Bilaterl Hindlimb PSD and surgery - help!

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Cripple101

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Also posted in Veterinary, just sometimes get more replies here!

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!
 
It doesn't prevent BE competition, it has changed. If does FEI in theory.

There is FB PSD discussion group, worth joining and searching old threads with similar questions.
 
Mine was diagnosed with PSD at 5 years old.
We went for faciotomy which relived the pressure. We did not go for neurectomy. The prognosis was not good, especially for a big and young horse. Maybe a year at best.
We found that in most cases, PSD was a secondary issue, the reoccuring PSD being that there was something else going on causing it. In our case it was Pelvis and hock arthirtus.
 
My horse had n&f prior to me getting him. It's taken blood, sweat and buckets of money to get him right. He is quite straight through the hocks which is now suspected to be a factor. Loads of bodywork has un-tilted his pelvis and I try to keep him relaxed and working from the back. He's 4 years post-op and looks better than when I got him. Vet suspects his nerves are starting to regenerate too.
 
I don't know the answer to all your questions but my good friend's horse had this done about 3 years ago, think he was 8 at the time. I went with her to drop him off and collect him so spoke to the vets at the time, plus been following how he's doing.
In his case the op seems to have been a complete success. As far as I remember he was walking under saddle after about a month and back in the field pretty quickly. No complications from the surgery and his legs look perfect. He does have straightish hocks I'd say.
He is going better than ever, he has a "wow" trot now which he didn't before. She has got into classical dressage a bit and has really worked hard to get him using his core and strengthening his back end, which tbf, he now finds easier.
She does a lot of hacking with him and less conventional schooling, they are out competing at a decent level very successfully.
 
Hm I feel like I do need to push a bit more regarding primary causes - it seems odd to happen in a young horse that has done very little for no apparent reason. Worrying we haven't been able to find anything so far. He has come up a little sore through his SIs but this has only came up in the last few weeks so I don't think this can be a primary cause considering how long ago diagnosis was.
 
That's very good to hear! I've been doing a lot of core strengthening work with him, and I avoid schools where possible, much preferring work whilst hacking, which for the level I do is quite adequate. Thanks for the reply!
 
Oh I didn't realise that. Yes I've heard there's rather a lot of horses out competing FEI who have had it done - not sure we'd get to that point anyways, and morally I wouldn't do it, but its interested to know!

Yes I'm in that group, makes for interesting reading - most people seem to fall very strongly on one side or the other for the op!
 
I've known fairly well of three who have had the surgery suggested. Two had the surgery, one of which never really came right (but to be honest he was very badly put together) and was retired to the field age 5 having had the surgery age 3, and the other went on for a few years after the surgery age 7 but would have good and bad periods performance-wise and was rehomed as a light happy hacker age 11.

The third horse didn't have the surgery but the owner went full out on bone scan, multiple treatment types for everything found and very slow rehab instead. Two years down the line he's looking and going really well, out competing at BE100s now so fingers crossed. I can't remember what they found on the bone scan but it was a whole raft of random bits and pieces. He was 6 at the time and the vet said it was like he just hadn't done a very good job of growing into himself and needed some help. There was no major damage anywhere, just lots of niggles.
 
I have one who had the operation 6 years ago. Still sound and working, however one thing I would say is be sure there are no secondary issues before you make your decision. Kissing spines, si issues and hock spavin often occur when PSD is found (not always) and that can hange the prognosis long term. Before surgery I had back x-rays, hock x-rays and si scan so I knew exactly what I was dealing with and was able to formulate a plan. They key with mine has been changing the way in which I work him to ensure he is carrying himself rather than being ridden to go a certain way by being blocked.
 
Cripple101 said:
How did you get on with your horse post surgery Hannahgb? and why did you go for the fasciotomy rather than the neurectomy as well?
Click to expand...

The faciotomy relived the pressure on the suspensory, we saw instant results. We didnt agree with the neurectomy. We were otld in a young horse it was likely to be unsuccessful anyway or atleast not be a permenant success.
He came back from the faciotomy really well, started competing. Unfortunately he has multiple unrelated problems anyway!
 
That's interesting to hear. I don't know how I feel about the neurectomy, but equally couldn't afford to go back to it if the fasciotomy failed. Why do they think it's less likely to be successful in a young horse - more likely nerve regrowth?

Sorry to hear he had other issues! It's a total nightmare.
 
Hi there. Definitely check out a page on Facebook called 'PSD Discussion Group'. It's been SO helpful for my situation. My horse was diagnosed as 3/10 lame bilaterally (right hind, fore front) a year and a half ago. I was lucky, in that we caught it early because I pushed for scans etc. He had mild PSD, no lesions, thankfully. But through my incessant research and speaking to people on the PSD group, and from what people above seem to echo, PSD is most of the time secondary to something else. If it was one leg it could be due to injury, however the fact that it is bilateral to me would suggest that he most likely has back issues. Don't quote me on that, but if I were you I would get his back xrayed. A lot of the time it goes hand in hand with either kissing spine or SI disease.

