Help me understand this diagnosis

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frankieduck

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Not my horse.

Friend has been to the vets today for investigation of a mild on/off lameness that appeared to be behind. We suspected beginnings of some arthritis.

Diagnosis has been a complete curveball. Lame bilaterally in front, only appearing off behind due to over compensating.

Nerve blocked from foot up until suspensory block proved positive. Scanned both legs. Not loads to see on scans but enough. Diagnosis chronic suspensory desmitis in both forelimbs. Prognosis pretty much immediate retirement from any ridden work. No recommended treatment.

I’ve only ever dealt with PSD in hinds and there seems to be really limited information out there on chronic PSD in forelimbs.

Has anyone dealt with this before? Is there really no hope with appropriate rest and rehab?
 
Not having dealt with OSD myself so I can’t comment but wanted to bump maybe so you could get some replies and say how sorry I am, that must have been a HUGE shock for your poor friend.
How is she handling it?
 
poiuytrewq said:
Not having dealt with OSD myself so I can’t comment but wanted to bump maybe so you could get some replies and say how sorry I am, that must have been a HUGE shock for your poor friend.
How is she handling it?
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Thank you yes a huge shock and terribly upsetting with no real advice on rehab or next steps other than he might be able to hack lightly in the future if he comes sound with rest 🫤

She is devastated and also feels awful to have been carrying on but horse really wasn’t visibly lame at all. I am pushing for a second opinion and really think there is more to the story biomechanically where the horse is overloading front tendons due to being crooked behind.
 
frankieduck said:
Thank you yes a huge shock and terribly upsetting with no real advice on rehab or next steps other than he might be able to hack lightly in the future if he comes sound with rest 🫤

She is devastated and also feels awful to have been carrying on but horse really wasn’t visibly lame at all. I am pushing for a second opinion and really think there is more to the story biomechanically where the horse is overloading front tendons due to being crooked behind.
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I’ve got a share in a racehorse who is lame in front due to over compensating behind. He’s had joint injections (that’s the vet’s go to for everything) and is turned out atm. I’ve no idea of his long term prognosis.
Having re read your original post I do see as usual I’ve got my wires crossed!
 
I had a horse with a front suspensory branch issue. he was visibly lame but could be 'ridden sound' and the lameness only presented when changing rein, for a few strides.

I had PRP, shockwave, icing, magnets and microcurrent, all along with rest.

He became completely sound but I would not have taken him eventing again.

The suspensory scanned perfect at the end of treatment.

ETA - My vet indicated that a front suspensory issue was more likely to be successfully rehabbed than a rear.
 
PSD is a different issue than an injury to the suspensory. Most of the treatments used for injuries are not applicable as there's not a specific injury site and the ligament is damaged in a more generalised way. If the horse is young, has done little work up to date and there is bilateral ligament damage then it starts to look like dsld which cannot be treated, only possibly stabilised by rest. An older horse who has been worked harder might be able to be stabilised with a lengthy rest period and then brought back into a much reduced level of work.

If the hind suspensories have not been scanned it would be worth doing this. If either of these are affected as well then it does look like dsld where the outcome is bleak.

My horse with dsld had to be euthanised age 6 as he went down hill quite quickly when retired but he was initially affected in both hinds and then started showing lameness in a front leg.

Also look for a broken forward hoof pastern axis which is an indicator that things are not good.
 
Red-1 said:
I had a horse with a front suspensory branch issue. he was visibly lame but could be 'ridden sound' and the lameness only presented when changing rein, for a few strides.

I had PRP, shockwave, icing, magnets and microcurrent, all along with rest.

He became completely sound but I would not have taken him eventing again.

The suspensory scanned perfect at the end of treatment.

ETA - My vet indicated that a front suspensory issue was more likely to be successfully rehabbed than a rear.
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Thank you.

Horse is mostly a happy hacker with owner just wanting to do the odd fun ride and pop a 50cm fence, certainly not destined for high level competition or anything intensive. Current prognosis was that she’d never be able to get out of walk again and that there is zero treatment options which just feels so dire. 😪

Horse was also scanned immediately after never blocks which I’ve since read can give a false positive as the block swells the tendon and gives air pockets on the scan?

Horse has come in very visibly lame behind today just in walk, so I am really confused to be told there is nothing wrong behind?

Owner is going to seek a second opinion I think.
 
nutjob said:
PSD is a different issue than an injury to the suspensory. Most of the treatments used for injuries are not applicable as there's not a specific injury site and the ligament is damaged in a more generalised way. If the horse is young, has done little work up to date and there is bilateral ligament damage then it starts to look like dsld which cannot be treated, only possibly stabilised by rest. An older horse who has been worked harder might be able to be stabilised with a lengthy rest period and then brought back into a much reduced level of work.

If the hind suspensories have not been scanned it would be worth doing this. If either of these are affected as well then it does look like dsld where the outcome is bleak.

My horse with dsld had to be euthanised age 6 as he went down hill quite quickly when retired but he was initially affected in both hinds and then started showing lameness in a front leg.

