medial suspensory branch strain. Any experiences??

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Harri Green

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So my mare has strained (just thickened, no tear or hole) the medial branch of her suspensory and (this is the weird bit) on x-ray the sesamoid fetlock bone it attaches too is actually weakened. So in most cases this would be a tear of the branch but actually she must have strong tendons to yank and weaken a bone. She's only 1/10 lame to trot up and 3/10 to lunge one rein, sound on the other rein. It's such an unusual one that I'm being referred for a second opinion as my very good vet isn't 100% on prognosis or rest time. I'm wondering if anyone has had any experience as no one I know has seen this before (and we're in racing!!). Treatment will be shock wave etc.
I'm totally devastated and praying this isn't a career-ender as I was just getting her ready to low-level event. She's only 7 but 7/8th TB and will not enjoy box rest and walk work! Anyone had this injury or similar?
 
Fatty when he was nine .
He had lots of ice therapy box rest and shock wave .
He's fifteen now hunts two days most weeks and it's never troubled him again
 
Oh gosh that's great to hear! My worse fear is a reoccurring injury as I've previously had two horses with niggling blown check ligaments. I decided if it's going to reoccur with this mare I can't put her through it, so thrilled to hear there is hope! Thanks
 
Two. A TB racer who pulled both suspensories away from the sesamoids on a back foot. One year rest, came to me to rehab and went cross country with no issues.

A 3/4 ID who did a medial on a front leg. Had six months in the field, brought back into work and later show jumped with no issues.

Good luck with yours.
 
Harri Green said:
So my mare has strained (just thickened, no tear or hole) the medial branch of her suspensory and (this is the weird bit) on x-ray the sesamoid fetlock bone it attaches too is actually weakened. So in most cases this would be a tear of the branch but actually she must have strong tendons to yank and weaken a bone. She's only 1/10 lame to trot up and 3/10 to lunge one rein, sound on the other rein. It's such an unusual one that I'm being referred for a second opinion as my very good vet isn't 100% on prognosis or rest time. I'm wondering if anyone has had any experience as no one I know has seen this before (and we're in racing!!). Treatment will be shock wave etc.
I'm totally devastated and praying this isn't a career-ender as I was just getting her ready to low-level event. She's only 7 but 7/8th TB and will not enjoy box rest and walk work! Anyone had this injury or similar?
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You might like to consider PRP. Here is a link: http://www.prptreatments.org/veterin...ment-injuries/

I had PRP for my horse when he did sprained the second of his three suspensory branches (all on different legs). It worked really well and he went back to SJ at 90cm - 1.05m for about 18 months to 2 years before hurting his leg in an accident at the yard. We went back to square one with the leg which took an age to heal (shockwave didn't work and repeated scans showed no improvement) but he came sound again enough to jump/event (low level stuff). On Saturday following 7.5 months of rehabbing him back into full work following another suspensory branch sprain we did our first SJ competition (although I only did the clear round instead of the class)

Two have been lateral suspensory branch sprains (each described as very slight sprains) and the other was a medial (near hind) again very slight sprain. Detected quickly and dealt with, with copious amounts of ice therapy in the form of ice cups and ice boots.

I would advise you to buy the ice vibe boots. From their website: The ICE-VIBE boots are rechargeable vibrating boots that help to boost circulation in horse's legs by creating a massage effect. They combine the effects off cooling and massage therapy to effectively treat strains, ligament and tendon damage. The massage effect helps to stimulate the lymph system to remove soreness and swelling as well as improving circulation. Everyday wear and tear on joints can be managed with daily use of the boots and rehabilitation through injury can be achieved more effectively.

Using the boots before you ride can assist you to prepare your horses legs for exercise whilst in the stable. After exercise you can use the vibrating boots with the inner cold packs creating cold circulation. They assist your horse to repair wear and tear whilst in the stable or out in the field, both before and after exercise.

I use them religously and they are fantastic for rehab.

