PSD (Proximal suspensory desmitis)

Aimeetess

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Had the vet out this morning to look again at my young gelding after having a week bute trial because he wasn't right but didn't look lame. Bute made a big difference so he was taken off bute for a couple of days and the vet revisited. After trotting up he is now 2/10th lame on one hind. After the first nerve block he went completely sound. Vets given the diagnosis of PSD, Proximal suspensory desmitis and will confirm for definite after x-rays and more scans as I want him to look at his hock as well just in case. Hes sore in his back and sacroiliac too but thinking thats from over compensating.

Vet suggested if so, its usually either 6 months box rest/in hand walking with 30% chance of returning to work or a operation on both hinds to snip it, not sure what thats called?

He did say not to google or research it as its all negative things on this subject.. but does anyone else have any experience or know a lot about it? He won't box rest for a week let alone weeks, he'd get dangerous, so can't see that option going down well.
 
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SEL

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Had the vet out this morning to look again at my young gelding after having a week bute trial because he wasn't right but didn't look lame. Bute made a big difference so he was taken off bute for a couple of days and the vet revisited. After trotting up he is now 2/10th lame on one hind. After the first nerve block he went completely sound. Vets given the diagnosis of PSD, Proximal suspensory desmitis and will confirm for definite after x-rays and more scans as I want him to look at his hock as well just in case. Hes sore in his back and sacroiliac too but thinking thats from over compensating.

Vet suggested if so, its usually either 6 months box rest/in hand walking with 30% chance of returning to work or a operation on both hinds to snip it, not sure what thats called?

He did say not to google or research it as its all negative things on this subject.. but does anyone else have any experience or know a lot about it? He won't box rest for a week let alone weeks, he'd get dangerous, so can't see that option going down well.
I actually think the facebook PSD page is quite realistic and honest on how horses have got on. There is everything on there from PTS to people whose horses returned to competing at quite high levels. If you're on FB then I'd say its worth posting your Q there.
 

ester

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SI is very often connected with it so that they need it treating too.

The op is fasciotomy/neurectomy and seems to be generally successful unless they miss something elsewhere.
 

ihatework

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Whatever you do you will have some period of boxing and controlled exercise.
IMO not intervening medically won’t solve this.
Did the vet not discuss shockwave?
Personally I’d jump straight in and operate provided you have ruled out KS and primary sacro injury. Dope for the box rest and walking as required.
If you have a confirmed KS/Sacro then I wouldn’t operate, would treat those, shockwave the PSD and hope you get lucky but I’d prepare yourself to write the horse off competitively.
 

emfen1305

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Second the FB group, it has a wealth of knowledge and experience from the Dr Green route to surgery. Most people will tell you PSD in secondary to other issues and in my case, my horse had terrible ulcers, hock arthritis and PSD diagnosed over about one year. He had the surgery this time last year on both hinds but sadly was PTS in April due to going very lame 12 weeks post op, suspected stifle problems and I wouldn't put him through any more investigations. I am not sure whether I would do the surgery again unless I was as sure as I could be that I had treated everything else first. The horse stabled next to mine did her suspensory (i know different to PSD but rehab is the same) and she's had 9 months of box rest and has come back into work absolutely fine. You will have to box rest for 2-8 weeks (depending on vet) post surgery regardless, and then its another period in a small pen (12 weeks total in either box rest or pen) so it sounds like surgery might not be a good route unless you give sedalin.

Good luck whatever you decide!

ETA: just seen IHW's post and agree with surgery only if you have ruled everything else out, if there are ongoing issues, fix those first and the PSD may fix itself over time.
 

Aimeetess

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Thanks all for your comments, knew H&H forumers would know more than me! I'll look at the Facebook group now, didn't even know it existed so thank you.

Yes vet is back out to x-ray/scan end of the week hopefully so will know then, hes certain it isn't KS but I also want to double check that as can never tell. I did say to the vet I thought PSD is always secondary and he seemed to think it wasn't in every case. His symptoms also match hock arthritis and the pain is coming from that area so vet is still going to x-ray everything to see where we stand, including back, stifles. He did suggest his hocks could be buggered and suspensory could be secondary, thats my worry.. but he didn't block the hock joint itself just the PSD which showed a massive improvement and he was sound instantly. He seemed to think if the hock was involved he would still be lame and would need to nerve block that to show it was the joint but he was sound after the PSD was blocked, will see once x-rays are done.

