Hind medial suspensory branch strain

[applecart14]

For info sharing purposes I just wanted to share with you my recent experience with my horses new injury!

I referred my rising 18 year old WB gelding Bailey to my veterinary clinic for a lameness workup after he went lame following a jumping class at my usual venue. He has been diagnosed with a mild medial suspensory branch strain and luckily it was caught early before too much damage was done. Although he has very wingally back legs anyway I knew that the type of swelling he developed two days following the injury was different to normal and because he was on/off unsound at in hand trot up, was pretty sure he'd done something sinister, I thought maybe it was the tendon sheath he'd done some seven or eight years ago. He was diagnosed following a trot up and flexion with palpation of the area. The vet said it was up to me if I wanted to have a scan but as I am no longer insured with anything to do with tendons/ligaments other than injury from a visible wound there didn't seem much point as he'd most likely still need the same amount /type of rehab.

The vet said he could have done it anywhere, in the field, stable or whilst riding and was more likely to be a repetive type of injury. This got me thinking about something I'd read recently in one of the equine publications that new research has shown that a lot of tendon injuries are caused by repetetive work, i.e schooling/lunging. Luckily where I am the surface is very good and is often harrowed but I know that's not always the case at some yards.

So Bailey is being ice cupped once a day, also ice booted, and was initialy cold hosed following the injury. He is having support bandages on at night and is back on anti inflammatories -, 2 per day for a fortnight then one a day for a fortnight, then half a sachet a day. Its a good prognosis for a full recovery if all goes well, but obviously with the chance of reoccurence which is the same as it was with the fore leg, when he did his lateral suspensory branch. Apparently the suspensory branch is one of the most common type of tendon/ligament strain.

With all his other problems the worse thing for him would be to shut him in the stable on box rest as he would just seize up so the vet has said hacking up to an hour a day walk only for the next month/staight lines in the school with a view to reassessment in a months time where, if all goes well, he can start trot work. After the third month if all is well he can start jumping again. He can go out in the sandpit where ours go in the winter, so luckily to trudging through deep boggy mud for him!

I am so pleased that the prognosis is good and I am fully prepared to give him the time he needs to heal. I am also very lucky that I have a good vet, who knows my horse and his problems inside out and is prepared to give him the time and effort and for good facilities at my yard which means that he can be turned out without the typical deep mud that just makes this type of inury ten times worse.

 

[*hic*]

Just wondering why you'd ice boot during the day to cool down and then "support" bandage at night which will inevitably heat up?

 

[ester]

As the vet has said it is likely a sort of RSI do they think that it might have occurred because of him moving differently because of his other issues/compensating?

 

[applecart14]

Just wondering why you'd ice boot during the day to cool down and then "support" bandage at night which will inevitably heat up?

Because icing is the best thing to do with any type of ligament/tendon injury. Support bandaging using stable bandages at night is also good because it offers compression. This is a common way of treating such an injury. Unfortunately you can't have it all ways, and providing bandaging is done with even pressure over gamgee or other similar padding it is considered the best thing to do even if it does heat up the tendon slightly. But he's had bioflow boots on every single night for the last eleven years so you could say the same thing about that I guess. Bandaging also provides support to the opposite limb which is important as the horse will be taking more weight onto the other limb.

Hi Ester, my vet says that his particular injury is one of the most common injuries for both dressage and showjumpers. He didn't say whether it was related to the other issues, but I would have thought not given the amount of time gone by now, since he last did his near fore suspensory, as this was nearly 2 years ago now. He was saying that its common in horses that are schooled on a surface as the recent equine magazine article I read pointed out. He also said he could have done it in the stable, out in the paddock, getting cast in the stable or going mad on the lunge (which he does every now and then).


Taken from a H&H article :

Sprain of the suspensory ligament (suspensory desmitis) is usually restricted to one of three areas:
•injury to the upper third of the ligament (called high, or proximal, suspensory desmitis) is common in horses in all disciplines
•injury to the middle third, or body, of the ligament is easiest to diagnose, but least frequent. National hunt racehorses and point-to-pointers are most likely to suffer this injury
•damage to the inside or outside branch of the suspensory ligament is also common, particularly in horses which jump

 

[ester]

That article extract amuses me a bit as it those three areas pretty much do cover the entire of the ligaments so it isn't really 'restricted' to those areas!