My horse has close spines but close enough to be sensitive to him and also his size and shape (nearly 18 hands and very short backed) means he had a lot of pressure on the SI. After getting a bone scan (which my insurance company paid for) we could tell he was mostly sore in his SI region. So after the initial shockwave treatment and box rest for the PSD (box rest is the worst thing for SI pain, however so keep that in mind) we started to treat the SI. This involved as much turnout as possible, regular physio, chiro (including a couple of visits from Rob Jackson, the horseback vet), steroid injections to the SI, heating the SI before riding (either solarium or a chordless heat pad) and rehab training including a very long warm up and cool down.

I avoided the surgery thus far and while he does sometimes have days where he seems not himself and there have been competitions where we've had to withdraw from because he's had an 'off' day, he's now training at PSG level dressage so it can be done.

I have another friend who went straight in for the surgery and her horse isn't quite right after it.

Throughout my ordeal I learnt some things;
- ALWAYS listen to your gut...if something tells you your horse isn't quite right, it probably isn't
- Your vet doesn't always know everything and you don't have to stick to that vet...if you're not happy, get a second opinion
- Be as patient as you can be with the rehab...slow and steady wins the race
- Pay as much attention to your horses back as you can....get the saddle checked, have physio and chiro regularly
- Turnout is a horses friend. If they have to recover with box rest then I would still look for my horse to have regular movement if possible....hand walking multiple times a day to stop the lumbar region from seizing up

Feel free to PM me if you want further info. I really did try everything with my horse to avoid the surgery....mainly because the nerves can regrow and the long term success rate of nerve cutting isn't great. But in saying that....you just don't know. It's a gamble that many people take and have successful outcomes. Even if you do go down that route there are still multiple things you can do to try and maintain a happy horse. But get his back checked as a starting point, IMO! (Sorry for the long post!!)
 
Morning, thanks for the detailed reply!

I am on that group, and I do find it very useful, but I also find it's a page with very strong opinions either way! We haven't found any primary cause yet, but I am going to push to look for more when I speak to my vet next week. He does have regular physio and chiro, and has developed some SI pain, but this has only developed since the PSD, so both vet and physio think it's secondary to the PSD rather than the other way round, but we'll be treating the SI regardless. I have considered asking for bone scans, but equally it's going to be getting very tight in my insurance which obviously makes things more difficult if we still end up going down the surgery route!

I'm happy with my vet, he has a lot of experience in treating this and a very good track record - he also rehabbed mine from a ICL injury last year. It's a gamble I'm really struggling with, and if there wasn't the time restriction on the insurance I'd be more confident in doing more investigations before looking down the surgery route, as it's not something I really want to do.

My main concern is that we haven't been able to find a primary cause - unless it began when he was compensating for front leg ICL injury? I'm just not sure, I'm so torn.
 
Cripple101 said:
Also posted in Veterinary, just sometimes get more replies here!

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!
Click to expand...


Bumping up a old post. But in a similar situation with a young gelding. What did you do OP? Did you operate, how is the horse now?
 
Cripple101 said:
Morning, thanks for the detailed reply!

I am on that group, and I do find it very useful, but I also find it's a page with very strong opinions either way! We haven't found any primary cause yet, but I am going to push to look for more when I speak to my vet next week. He does have regular physio and chiro, and has developed some SI pain, but this has only developed since the PSD, so both vet and physio think it's secondary to the PSD rather than the other way round, but we'll be treating the SI regardless. I have considered asking for bone scans, but equally it's going to be getting very tight in my insurance which obviously makes things more difficult if we still end up going down the surgery route!

I'm happy with my vet, he has a lot of experience in treating this and a very good track record - he also rehabbed mine from a ICL injury last year. It's a gamble I'm really struggling with, and if there wasn't the time restriction on the insurance I'd be more confident in doing more investigations before looking down the surgery route, as it's not something I really want to do.

My main concern is that we haven't been able to find a primary cause - unless it began when he was compensating for front leg ICL injury? I'm just not sure, I'm so torn.
Click to expand...

I own and modertate that group (though I am not involved as much as I was when my horse was diagnosed with PSD in 2012/13).

The idea behind the group is that it is an open minded, supportive group, that is neither very pro or very against surgery. That supports sharing stories, sharing knowledge, discussing options and supporting one another.

If you feel posts are becoming to bossy or critical feel free to report / flag to moderator. I want all to feel supported in discussing views.
 
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Laafet said:
My horse had it done at 8 years old and is now 15 years old and competing at a much higher level. I keep him in constant rehab though and am careful with him.
Click to expand...
How are you finding things is your horse still ok just had my daughter's 9 yr old diagnosed with PSD and offered option of surgery. When you say constant rehab what do you do? My daughter is so upset. I'm trying to find something to reassure her. Thanks.
 
If it helps mine that had surgery 7 years ago is still in ridden work and now competing at a higher level than prior to surgery. However we still had issues after surgery and if was only completely retraining from the ground up biomechanically with an amazing instructor who specialises in these sort of cases that made the real difference. There are often multiple issues along with psd so for me you need to take more of a holistic approach and be prepared to look closely at yourself and how you ride/train for the surgery to be and remain successful.....I know this is an old thread but I think it's a long term perspective you are looking for, only my opinion but hope that helps
 
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