Don't want to worry to much as not 100% diagnosed yet but its hard not too. The nerve block was quite clear thats where he hurts so I suppose thats a good thing.
I won't be operating or anything until we know the full picture/and have sent the claim form into the insurance company to say they'll pay if we go down that route. I know what its like to need the full story, we operated on my last horse (KS) to find out she was basically f**ked and was PTS after a big back operation, tons of steriod injections, her hocks, stifles, suspensory, bad ulcers (medicated those too) she was 9 with the body of a mid 30yr old. and she never got better. I put her through so much and regret it to this day not getting the full picture.

Its so sad hes only just 7. I wouldn't put him through all of that if he has lots of issues, it isn't fair.
 

scats

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I chose not the treat mine, but she does have other niggling issues aswell so we weren’t just dealing this. Definitely worth joining the Facebook group.
 

timbobs

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Thanks all for your comments, knew H&H forumers would know more than me! I'll look at the Facebook group now, didn't even know it existed so thank you.

Yes vet is back out to x-ray/scan end of the week hopefully so will know then, hes certain it isn't KS but I also want to double check that as can never tell. I did say to the vet I thought PSD is always secondary and he seemed to think it wasn't in every case. His symptoms also match hock arthritis and the pain is coming from that area so vet is still going to x-ray everything to see where we stand, including back, stifles. He did suggest his hocks could be buggered and suspensory could be secondary, thats my worry.. but he didn't block the hock joint itself just the PSD which showed a massive improvement and he was sound instantly. He seemed to think if the hock was involved he would still be lame and would need to nerve block that to show it was the joint but he was sound after the PSD was blocked, will see once x-rays are done.

Don't want to worry to much as not 100% diagnosed yet but its hard not too. The nerve block was quite clear thats where he hurts so I suppose thats a good thing.
I won't be operating or anything until we know the full picture/and have sent the claim form into the insurance company to say they'll pay if we go down that route. I know what its like to need the full story, we operated on my last horse (KS) to find out she was basically f**ked and was PTS after a big back operation, tons of steriod injections, her hocks, stifles, suspensory, bad ulcers (medicated those too) she was 9 with the body of a mid 30yr old. and she never got better. I put her through so much and regret it to this day not getting the full picture.

Its so sad hes only just 7. I wouldn't put him through all of that if he has lots of issues, it isn't fair.
Sorry to hear you're going through it at the moment! I'm in a similar position, except we've found things the other way around. Ed has hock arthritis, 4 kissing spines and as we found out today, significant injuries to both hind suspensories. He's also the same age as yours.

The vet is due to call me back this afternoon to talk about different options as I was a bit overwhelmed this morning!

Good luck with the x-rays and further investigations.
 

Aimeetess

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Sorry to hear you're going through it at the moment! I'm in a similar position, except we've found things the other way around. Ed has hock arthritis, 4 kissing spines and as we found out today, significant injuries to both hind suspensories. He's also the same age as yours.

The vet is due to call me back this afternoon to talk about different options as I was a bit overwhelmed this morning!

Good luck with the x-rays and further investigations.
Oh wow Timbobs... that is a lot in one day and a lot to treat. Did he have x-rays which showed all of this and scans i'm guessing?
So sorry to hear, I may pm you to see what you decide in the future. Its such a shame, especially such young ages.
 

timbobs

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Oh wow Timbobs... that is a lot in one day and a lot to treat. Did he have x-rays which showed all of this and scans i'm guessing?
So sorry to hear, I may pm you to see what you decide in the future. Its such a shame, especially such young ages.
The hock arthritis was diagnosed in November, the KS a few weeks ago and the suspensories this morning so not all at once at least.

See how you get on with your further investiagations as that may change your treatment plan.
 

Aimeetess

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Just a update.

X-rays of hock, back and stifle were clear, however the hock x-rays showed a thickened (darker) layer of bone where the suspensory has been pulling on the left hind.

Suspensory scan showed no holes but a large amount a thickening to his left suspensory. Right is completely fine.

Vet has recommended surgery as when there is no tears or holes, its usually difficult to heal the thickening suspensory with box rest alone, more success if there was a clear hole or tear. We are currently awaiting for a reply from the insurance to see which way to go.