I only asked as we have one at home who is nearly 18 months from a lateral branch injury, in hacking work but moving differently to before which might increase the likelihoood of strain elsewhere particularly if jumping/schooling although we have no plans to do that with her.

 

[applecart14]

That article extract amuses me a bit as it those three areas pretty much do cover the entire of the ligaments so it isn't really 'restricted' to those areas!

I only asked as we have one at home who is nearly 18 months from a lateral branch injury, in hacking work but moving differently to before which might increase the likelihoood of strain elsewhere particularly if jumping/schooling although we have no plans to do that with her.

Hi Ester, I just grabbed an extract from the article because I was trying to point out that this kind of injury is prevalent in horses that SJ in particular. Obviously it isn't just confined to horses that SJ as your case proves. It can also be related to poor foot balance (xrays have shown my farrier is very expert in his field) and it can also relate to horses that are straight at the hock (something I don't believe Bailey is as people have always said he's got very nice confirmation).

Horses are very good at compensating. If something has hurt her previously then your filly will already have learnt to move in a different manner. The vet thought that is why Bailey appears slightly 'hoppy' on the opposite leg to the one he injured (with the suspensory branch injury he did 2 + years ago) due to overcompensation and has also mentioned 'mechanical lameness' to me previously as during a bute trial it was interesting to see the horse was more lame on three bute a day rather than half a sachet a day.

So if my experience is anything to go by, I would suggest getting a good physio to assess her, see where and how she moves differently and treat accordingly as this really helps. Eventually the 'hopping' dissapeared as I did more with the horse as slowly his health/fitness/injury improved and I was able to compete in unaffiliated dressage again without it being too apparent.

I am unclear whether your horse has an injury which is 18 months old, or SHE is 18 months old. I suspect it's not the latter as you wouldn't have her in hacking work???

 

[ester]

She's 15 was in full work pre injury- to lateral branch in front leg - though not much jumping as not her forte and not much school work as we don't have one at home! and does get physio etc I just think that we perhaps need to be careful with horses with previous injuries that they aren't then more susceptible to injuries elsewhere- always jumping off the same hind leg for example, hence why ours will only be hacking really.

 

[applecart14]

She's 15 I just think that we perhaps need to be careful with horses with previous injuries that they aren't then more susceptible to injuries elsewhere- always jumping off the same hind leg for example, hence why ours will only be hacking really.

There is no link between the front suspensory injury of three years ago and the one last week. Bailey is only jumped at home once a week and goes down a grid of five fences maybe four or five times in total so isn't over jumped in the slightest. At shows (usually every third or fourth week) he does one practice jump per class and then one round per class and always two classes total at the show.

So I don't think its over work, lack of preparation or anything else, its just one of those things
Horses are so precious!

 

[PolarSkye]

There is no link between the front suspensory injury of three years ago and the one last week. Bailey is only jumped at home once a week and goes down a grid of five fences maybe four or five times in total so isn't over jumped in the slightest. At shows (usually every third or fourth week) he does one practice jump per class and then one round per class and always two classes total at the show.

So I don't think its over work, lack of preparation or anything else, its just one of those things
Horses are so precious!

So he has TWO suspensory injuries in two different limbs and you think his prognosis is good? Suspensory injuries in the hind limbs are notoriously difficult to treat and heal . . . if I had a horse who had damaged suspensory ligaments in two different limbs I'd be either questioning my management or retiring or even considering having him PTS . . . one suspensory injury can be attributed to bad luck, two (in different limbs) would make me think there was an inherent weakness, and I'd certainly be curtailing his workload and not include jumping (competitive or otherwise).

I know this post will result in a "woe is me, you are bullying/attacking me, I love my horse, you just don't understand, he gets the best treatment" response from you . . . but I don't care. If you give half a damn about Bailey you'll stop jumping him, you'll change your vet and you'll be much, much more careful with him from now on. Medial suspensory injuries in the hind limb don't have a great prognosis. Please - take care of him. Stop jumping him. Stop mucking about with (at best) dodgy therapies. Turn him away - for a year - and then limit his work to what he can cope with . . . and if he can't cope with work, do the right thing.