I can't put across how important early icing is for the injury. It really does make a difference, my vet is convinced that its all the hard work I have put in with rehab that has made the difference to how my horse responds and the quickness of his healing. Also having a good programme to bring your horse back into work is essential. I did months of walking hacks and straight lines in the school before progressing to trot, even longer starting circles and canter work. Putting the horse on a variety of surfaces is essential for repair. My horse had to be turned out everyday into a sandpit yet it did him no harm, less harm than it would have done in a large boggy field where he would have been free to run around like a loon!
 
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Jay Man did his last year, he even broke a bit of bone off the fetlock.

My vet did not initially seem so concerned, recommended rest, but being turned out in a paddock for a few hours a day. He also recommended PRP and 3 X shockwave.

Having educated myself I did ice a lot (thank you Goldenstar for a reply to another person's enquiry, as I followed your icing recommendation), bought an ArcEquine and had pulsed magnotherapy. His initial 3 month scan was great, almost healed.

Sadly, with being "off" Jay sort of sagged in the middle, and showed neurological signs, as in he became a wobbler. It got so bad a stiff breeze could have blown him over, and I was convinced it was PTS time. X rays were not bad though, so the vet suggested steroids and bringing him back into work of lunge every other day, which did stabilise his symptoms but obviously put his leg back a bit as he was not ready for work. At the time it was Hobson's choice, as without the work he would have been PTS anyway.

So, the next scan was not good, and I reconciled myself for Jay to be retired, just a bit of hacking and lungeing to keep him entertained and supported (obviously I love this horse!) but with no plans at all for the future, i even set about buying another......

Roll forward another 4 months, and Jay was majorly improved. A bit bewildered at how well he was going, I took him for one last scan, which showed it was all healed up, to all our surprise!


So, we started fittening in earnest, 6 weeks walking, then 6 trotting, then we will see how the mood takes us.

The plan is to do a bit of this and that this year, but not a lot, hopefully get back to some dressage, maybe do Novice Freestyle so he won't rack points up, maybe over the winter start a bit of jumping..... If all goes well we may even get back to some low level eventing next year :-)

TBH I think it was the time that healed better than PRP and Shockwave, and if it were to happen again, and if I were not insured, I think i would do the ice and rest, and a long period of low level work, but maybe not the other treatments.
 
I would like to point out that I still consider ice-vibe boots to be a complete oxymoron with regards to vibrations increasing circulation on something you are cooling and therefore trying to reduce circulation/inflammation on. I am yet to see any convincing logic or science behind them as a concept past the marketing blurb/nonsense.

Hope you feel a bit better now OP and hope the 2nd opinion goes on.
 
I don't know if Applecart's horse has been done or not, but I would suggest that any horse that has has suspensory ligament damage in three different legs should be tested for degenerative suspensory ligament disease (DSLD) now known as ESPA, equine systemic proteoglycan accumulation and IME, woefully 'unknown' and therefore under diagnosed in this country.
 
gunnergundog said:
Time and Dr Green are great healers. I would also become VERY VERY fussy about medio-lateral foot balance.
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I think good foot balance and time and the right sort of grass followed by the correct type of regular work are better healers than many of the massively expensive treatments the vet like to sell us .
 
Btw my favourite way of icing a limb is to use a bonner bandage ( around £40 )cooled in a cool box with ice and water in it .
We leave the cool box outside the horses door and apply the bandage every hour on the hour for twenty minutes .
I always have bags of ices in the freezer so we are ready at any time to ice an injury
 
gunnergundog said:
Time and Dr Green are great healers. I would also become VERY VERY fussy about medio-lateral foot balance.
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I have read a bit about this having had the horse twelve years and him only having suspensory branch problems in the duration I have had my farrier I did wonder if this was a contributory factor. However I consulted two professionals who both felt that it was just a coincidence and very unlikely to be caused by the farrier. Previous xrays have shown the farrier to be balancing my horses foot very well indeed.
 
ycbm said:
I don't know if Applecart's horse has been done or not, but I would suggest that any horse that has has suspensory ligament damage in three different legs should be tested for degenerative suspensory ligament disease (DSLD) now known as ESPA, equine systemic proteoglycan accumulation and IME, woefully 'unknown' and therefore under diagnosed in this country.
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Hi YCBM Just wanted to say its always been a very slight sprain of the suspensory branch (two lateral and one medial). The last one was caused as a result of an accident lunging so I know how it happened and I think the vast majority of horses would have had a weakness there as a result. The first one was caused by stopping abruptly after bolting in a deep ménage surface and the second one I have no idea how it happened.

