. I'm very conscious my boy is only a 5 year old.

What's the rehab and recovery process like with this surgery? After a long spell of box rest when this was initially diagnosed, he lost the plot in the stable so not sure we can go through a long term box rest again.

Is there always a primary reason for PSD? Doesn't look to be conformational, but we've not found a primary reason so I'm concerned about why it's happening - especially if we go down the surgical route and it continues to cause issues.

I know the op prevents you from being able to compete BE/FEI, but has there been any other restrictions people have found once they've had the op?


I've been religiously using the ArcEquine throughout but doesn't seem to have helped at this point. Insurance is out in Jan, so I have a little bit of time to play with, but not loads!

Thanks in advance for any replies to this!

 

[ester]

Those I've known had it done it has been successful several years out. I do think it is important that the vets have eliminated other hind end issues though (I didn't mention that to one friend and wish I had as during post op rehab horse was lame and determined as SI joint too).

 

[ihatework]

It’s so multifactorial that it’s impossible to give any certainties.
What I would say is it’s a condition that seems to give them a disproportionate amount of discomfort to the apparent damage.
So to my mind you either write the horse off or you operate.
IMO the op is pretty straight forward, it wasn’t months on end of box rest, just a few weeks with controlled exercise - if he is tricky you could always send him to someone else to deal with.
You may well have something else going on, have you been able to rule out a KS or sacro?
I think ultimately you probably need to have a good look at if there is anything in your current management that could be changed (particularly school - is your surface deep/uneven?) and what sort of jobs your horse might be good for if other niggles come to light.

I operated on a 6yo that I didn’t get on particularly well with, purely with the aim of giving him a chance in another job/Home. The op was uneventful, I stuck steroid into the sacro joint at same time. Rehabbed him and sold him as an allrounder/hunter. He did the job for the new owner.

 

[Cripple101]

That's good to hear thanks! We have been looking into it, and so far have only found some minor SI discomfort, which vet and physio thinks is secondary to the PSD as opposed to the other way round, not likely to be a causal factor

 

[Cripple101]

Definitely seems like that, my boy's scans only show minor damage but its causing a lot of grief! SI has just started to show up as a bit sore for him, but it's looking like that's secondary to the PSD rather than a causal factor - will treat that concurrently with the surgery if we go down that route.
He's only ever occasionally been in the school (he's a big young lad who has done a lot of growing, so he's mainly been lightly hacked with very occasional rides in the school) and the surface is very firm and well maintained.
If he can make a nice dressage horse I'll be happy - my jumping days are numbered anyway (but that's another story!) so if not jumping would give him a better chance of staying sound for dressage, then that's not a problem. If not he would happy hack (with a competent, confident rider - he enjoys it, he can just be a little enthusiastic about it!), but I have no intentions of passing him to someone else as he's not the easiest. Hopefully it won't come to that, but he's with me to the end!