Box rest would be 6 weeks plus (could be up to 4 months box rest) with in hand walking (would be dangerous) and the operation is 2-4 weeks box rest with less in hand walking, and less worry of it being damaged again.

It seems the operation either goes to plan or not, some never come sound and some go back to competing. I have joined the PSD facebook group, great advice but it seems a lot are against the op so really am pulling my hair out on what to do.
 
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I went for the op with my boy, he had N&F surgery on his hind right but unfortunately in our case, although scans showed it had repaired, and having SI injections and regular physio and chiro, he never quite came right and was still broncing and arching his back after a full rehab programme and I retired him in the end. We did however have to turn him out for a winter as he had gone ballistic on box rest and that just didn't work for usm however if you have something sane enough to box rest I know it is the most advised route to take! My boy had hunted in Ireland from a 4 to a 7 year old prior to me having him and the vet thinks that this contributed somewhat to his issues given his size (17.2 hunter). The PSD group on facebook is invaluable though, there are some very knowledgeable people on there. I think if I had to re-run the situation, I would have had Rob Jackson out also as he seems to be a bit of a miracle worker!!
 

Aimeetess

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I went for the op with my boy, he had N&F surgery on his hind right but unfortunately in our case, although scans showed it had repaired, and having SI injections and regular physio and chiro, he never quite came right and was still broncing and arching his back after a full rehab programme and I retired him in the end. We did however have to turn him out for a winter as he had gone ballistic on box rest and that just didn't work for usm however if you have something sane enough to box rest I know it is the most advised route to take! My boy had hunted in Ireland from a 4 to a 7 year old prior to me having him and the vet thinks that this contributed somewhat to his issues given his size (17.2 hunter). The PSD group on facebook is invaluable though, there are some very knowledgeable people on there. I think if I had to re-run the situation, I would have had Rob Jackson out also as he seems to be a bit of a miracle worker!!
Thank you for your reply! So sorry to hear about your horse, is he retired now or did you pts?
My gelding will also be crazy on box rest, which is why the vet partly opted for the operation as its less box rest involved. I have found having 2 horses needed lengthy box rest they do get use to it and it does help to have some sedation sometimes.
I’ve posted in the PSD group but it seems a lot are against the op, so feeling a bit deflated.
 
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I retired, I wouldn't normally opt for that route but he was a very easy horse to do and enjoys living out, and fortunatley I found a lovely home for him on the Yorkshire dales!

I think the op is personal preference, in my situation, money was no infinite and it does seem very pricey to rehab without the op, only to decide to have it anyway if the rehab without doesnt work.
 

Aimeetess

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Just a update if anyones following.

My gelding had the Neurectomy and fasciotomy operation 5 days ago now. He came home Sunday and seems more chilled everyday on box rest, fingers crossed it stays that way. We have 3 1/2 weeks of box rest left with in hand walking 5 minutes a day increasing to 30 minutes by the end of the box rest. He enjoys his walks to the grass and so far has been very well behaved to my shock. Vet is coming out tomorrow to change his bandage (its a huge bandage, up both legs, so rather him show me the first time around!)
Hes sound at walk but is getting a pins and needle sensation in his legs occasionally, which is apparently very common and 'normal' so time will tell if its worked.
 

Aimeetess

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Just another update. 26/3/19
10 days post operation.

Hes setting in to box rest, we have some piaffe moments when having a walk but hes been very good.

He had a walk Sunday, all fine and he was happy as larry. Monday morning he was hopping on his hind. Couldn't walk or put any weight on the leg. He kept lying down he was in so much pain and was covered in his pee where he'd peed and led in it (he has a big shavings bed but it was completely destroyed) It was swollen all around the hock, I rang the emergency vets in tears. Its awful seeing them like that, he was in so much pain.

The vet was out within the hour, agreed he has a infection in one of the wounds, hes on antibiotic and painkiller jabs for the next few days every day. On the plus side the other hind looks great.
This morning he was much much happier so hopefully the jabs are doing the job.
 

Aimeetess

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How do you know he's getting a pins and needle sensation? Genuine question!
I suppose we don’t ‘for sure’ but the surgeon said after the surgery the sensation will feel very strange and if they start kicking their legs out, rubbing them, stamping them it’s because they have what they describe as pins and needles and it feels a bit funny to them but it’s completely normal. If only they could talk!
 