I have already asked the vet about possible DSLD as the horse was at one time resting his bum on the wall of his stable and the lorry parked next to us at the show centre, he would also stand pointing toes down. The vet said he was certain he was not suffering from this, he just felt that some horses are unlucky, sometimes it can be contributed to poor ménage surface and also from over compensation from other problems (which he has) and sometimes poor conformation (which I don't think he has). However as far at the leaning goes, the only time I see him leaning on something now is when he scratches his bum, and the toe pointing has not happened since as I am careful to fill in the large dip I have in my stable (we are not allowed stable mats as its a dirt floor).
 
ester said:
I would like to point out that I still consider ice-vibe boots to be a complete oxymoron with regards to vibrations increasing circulation on something you are cooling and therefore trying to reduce circulation/inflammation on. I am yet to see any convincing logic or science behind them as a concept past the marketing blurb/nonsense.

.
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Really Ester?

Well they worked very well for my horse and continue to do so, and they have worked very well for clients of my friend who is an ACPAT physio. My vet also seemed to be impressed by how well they have contributed to my horses recovery.

I don't need convincing logic or science to know they are worth their weight in gold. :) :) :) :)
 
Really, I wouldn't have said it otherwise would I?
They are the sort of thing I would like to see measurable data on rather anecdotal evidence. They 'sound good' and nothing like a bit of pseudoscience to sell stuff to lay people worrying about their horses.
It isn't really arguable that they are trying to sell them as a product based on science but afaik have no trials to go with that.
 
ester said:
Really, I wouldn't have said it otherwise would I?
They are the sort of thing I would like to see measurable data on rather anecdotal evidence. They 'sound good' and nothing like a bit of pseudoscience to sell stuff to lay people worrying about their horses.
It isn't really arguable that they are trying to sell them as a product based on science but afaik have no trials to go with that.
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Well there are a lot of people that have bought them and had a lot of success with them so I guess they have been helpful for many.
 
people *think* they have been helpful.
no proof either way as no control.
Sorry to be pedantic but that is just how science is.
 
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But that's like anything in life.

For example Hit Air who make the air jackets don't claim that they will save your life. But you have to use your common sense to realize that once inflated it will help considerably to minimize any injury you have.

Horsewares web site claims the following:

  • Using a thermal camera we compared the ICE-VIBE boots to other cold therapies and found the leg does not on average get as cold and returns to its previous temperature faster
  • When an area is healing scar tissue is formed, the movement created by the vibration and massage helps to break down adhesions and scar tissue whilst increasing blood flow to assist healing.
  • Tendons are much slower to heal than muscles due to their poor blood supply and slow metabolism.
  • Tendon problems are often the result of a buildup of damage. By using the ICE-VIBE boots regularly you can help stimulate blood flow to your horsess legs whilst they are standing in a stable.
  • You can put them on before exercise with just the vibration to create a massaging effect to stimulate blood flow, when blood flow is increased tendons and ligaments become more elastic which can help to prevent damage.
  • The ICE-VIBE boots have cold packs in them that reduces blood flow slowing down inflammation whilst the movement created by the massaging effect similar to exercise can help to stimulate the lymph system to move out existing inflammation
  • The vibrating motors are set to work intermittently so that when you are treating soreness the damaged tissue does not get overworked and tired.
Oliver Townsend and William Fox Pitt both use them so obviously feel they have some confidence and faith in them.