P

 

[ester]

Yup they are precious, you don't seem to understand that a horse doesn't have to be doing lots of high jumping to put a significant pressure on it's limbs, taking off from the ground at all introduces a lot of force in the limbs.

I do find it difficult to see how 2 suspensory injuries within what is a relatively short time are completely unrelated to each other or to the other physical issues he has. We didn't even have a 'hole' just a slightly unhappy looking area and although she was walked in hand throughout the mare wasn't trotted until 12 months post injury, a mare that has never been lame in her previous 10 years with us. Pretty sure bailey was jumping by that point!

 

[applecart14]

. if I had a horse who had damaged suspensory ligaments in two different limbs I'd be either questioning my management or retiring or even considering having him PTS . . . .

P

Yes you are right Polar Skye. Vet is crap. Five years of vets school and fifteen years practising obviously was a waste of time. You are right, horse being pts next week on your advice, as if I would even contemplate that the vet knows more than a complete stranger who has never met the horse, read his notes, spent eleven years dealing treating the horse or seen him ridden pre injury.

Stop preaching and pretending to know something of which you know absolutely NOTHING about!!!! And stop acting all 'holier than thou" because you sound really false.

 

[applecart14]

. We didn't even have a 'hole' just a slightly unhappy looking area and !

At no stage did Bailey ever have a hole, I never stated that he had a hole. I am not sure where you have got this info from???? The vet said the xray indicated he had calcification in his suspensory ligament but he has come sound on this leg given adequate time off. The fore suspensory was a very slight sprain. This near hind injury is also a very slight sprain. The two are almost four years apart, it was June 2011 when he first did it although the near fore injury was compounded by teh fact he got the same leg stuck in a wheelbarrow and dragged around the yard.

Obviously the treatment of any sprain depends on the severity. Luckily Baileys first was very slight, and the second (now) is also very slight but was also caught very early, hence the difference in the treatment and prognosis for a return to work.

 

[KautoStar1]

OP – I have followed some of your threads with interest ref your horse’s numerous injuries and ailments and whilst I don’t doubt the love you have for your horse, I do question your motives for continually putting him through treatment plan after treatment plan as being more about your needs than his. And I understand that to a degree, we all want our horses to be fit and well and to carry on doing the things we love (& assume they love too). But I do think now is the time you need to start some serious soul searching to decide what is best for this horse’s interests in the long term. I am not advocating you have him PTS, but I do think the time has come when you need to look at a quieter life for him, whether that is one of retirement or low level hacking.
I am also not suggesting his problems are down to you, these things are sometimes just bad luck, no matter how hard we try to protect our horses. But something must be wrong for this horse to continually ‘break’ and I think you need to explore that too, whether its conformation (which you can’t change), fitness, work regime and adapt your on-going management to suit.

I also know you take great exception to some forum members who question your management of this horse, but the reality is, if you keep posting about his ailments on a public forum you are going to attract comment / criticism from people. You say over and over again that none of us know the details of your horses injuries so we are not in a position to comment, yet you go into so much detail that I think a lot of members do feel they know because they can equate your horses problems to ones they have experienced themselves and the outcome of those problem. The simple answer, if you want to avoid comment, is don’t keep posting.

 

[ester]

Sigh - I never said that Bailey did have a hole.... just that our mare didn't have so it wasn't a major injury and her prognosis is still guarded and she was rehabbed a lot slower. It is obviously important to us that she stays comfortable and happy for as long as possible and a slow return to work and limitations to her workload is what she will do. Do you still believe that as long as you are jumping 'small' or only a few at a time that strain on the legs is limited, have you ever watched any slow mo video of horses jumping small fences?

4 years apart is still a relatively short time period in my book with regards to horses, especially as they aren't his only physical issues. I certainly don't ever remember him being completely sound/not having to be managed in some way. At the end of the day your vet is working for you not the horse so I am never surprised when you say how brilliant they are.

I mostly just wanted to add that suspensory rehab is not necessarily quite as easy/issue free/return to full work as your post might make out, even more so in a hind, and that there might be compounding reasons for the injury occurring. I already decided I was happy I wasn't Bailey a long time ago.

 

[applecart14]

The simple answer, if you want to avoid comment, is don’t keep posting.

Yes you are right KautoStar1. Shame as I only post to help other people, and the reason why I started this particular post was to help others who may have had a similar problem with their horse.