Fransurrey

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I suppose we don’t ‘for sure’ but the surgeon said after the surgery the sensation will feel very strange and if they start kicking their legs out, rubbing them, stamping them it’s because they have what they describe as pins and needles and it feels a bit funny to them but it’s completely normal. If only they could talk!
Oh I see. Yes, that would make sense. If only they could talk, indeed!
 

Aimeetess

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UPDATE 12/3 (got the above post wrong, it was suppose to be 5/3)
The infection in his RH is now getting better by the day. Hes more sound each day and seems much happier so hopefully that is at bay.

The vet mentioned some CT scan results on Friday but didn’t explain in detail so called the surgeon at the hospital for some answers as she really knows her stuff.

The surgeon explained the CT showed his hock has ‘ bone thickening’ on the back of both his hocks, worse so on the LH (hind with suspensory issue) he could have been born with this, who knows. The issue is it can cause problems with the plantar ligament. The plantar ligament would also show positive to the same nerve block we done (which is worrying) but she doesn’t think it will affect him however said they have nothing to compare it to yet as have only just started doing free CT scans to find out more on this injury (and why this operation doesn’t always work) To add, the nerve was cut BELOW the plantar ligament, so if that is the root cause of his pain the nerve being cut will have no effect on his lameness.

Everyone told me there was always a primary issue to suspensory, but my vet said there wouldn’t be yet the surgeon said if they don’t return sound there is usually always another issue.

Basically, time will tell. If hes 100% sound clearly the thickened bone isn’t effecting him but if he does have pain from the plantar ligament it would make sense why he was always backwards to back as a youngster as hes been in pain a long time and been over compensating on other areas which has caused to the thickening of the suspensory. I am not sure how else he would get that thickened bone, apart from being born with it or possible old injury to that plantar ligament.

The surgeon also recommended my gelding had 2/3 months turned away, due to his ‘case’ which also made me suspicious as well as she kept using ‘IF he returns sound’ rather than ‘when he returns sound’. Most horses return to work within 8-12 weeks of the operation.

A few days ago I saw a girl on social media who’s horse had the same operation as my gelding 7 weeks ago, same age and same issue with the thickened suspensory. Her horse is still lame specially on the LH, the vet could not work out what the issue was and was scanning everywhere on that LH to find the cause, they then found out the plantar ligament is damaged. They have now advised 12 months turned away but there is no certainty if the horse will ever return to work.

Will keep everything crossed, but this news really does rest on my mind and I feel bad for putting him through the operation. I wouldn’t of put him through all the stress and pain if I knew that nerve block can have other reasons why its positive as well as the suspensory so we could of investigated that first.
 

Ceriann

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Well done! My mare just diagnosed with injury to medial branch suspensory of left hind and thickening of prox suspensory of left fore. No other issues (full bone scan and multiple X-rays). Feet confo are a contributory factor but not a clear primary cause. Vet did say they tend to come with multiple issues but not in this case. We start walking tomorrow - farrier has been today so she now has heart bars on back to support. Very much short term to get through initial rehab. Mine is behaving v well so far - she needs the walks now though as she’s starting to get a bit flat. I may regret saying that tomorrow if we have a lively potter!
 

Aimeetess

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Well done! My mare just diagnosed with injury to medial branch suspensory of left hind and thickening of prox suspensory of left fore. No other issues (full bone scan and multiple X-rays). Feet confo are a contributory factor but not a clear primary cause. Vet did say they tend to come with multiple issues but not in this case. We start walking tomorrow - farrier has been today so she now has heart bars on back to support. Very much short term to get through initial rehab. Mine is behaving v well so far - she needs the walks now though as she’s starting to get a bit flat. I may regret saying that tomorrow if we have a lively potter!
Ah best of luck with the rehab. Feet confirmation does contribute, my farrier is great but he was barefoot previously and I am sure that didn't help - being a welsh you'd expect good feet - not in his case!

Part of me wishes we in-hand rehabbed him but due to the suspensory being so thickened (no holes, tears) they think its a long term injury and much harder to heal with box rest with only 40% chance of becoming sound.
 
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