Horseware say:

Medical Disclaimer

Horseware [The Company] of which ICE-VIBE is part, does not make any claims that the Ice-vibe boot [The Equipment] cures any ailment that a horse may present. However it is proven that the ICE-VIBE BOOT [The Equipment] can help to alleviate the symptoms of ailment stated and aid the healing process. The advice in the ailment category hereinafter is intended as a guide to how the ICE-Vibe boot (the equipment) can help. Such advice and information has not been compiled by veterinarian surgeons but is based on accumulated knowledge and experience of use of the Ice-vibe boot (equipment) by professional equestrians, who therefore do not assume responsibility for technical accurateness/correctness.

I have gone by friends recommendations, what I have heard in the equestrian press and with what I have heard from professionals. I can only see the results on my own horse, that's not to say they will work on others but then you could say that about anything.
 
No it isn't like anything in life, we can't release anything (diagnostics) without proving, scientifically with approved protocols it works first and providing the associated data and plenty of industries work along similar lines not just science-based ones.

Even if you just use common sense on the concept of the ice-vibe boots as I said in my first post they are a a bit of a misnomer as they are trying to do two opposite things at the same time. They suggest that by adding the vibration blood flow is not restricted (they don't know this, they are guessing) and that somehow you then get cool blood flow around the lower legs of the horse and that somehow promotes the alleviation of symptoms and aids healing. I am yet to find anything that suggests that a) that is what actually happens if you apply an ice vibe boot or b) that if that is what happens it helps. As opposed to just iceing legs where the whole idea is to restrict blood flow to reduce swelling...
Common sense should tell most people a random hologram sticker isn't going to do anything but plenty think they are amazing too.

I know what the website says, and am aware they are very careful with their claims.

Anyway this is taking it off topic for the OP. I just wanted to highlight that they perhaps aren't as amazing or well thought out away from the sale patter as people seem to think.
 
ester said:
No it isn't like anything in life, we can't release anything (diagnostics) without proving, scientifically with approved protocols it works first and providing the associated data and plenty of industries work along similar lines not just science-based ones.

Even if you just use common sense on the concept of the ice-vibe boots as I said in my first post they are a a bit of a misnomer as they are trying to do two opposite things at the same time. They suggest that by adding the vibration blood flow is not restricted (they don't know this, they are guessing) and that somehow you then get cool blood flow around the lower legs of the horse and that somehow promotes the alleviation of symptoms and aids healing. I am yet to find anything that suggests that a) that is what actually happens if you apply an ice vibe boot or b) that if that is what happens it helps. As opposed to just iceing legs where the whole idea is to restrict blood flow to reduce swelling...
Common sense should tell most people a random hologram sticker isn't going to do anything but plenty think they are amazing too.

I know what the website says, and am aware they are very careful with their claims.

Anyway this is taking it off topic for the OP. I just wanted to highlight that they perhaps aren't as amazing or well thought out away from the sale patter as people seem to think.
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Maybe they should do more research with them then. In the meantime if people want to read up on them, just do a search on this forum and you will see many people and horses have benefitted from them.
 
Going back to the OP's question, we had one who had a slight tweak of his suspensory (in front) which had torn away a bone chip from his sesamoid. He had 8 weeks box rest and scanned clean at the end of the time in. He was then meant to walk in hand for 2 weeks (5 mins 2xday up to an hour at the end of the fortnight) but was a nightmare so I took him to a local yard with a walker.

I know it wasn't ideal to have him turning, but we alternated it each time and it was a lot safer than how he was in hand.

3 weeks of walker and we turned him away for his normal summer holiday (he's a hunter). Brought him back in 3 months later, did his normal 4-6 weeks walking, and he hunted fine all last season. He doesn't do many days - probably about 15 - but he was 100% good on his legs.
 
Again, many people think that there horses have benefited from them, they don't actually know and can't prove that is what helped. I don't quite get what is so difficult to understand about that and maybe I am being super pedantic but thinking something has helped isn't the same as actually being able to provably know it.