My vet doesn't feel there is a problem with the management of the horse, nor with the workload I give him and that is for me enough, and I don't feel the need to continually justify myself to others.

The horse is not going to be retired. Nor is he going to be pts. The vet laughed when I told him what the people on this forum have said as have those that know the horse. They say its typical of this forum and why they have stopped using it themselves.

I won't be posting anything else about my horses problems.

 

[Prince33Sp4rkle]

and here we go again....................

interesting isnt it because my vet would 100% say retire it or PTS because they never come back from multiple injuries of this type to anything bar pasture sound, especially in older horses where the injury is due to workload only ie no catastrophic accident/injury.

this horse has been on and off lame the entire time ive been a forum member-does that not tell you he cannot cope with his work? his body is trying to tell you it cannot continue at this level and you ignore it.

shame on you and shame on your vet for encouraging you albeit i would be interested to hear his side, from him,without you present!

 

[ester]

I don't remember him ever being sound either PS, I think that is what gets to me a bit for him.

 

[KautoStar1]

Sorry OP, I don’t quite agree with you when you say you post to help other people. Your posts are specifically about your horse, which usually start along the lines of ‘Bailey has been diagnosed with…..’ But I stand to be corrected, maybe other people do find your updates useful. Personally, whenever I read your posts I think ‘oh no, not again’, I don’t read them looking for helpful advice.
And I just don’t see how him continually being broken is a sign of good management. Something is fundamentally wrong and surely you have to stop and consider if what you want to do and how you are approaching these things (eg through fitness and appropriate training) and what your horse is capable of, actually match up.
I genuinely do think you need to take a step back and look at things with a little more logic. Imagine if this was you. And there is no point in saying well he loves to jump, if physically he’s not able to withstand the stresses and strains. What he likes and what is ultimately best for him are different things.
For all of us, we will get to a stage where our horses are no longer fit for the purpose we may have initially bought them for. However, that doesn’t mean we continue to push them beyond their limits but it does mean we do the right thing for them in their twilight years. Sometimes that means the ultimate sacrifice and other times it means a slower pace or life or full retirement. I think you need to think about that. Sadly I know you wont 

 

[ellie11987]

And why does this thread not surprise me... OP something needs to change. Time after time I read about lameness problems with this particular horses so do not expect sympathy. This horse is not up to the workload you are asking for and has broken, simple. He needs a different vet opinion, some good time off at rest and may well be suited to a quieter life somewhere. Horses owe us nothing and there is no need to bring him back into jumping for him to break again.

 

[Frumpoon]

Not sure if it is of interest but I've got a big ISH diagnosed with hind suspensory knackerings (roots and branch I think) which we believe occurred secondary to kissing spines operation carried out 2 years ago.....he's also had v tightness in SI joint which we have medicated....fingers crossed he's rehabbing ok at the moment...

 

[Frumpoon]

Oh god, ignore my previous post...had no idea thread was this bonkers

 

[AandK]

History of the horse aside, I would be concerned about the short recovery period you have referenced in your initial post OP.

My horse injured the medial branch of his left hind suspensory back in 2008 as an 11yo, he was eventing at PN level at the time. Vet advised it was a chronic (e.g. repetitive strain) injury rather than an acute accident type, also showing some calcification on the scan. His recommended recovery period was much longer, and I then added a bit on. I believe too much work on a surface (and it was a v good one!) coupled with him needing to wear wedge pads behind at the time, were the cause of the injury. He was box rested for 5 months in total, month 1 was 10mins walking daily, month 2 20mins walking, month 3 30mins walking, month 4 added short trot, month 5 40mins walking and 5 mins trot. He also had a course of Adequan injections and a course of shockwave treatment to the area in the first month after diagnosis. At this point I found grass livery for him and turned him away for 3 months. After the 3 months, I got back on him and spent the next 4 months very slowly bringing him back into work. He did his first ODE 14 months after the injury was diagnosed.
I totally changed how I managed him and I believe this has helped him carry on working for the last 7yrs with no further issues, he is 18yo now and since the injury has evented, team chased and drag hunted, and is still eventing/jumping! He lives out 24/7/365 and has done since I turned him away, no wedges behind (a period shoeless whilst recovering from the injury cured the need for them) and I try to limit school sessions to 3x a week max. Much more hacking now.
Time is absolutely the best remedy for tendon/ligament issues, and I really would reconsider the length of time you spend rehabbing him and also how he is managed once sound, e.g. workload, environment and so on.

