Proximal suspensory ligament damage

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maw

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Hiya, am hoping i can get some positive feed back about Suspensory ligament damage.
Approximately 6 weeks ago my wonderful horse went lame in trot.Then sound, Then lame, then sound. he was dignosed with a splint originally. then he went really badly lame, after he was stood in for one night, to the point he wouldnt put his foot on the floor. He was diagnosed with an infection again which burst out of his heel, but he was still lame. Has been nerve blocked and bone scanned and the prognosis is that he has damaged his proximal suspensory ligament. However he is a cob and they cant scan him due to thick legs, so they cant say how bad it it. They have however written up a report to say that the prognosis for returning to full function is guarded. they expect him to be lame for 9-12 months, and they believe he will have a small amount of residual lameness there after.
My question is how can they make that prognosis when they can not see the damage done. They are saying he must have come to a sliding stop in the field, or something similar. In the 6 years i have had him i have never seen him do anything like that. I do think he fell in the field though. Please i just need some positive feed back. He is everything to me and we love our XC and jumping so much. he has come through a serious colic operation with no after problems. also a serious skin infection and came back fighting fit. Now this. He is having shock therepy treatment 4 times, plus a regular physio. He is on box rest for 3 months, with limited walk in month 2 and 3. He is sensible. i just need hope and experiences from people who have gone through this. all i see at the moment is darkness. please help.
 
Hmmmm I do find it odd they say they can't scan. Normally a scan is key to diagnosis of PSD.... And the severity of the damage would be determined by scan, which of course affects prognosis. I would be tempted to get a second opinion on that from one of the bigger vet hospitals.

If it is PSD, though, it ain't great :( a big factor is working out if that is the only problem or if something else is also going on - SI pain is often linked to PSD and the two together have a much worse prognosis than PSD alone.

There is a really good Facebook group for horses with PSD, which you may like to join.

Fingers crossed for you. X
 
Sorry, for some reason I assumed OP was referring to hind leg PSD but re-reading I'm not sure...... But yes, the SI issues are normally associated with hind leg PSD, I agree.
 
OP - am so sorry to hear this, always a very depressing diagnosis

However, I find it bizarre that they 'can't scan him due to thick legs'. How have they diagnosed it then ? The bone scan will show hot spots, to direct a precise area for a scan but will not pick up an injured tendon. A powerful scanner on a shaved tendon area should be able to pick up and identify damage properly. Surely your vet (if he took him away for three days to bone scan him and had the equipment to do that) must have a scanner for his tendon ? I was so intrigued by this post I called my own (very highly regarded vet) who is also a chum, and asked him - he laughed when I suggested a leg was 'too thick to scan'.

You might want to revisit this before going much further? I am though, very sorry to hear about your problems and hope they get resolved. It takes time, but it is possible for them to come back into full work, depending on the extent of the damage.
 
Thank you for your reply. They say that the ultrasound scanner cant see through his leg because he has a lot of scar tissue from having had mites before i got him. What other problems in that area could a bone scan pick up. He had got a splint on the inside quite near the hock, and has also lost his chestnut very recently too in that area. Could bruising atract the scanner to look at the area as a hot spot. Like i said how can they diagnose a PSL damage without actually being able to see it. My horse is bright alert putting all his weight down on that leg now, however after his infection previously he continually rested that leg, but he doesnt do that now ever since he was box rested on bute before his bone scan. Could a pocket of infection in that area show up as hot spot. I just cant believe he could have done such an injury slipping in the field. Not that seriously anyway. Also when we took him for his bone scan after being box rested for 10 days he ran up a very steep ramp, travelled 20 miles and came off with no lameness even when he tried to trot. Just very confused
 
Hi Just to say I had a tentative diagnosis of PSD after my boy had xrays a few weeks ago, was panic struck - if it is the case go look at googling PRP (Platelet replacement plasma) which can be helpful and I also investigated the ARC equine unit which the inventor seems to believe to be helpful in such cases, he seemed not to be so fond of shockwave, so before you go down this route I would investigate thoroughly the pro's and con's of everything and get a conclusive diagnosis before you start treatment.

Because I was so shocked at a PSD diagnosis and wanted to understand how this could be the case given he has always been worked so carefully, my vet and I decided to bonescan to ensure this was the right diagnosis, as xrays can sometimes be misleading. I also wanted to understand if anything else underlying could be the cause, with the PSD being a secondary symptom as he loked so sore through the pelvis. The bonescan showed hocks as the problem, (sore backs/pelvis from PSD and Spavins normal as it transfers up) an ultrasound of the ligaments confirmed they were normal and not a problem or needing treatment.

Moral of the story is that diagnostics these days are fantastic and had we just taken the xrays or a best guess as read, my horse would have been written off as a field ornament. He has now had his hocks medicated and is being gently returned to work in the hope that over the next 12months he can come right! So ask and ask and do the investigations if you can afford to. At least if it is confirmed you will have a clear idea of how to go forward anything less and you'll always worry. Good luck.