Also look for a broken forward hoof pastern axis which is an indicator that things are not good.
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Thank you. Horse is 15 and was completely sound up until a couple of months ago.
 
frankieduck said:
Thank you. Horse is 15 and was completely sound up until a couple of months ago.
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So it seems less likely to be dsld which is genetic and usually shows up at a much earlier age. It's probably worth taking a video to show the vet what you are concerned about with the hind end, especially if there is a problem that can be seen in walk. It sounds like a horrible situation to be in anyway but your friend needs to know more clearly if there is or isn't a hind end issue and if this can be treated. Hope there can be a more positive outcome.
 
nutjob said:
So it seems less likely to be dsld which is genetic and usually shows up at a much earlier age. It's probably worth taking a video to show the vet what you are concerned about with the hind end, especially if there is a problem that can be seen in walk. It sounds like a horrible situation to be in anyway but your friend needs to know more clearly if there is or isn't a hind end issue and if this can be treated. Hope there can be a more positive outcome.
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Thank you. Yes she has documented the hind end issue on video today, it literally seems to be one day to the next, so very frustrating it didn’t show on the work up!

She is seeking a second opinion and going to show the videos 🤞
 
frankieduck said:
Thank you.

Horse is mostly a happy hacker with owner just wanting to do the odd fun ride and pop a 50cm fence, certainly not destined for high level competition or anything intensive. Current prognosis was that she’d never be able to get out of walk again and that there is zero treatment options which just feels so dire. 😪

Horse was also scanned immediately after never blocks which I’ve since read can give a false positive as the block swells the tendon and gives air pockets on the scan?

Horse has come in very visibly lame behind today just in walk, so I am really confused to be told there is nothing wrong behind?

Owner is going to seek a second opinion I think.
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For such a dramatic diagnosis, I do think that a second opinion is a good idea.

I would go to a vet with an excellent reputation for seeing through lameness issues. One of mine was due to go to the vets for a week as he seemed lame in 3 legs. They were going to block a leg a day, hence staying in.

As it was, he was there first day and they blocked to his foot on a fore leg, whereupon the two hinds also became sound. He'd just been moving them funny to take weight off the fore limb.

He wasn't insured and had shown this on/off slight 'offness' from being a youngster and it had never been traced exactly. He had a steroid shot into the area that had blocked and made a happy hacker (he'd been eventing). There didn't seem point in paying out for an MRI as steroid jab and rest would have been the likely outcome, and he'd reoccurred the lameness even after 3 years of rest and a further year of bringing back into work slowly.

If this horse is insured, your friend may as well do the specialist lameness vet, have the scan and see what it is. At least you will have a firm basis to make a decision then.

Sadly, sometimes they are not mendable.
 
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Just updating for those who were following. Second opinion vet came out 2 weeks ago, agreed there was definitely something going on behind after seeing videos but didn't want to investigate further without rest first. So 5 days on bute as horse was really quite lame, then 5 days off bute and reassess. Horse has been off bute for 2 days and is visibly crippled behind, very odd action, dragging the toe and almost appearing to drag the whole leg. It's all very odd as he is SO lame you would expect it from an acute field injury etc. but it has been very progressive previously with a few stiff-steps here and there but then sound for the following few weeks, before reappearing again. Vet is back out again today to reassess.
 
If the horse stays lame this time then a decent vet should be able to pin down the issue at workup.

If your friend has access to a chiropractor vet then that would my port of call - mine can identify issues which have left regular vets and physios etc baffled.

Equally it would not be wrong to say that enough’s enough when a horse is on/off so lame.
 
Thank you, vet is one I have worked with before and referred her to, he is highly regarded for second opinions on challenging lameness cases so I am hopeful he will find an answer. It is all very odd but we are definitely not writing horse off yet, this has all really escalated very rapidly over a matter of weeks with no real answers and only limited diagnostics, so until we have some sort of firm diagnosis we will keep investigating.
 
Just re the appearing as an acute injury situ a friends horse went eventing as usual 1/2 days later crippled, ?lami in all 4, ?neurological, vet really not sure at that point.

He actually had major kissing spine degeneration, he was 15 by this point and been eventing at least the last 7 years, so although stuff looks acute sometimes it can just reach a major tipping point.
 
Well vet out today but first thing this morning whacking big abscess had erupted through coronary band! Hadn't shown at all before, despite lots of initial poulticing and farrier poking around when lameness first showed, so must have tracked up rather than down and been brewing for a while which would explain the on/off lameness and I wonder if the bute trial has encouraged more movement which has made it finally surface. So positive as seems the hind-end issue has been resolved. X-rays all up hinds have shown nothing. Front suspensories are still a question mark, continuing to rest and let abscess fully drain and see where we are then.
 
Update for anyone following out of curiosity. So after a few weeks of rest to allow the abscess to drain and heal and everything settle down, horse is now sound behind, vet returned and rescanned front suspensory's. Cannot find anything wrong with the suspensory.

Current thinking is that the chronic hind end lameness from the brewing abscess was overloading the front suspensory's and causing inflammation, or that the horse went lame in front as a result of the intensive lameness workup and then the nerve-block immediately prior to scanning had given a false reading (apparently the nerve block fluid can cause the suspensory to swell and show bubbles on the scans which can show as false tears).

Second opinion vet obviously won't dispute original diagnosis but has just said as of today, he cannot see anything wrong with the suspensory. Gradual return to work and see how they get on.

So quite the emotional rollercoaster and we will see what the next few months bring but certainly a more positive prognosis that we originally started with! Horses, never simple are they!
 
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