 

[ester]

That is much more what I would expect.

 

[AandK]

That is much more what I would expect.

I am always concerned when I hear of people saying horse has tendon/ligament strain and then they are back jumping it after only a few months.
As my story is a positive one, I thought it would be worth sharing. And my horse did not have any icing or bandaging as part of his treatment, I am not a fan of bandaging in the stable unless absolutely necessary.

 

[KautoStar1]

Mine did a similar rehab plan for a tendon injury although he was on box rest for 8 months with controlled exercise during that time. I don't think he cantered until month 9. Loads and loads of steady road work on like you AandK I manage him very carefully. I didn't bandage either so as to avoid over heating the leg. One thing I did find very useful was the spa and he had 10 sessions in that at the time. In fact I still use it now as a preventative measure (we have one on the yard very handy)
However as far as OP is concerned you are banging your head on a brick wall, as you can probably gather from some of the previous posts.

 

[applecart14]

However as far as OP is concerned you are banging your head on a brick wall, as you can probably gather from some of the previous posts.

Just taking vets advice Kauto Star. The way you talk about me is disgusting by the way.

With the first suspensory branch injury he had many months of time off with shockwave and injections and then when he reinjured it on the wheelbarrow he then had PRP and the rehab was slow and careful. He came back into full work fine and remained sound ever since on that leg. This is another leg and a very slight sprain which dictates a different kind of rehab. Its not rocket science. When he goes back to the vets at the end of the month I will see if he has made any progress and if not I will give him the time he needs. As I have already explained the horse is not an ideal candidate for box rest so this is out of the question. I will try and put my vets discharge report on here as I know a couple of you have commented that the vet would tell people differently had I not been present which I think is really unfair.

It appears that the likes of Princess Sparkle and another band of posters are people that know me, and PS is (or was on my FB page until someone told me they had actually been stalking me! so I have blocked them) I would suggest they get a life. Yeah, it might be fine for you to have a stableload of horses and just fling them out in the field when they are broken but I prefer to try and sort out my horses problem as I am a one hrose owner. If I can afford to do this then so be it the horse is lucky that he has someone who is willing to put the work in and get him well again.

I hope you are proud of the way you speak on your replies. I may be a lot of things but at least I am kind of heart and don't treat people in the shi**y way that you do and I am proud of that.

So go take your bullying bitchiness somewhere else and stop being so unkind. Especially you Fran as you are worse one of all.

 

[PolarSkye]

As I have already explained the horse is not an ideal candidate for box rest so this is out of the question.

FWIW, I don't think anyone has an issue with you resting Bailey in the field. It's perfect possible to rehab a horse with a soft tissue injury without box rest - although not ideal. My boy was a nutcase on box rest with his suspensory injury so we took the decision (with vet's permission) to turn him out with a companion for a couple of hours or so a day.

It appears that the likes of Princess Sparkle and another band of posters are people that know me, and PS is (or was on my FB page until someone told me they had actually been stalking me! so I have blocked them) I would suggest they get a life.

I hope this isn't true - if is, then it's rather sad. I've certainly never stalked you (or anyone else) - I don't even know your real name.

Yeah, it might be fine for you to have a stableload of horses and just fling them out in the field when they are broken but I prefer to try and sort out my horses problem as I am a one hrose owner. If I can afford to do this then so be it the horse is lucky that he has someone who is willing to put the work in and get him well again.

I'm not sure why this comment is relevant or what it means. Are you implying that PS wouldn't bother to treat her horses because she has more than one and therefore doesn't care about them as much as you care about Bailey? That's a pretty sweeping assumption (not to mention unfair/unkind). Also, I can assure you that not everyone who has replied with their own experiences of rehabbing their own horses with suspensory (or tendon) injuries has more than one horse - I certainly don't, Pops is my one and only - but that's pretty much irrelevant . . . rather baffled.

So go take your bullying bitchiness somewhere else and stop being so unkind. Especially you Fran as you are worse one of all.

Pretty sure it's against forum rules to mention posters by their real names (not that I have a clue which poster you have "outed") - if I were you, I'd edit the above sentence.