Oh and forgot to say - I think my boy's issue's were caused by the farrier not balancing his feet properly - would be interested to know if your horse has underrun heels and if the heels are the same height from side to side. I though my farrier was great - he was a master farrier - he turned out not to be so great, my boy was landing toe first - serious concussion!
 
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Well, first of all suspensory damage in a forelimb is infinitely more treatable with a lower risk of recurrence than in a hind limb - so you have that in your favour. Secondly, damage to the proximal part of the ligament (as opposed to body and branch) is also easier to treat with a greater chance of returning to work.

However, without a definitive diagnosis, which you're only really going to get from a scan of the affected area, you and your vet are really only guessing :(.

I know rather more than I care to about proximal suspensory injury because I'm currently rehabbing my own boy with the same injury (diagnosed by x-ray and scan). Because we know what we are dealing with, we have a specific rehab routine prescribed by the vet which includes bute, cold hosing, limited movement,, etc. . . . without a definitive diagnosis, you are kind of stabbing in the dark. A tendon injury might involve bandaging and longer periods of cold hosing/ice therapy. Ligaments shouldn't be bandaged.

In your shoes, I would turn the horse away for an extended time (six months at least) and then have the vet back to do another lameness workup . . . or I'd get another vet and insist on scans.

I so hope you figure out exactly what's wrong with your horse and figure out how to get him sound . . . best of luck.

P
 
BethH said:
Hi Just to say I had a tentative diagnosis of PSD after my boy had xrays a few weeks ago, was panic struck - if it is the case go look at googling PRP (Platelet replacement plasma) which can be helpful and I also investigated the ARC equine unit which the inventor seems to believe to be helpful in such cases, he seemed not to be so fond of shockwave, so before you go down this route I would investigate thoroughly the pro's and con's of everything and get a conclusive diagnosis before you start treatment.

Because I was so shocked at a PSD diagnosis and wanted to understand how this could be the case given he has always been worked so carefully, my vet and I decided to bonescan to ensure this was the right diagnosis, as xrays can sometimes be misleading. I also wanted to understand if anything else underlying could be the cause, with the PSD being a secondary symptom as he loked so sore through the pelvis. The bonescan showed hocks as the problem, (sore backs/pelvis from PSD and Spavins normal as it transfers up) an ultrasound of the ligaments confirmed they were normal and not a problem or needing treatment.

Moral of the story is that diagnostics these days are fantastic and had we just taken the xrays or a best guess as read, my horse would have been written off as a field ornament. He has now had his hocks medicated and is being gently returned to work in the hope that over the next 12months he can come right! So ask and ask and do the investigations if you can afford to. At least if it is confirmed you will have a clear idea of how to go forward anything less and you'll always worry. Good luck.

Oh and forgot to say - I think my boy's issue's were caused by the farrier not balancing his feet properly - would be interested to know if your horse has underrun heels and if the heels are the same height from side to side. I though my farrier was great - he was a master farrier - he turned out not to be so great, my boy was landing toe first - serious concussion!
Click to expand...

Terrific and helpful answer.

I have use PRP to very good effect on an advanced eventer with very bad suspensory damage in his off fore. Speak to your vet about it as an option. Great comment too, about the importance of balancing feet.
 
Hiya me again so sorry I forgot to say it was hind leg not foreleg. The vet has said cant use prp because they can not actually see it on the ultrascan therefore can not see to inject so am at a loss really. He is having 3 months box rest and shock wave treatment. Vets can not say if it is a tear or a rupture cos they can not see it on the ultrasound scan. Just this lesion on the bonescan in the area where the ligament starts. All i can hope for is that it is not that bad. My horse is a resilient fellow, and quite chilled. I also have a brill physiotherapist that uses magnets and ultrasound technoligy. If anyone can get it healing right and strong it is her. I know of a pony who badly cut its fetlock on barbed wire. It healed with horendous scar tissue to the point she couldnt flex her fetlock and was incredibly lame, 2 vets told the owner to have her pts.This pony could not move and was laid down in the field really struggling to get up. After 3 treatments from Becky that pony was running around and is now jumping and the scar tissue is no longer an issue. I am hoping that by having her treat the area straight away if it is the PSL then i am hoping she can encourage the ligament to fix straight and strong and not criss crossed x
 
Mine was deemed bi-lateral hindlimb initially - Look at the ARC unit just for info then as it seemed to also have generally healing properties - I haven't used it as didn't need to in the end but there are H&H'oers on here who I believe have. Seems odd they can't get an idea at least from ultrasound, it was ultrasound that confirmed the ligament were ok after xray thought not - if they can't see anything maybe there's nothing to see and it's something else in the area?....
 
Hi Thank you for your reply BethH. i am going to have an MRI scan done on him on Tuesday, to confirm the diagnosis and to see the severity of it. I need to know for Bobs sake. at least then we know what we are working with. Someone told me the other day that they thought he had pulled it completely away from the bone. How can any one say this without actually being able to see it. He is not lame at all in walk, and if he had done that i am sure there would have been more trauma to the area and at the very least some swelling. I would also of not expected him to come sound so quickly after he had initially done it.
 
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