OP fwiw I did open this thread in the first instance because Mum's mare had one, though more of a tear (not a nice hole), but not with the bone element, I think it was medial anyway.
She had PRP, 6 months box rest with walking from day 1, year long rehab overall.
she is hacking mostly on the flat and doing some prelim dressage but won't be doing any more (vet doesn't want her to go down the beach/up the hills to hack etc) but I think we were hampered because it was left too long before we found the issue - she wasn't lame, just had a fat leg. She is 15 now and was never going to set the world alight anyway ;)
 
My now 19yo injured his medial suspensory branch back in summer 2008 (was more chronic than acute) when he was 11. He had 5 months total of box rest with controlled exercise starting at 10mins month 1, 20mins month 2, 30mins month 3 etc. He then went into a small pen initially after the 5 months, and that was increased in size over a couple of weeks until he was back in a normal size field. I then turned him away for 3 months (24/7). He also had a course of shockwave and adequan injections initially. He came back into work (was PN level eventing prior to injury) and I slowly built him up and he did his first ODE back from injury about 13 months after the initial diagnosis.
He went on to continue to event, and also tried team chasing and drag hunting since! No further issues, although he has remained out 24/7 since. He's not been in work for the last year but that has been due to a string of completely unrelated issues!
 
AandK said:
My now 19yo injured his medial suspensory branch back in summer 2008 (was more chronic than acute) when he was 11. He had 5 months total of box rest with controlled exercise starting at 10mins month 1, 20mins month 2, 30mins month 3 etc. He then went into a small pen initially after the 5 months, and that was increased in size over a couple of weeks until he was back in a normal size field. I then turned him away for 3 months (24/7). He also had a course of shockwave and adequan injections initially. He came back into work (was PN level eventing prior to injury) and I slowly built him up and he did his first ODE back from injury about 13 months after the initial diagnosis.
He went on to continue to event, and also tried team chasing and drag hunting since! No further issues, although he has remained out 24/7 since. He's not been in work for the last year but that has been due to a string of completely unrelated issues!
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The prognosis for suspensory branch injury is a 40% chance of reoccurrence. I always look on the 60% chance of non reoccurrence side of things.
 
applecart14 said:
The prognosis for suspensory branch injury is a 40% chance of reoccurrence. I always look on the 60% chance of non reoccurrence side of things.
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Surely the chance of reocurrance is dependant on location (i.e. which leg, inside/outside), how soon it is picked up, the treatment, the severity of injury and also if it is acute or chronic? When giving me a prognosis, my vet said he had seen horses with worse injuries make a full recovery and return to work, and horses with lesser injuries have to be retired.
 
Thank you for all your opinions, I really appreciate them.
Certainly the jury is out on the ice vibes and frankly she's having so much else that I'll probably leave the boots. Plan is;
PRP today
Then every week for 4 weeks;
Shockwave therapy (again another controversial one!)
Cartrofen injections
Rescan in 12 weeks.
I've been advised she can have tiny paddock turnout because she's sensible and I live onsite. And that I should be walk working her in 3 months if scan ok. But she won't be jumping till the spring, which I'm not happy about but I know you can't push the recovery time.
I've got 12 months from date of injury to claim loss of use, so it's a fair chance to come sound.
 
Harri Green said:
Thank you for all your opinions, I really appreciate them.
Certainly the jury is out on the ice vibes and frankly she's having so much else that I'll probably leave the boots. Plan is;
PRP today
Then every week for 4 weeks;
Shockwave therapy (again another controversial one!)
Cartrofen injections
Rescan in 12 weeks.
I've been advised she can have tiny paddock turnout because she's sensible and I live onsite. And that I should be walk working her in 3 months if scan ok. But she won't be jumping till the spring, which I'm not happy about but I know you can't push the recovery time.
I've got 12 months from date of injury to claim loss of use, so it's a fair chance to come sound.
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Sounds like a good plan! My one piece of advice is to take your time bringing her back into work, dont rush the return to jumping - it will be worth it in the long run!

Good luck :smile3:
 
Medio-lateral foot balance must be correct, regular foot care at max 6 weeks to ensure this. Also, whatever time rest period your vets give, allow at least this, but more if at all possible.
 
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