P

 

[ester]

Yeah, it might be fine for you to have a stableload of horses and just fling them out in the field when they are broken but I prefer to try and sort out my horses problem as I am a one hrose owner. If I can afford to do this then so be it the horse is lucky that he has someone who is willing to put the work in and get him well again.

I/my mum are one horse owners. we will always try to fix them as much as possible but they will only ever do the work within their physical capabilities. Frank is currently in full work, Cally is not and will not be jumping and probably not schooling again. If either were to injure themselves badly enough that I thought it unethical to work them they would be a happy field companion. Just because you turn a horse away doesn't mean that you don't care about it or aren't trying to get it better. The trouble is Bailey doesn't have just one problem to solve and from what you have said (which is all I have to go on) I find what you do with him unethical.

 

[AandK]

I/my mum are one horse owners. we will always try to fix them as much as possible but they will only ever do the work within their physical capabilities. Frank is currently in full work, Cally is not and will not be jumping and probably not schooling again. If either were to injure themselves badly enough that I thought it unethical to work them they would be a happy field companion. Just because you turn a horse away doesn't mean that you don't care about it or aren't trying to get it better. The trouble is Bailey doesn't have just one problem to solve and from what you have said (which is all I have to go on) I find what you do with him unethical.

Yep, same here. Andy is my only ridden horse (I have another who at 25yo is retired) and I did not just throw him out in the field because he was broken, I turned him out to heal and be a horse after being stuck in a stable for 5months. I care about this horse deeply, he is my horse of a lifetime and a one in a million. I would of never forgiven myself if I'd pushed him too fast too soon and the injury had reoccurred, hence me taking plenty of time to bring him back.

 

[applecart14]

The trouble is Bailey doesn't have just one problem to solve and from what you have said (which is all I have to go on) I find what you do with him unethical.

First of all I respect what you are saying and I hear what you say Ester but the problems with him have been fixed. The spavin has been sorted by fusion and xrays have shown the hocks have fused. The coffin joint arthritis was sorted with 3 steroid injections covering an 11 year history, so hardly detrimental to his well being. The suspensory near fore is fully healed and the horse has been sound, albeit with an addition of buteless in his feed. The colic episodes have cut and he has had one episode in nearly two years (I believe the reason for the colics previously were to do with the fact that his previous yard was an ex dairy farm and the grazing was too rich for him). Many, many horses have multiple problems, but if they are under a vet and treated accordingly and successfully then I don't understand what the issue is. There are many that aren't treated and that are still ridden and competed and I see this time and time again, the owners either don't know or don't care. At least I have had his problems fixed and he is happy and healthy which is the most important thing.

He has no other issues that I am aware of (other than the one he is being treated with). So I don't really know where you are seeing the unethicial part. All through history horses have been injured and come back into work. Its not as if I am really aggressive with the work I do with him, he is schooled (or was prior to the injury) for about 25 mins four nights a week, most of it comprising of warming up in walk so really only about 15 mins of trot/canter (floodlight meter is £1 for half hour). Then hacked out for an hour to 2 hours once a week, the other day was competition (dressage, fun ride or unaff jumping at 2ft 6/9) or jumping practice at home comprising of grid work (five fences usually jumped about four / five times max). One day off a week where he is treated to a 'spa day' and is thoroughly massaged/groomed, trimmed, mane pulled and given extra loving.

I will see what the vet says when he goes back later this month. I will never push him beyond his capabilities/ability/body and will ALWAYS take vets advice. My current vet is away on holiday when I am due to go back and as a direct result of what has been said on this forum to me will ask him his opinion. A fresh pair of eyes may give a different answer. I will ask him if he feels I am pushing too much and ask his opinion on rest and rehab and see what he says.

I only have and have always had Bailey's best interests at heart. As you can see from my photos my horse is fit and well and is really loved and looked after and I have never wanted to or intended to cause him harm, he really is my world and I love him to bits. I am crying as I type this, I really do find all this very stressful and hard and am trying my best to do what is right but listening the vet being so optimistic and saying the injury is a slight strain and given the three month suggested rehab time and then everyone on here implying that I am cruel, I don't know what to believe anymore.

you can see my boy is loved and looked after by the photos (if a little too fat)! Lets see what the vets say at his next check up and take it from there.

[