Suspensory Damage

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Twiglet

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Hello all,

My new-ish boy has been diagnosed with damage to the external branch of his right hind suspensory ligament :( It is almost certainly from a trauma - ie. a kick - rather than a workload strain or conformational fault, and was unfortunately misdiagnosed for the first two weeks, and as a result the vet advised to keep working him to take the leg swelling down. He has remained totally sound throughout, the leg just swelled and had some heat in it.

The ultrasound showed a linear 'cut' in the lateral branch of the ligament, although it is fully intact by the time it joins the sesamoid bone. There isn't fraying or tearing of the fibres (at this stage).
The initial treatment was application of PRP (plasma replacement therapy) along with a cartrophen injection. The next stage is box rest for the foreseeable future - although the two vets treating him are at odds as to whether he should be in hand walking at this stage. One is advocating immobilization (he has a Robert Jones stable bandage on) and the other is insisting on twice daily walking to stretch the fibres and help prevent scar tissue formation.

In 6 weeks time, the plan is to start three sessions of shockwave therapy, and rescan.

Surgery hasn't been mentioned as an option - although I think that it is more suitable for PSD rather than this sort of injury?

I'm using an Arc Equine daily, he has an Equissage on 5 days a week, is being fed Global Herbs Tendoneaze (with MSM), wearing magnetic fetlock bands, doing daily stretches and having a sports massage every three weeks. Is there anything I'm missing?

Any good tips for entertaining a fit young otherwise totally healthy horse on box rest? I don't think there's a stable toy out there I haven't purchased....

Does anyone else have any experience with this sort of injury in a competition horse? Am I being utterly naïve to hope that he may return to (grassroots) eventing and dressage? My vet seems relatively positive, but his approach is somewhat vague generally....

(But please no PTS disaster stories, I've already lost one 8 year old in the last 6 months, I can't face the prospect of losing another young horse :( )
 
Oh no! So sorry to hear that - how frustrating and upsetting for you.

It sounds like you're doing all the right things and giving him the best chance to come back to work. Mine was diagnosed with suspensory damage in both hinds and my vet was moderately optimistic about horses returning to full competition work given the proper treatment, so I certainly wouldn't despair yet.

Best of luck, I really hope he comes right for you.
 
Mine had PSD and after the shockwave and restricted turnout (and magnet boots, and arnica sprays) he is I think back to normal again on that leg. Just don't ask about his other legs :D
 
going back a long long time ago (about 18 years!) my 17yo jumping pony damaged her suspensory branch when travelling. At the time shockwave wasn't offered (not sure it was even around then?!) but we did a combination of hosing and box rest then paddock rest for the rest of the summer. Brought her back into work the following year and she went on to hunt twice a week and found a new career in mounted games with another girl as I had outgrown her up until the age of 27 and never had a problem with it again - so there are very positive stories out there! Good luck!
 
Had a mare who pulled the internal branch on a foreleg and was very lame. Field rested for six months, she went back to work as a show jumper and was sound many years later when a new owner contacted me to find out her history. My understanding is that injury is often a better prognosis than a strain, depending on how bad the injury is. Given your horse is not lame, I would query the box rest, but I would certainly be going with the vet who wants him walked. A friend of mine ignored this advice from her vet and ended up with a horse with a permanently sticking tendon sheath.
 
Re entertainment, I'd actually recommend NOT trying too hard to keep a box resting horse busy doing stuff. The lower you can keep his energy, and the quieter his environment, the better - or he'll stay revved up. Horses that aren't over-stimulated tend to settle better to a period of box rest.
 
xspiralx said:
Oh no! So sorry to hear that - how frustrating and upsetting for you.

It sounds like you're doing all the right things and giving him the best chance to come back to work. Mine was diagnosed with suspensory damage in both hinds and my vet was moderately optimistic about horses returning to full competition work given the proper treatment, so I certainly wouldn't despair yet.

Best of luck, I really hope he comes right for you.
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Thank you, that's really positive. My vet is being relatively positive, and said that he's working on a racehorse that has much worse damage in a similar place to mine, who he expects to return to training in a year or so. His prognosis that I should be out at dressage by the Autumn seems at odds with what everyone else seems to be saying.... It's just so confusing. I've spent so much time with vets in the last couple of years, I tend to apply a bit of a bull**** filter but it's hard to know what to believe when they're directly contradicting each other.
 
ycbm said:
Had a mare who pulled the internal branch on a foreleg and was very lame. Field rested for six months, she went back to work as a show jumper and was sound many years later when a new owner contacted me to find out her history. My understanding is that injury is often a better prognosis than a strain, depending on how bad the injury is. Given your horse is not lame, I would query the box rest, but I would certainly be going with the vet who wants him walked. A friend of mine ignored this advice from her vet and ended up with a horse with a permanently sticking tendon sheath.
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Thanks. The box rest (in that no turn out is allowed) is because of the uncontrollable element of him being in the field. The vet's phrase was 'you'll be competing this horse before you're putting it out in a field'.
He's still sound to walk, and is so happy to be out of his box, my gut is telling me that he should be doing something in the way of walking at least. We have a nice covered barn where we can do large loops of the internal stables without any sharp turns - it keeps him occupied because he can see all the other horses.
 
Auslander said:
Re entertainment, I'd actually recommend NOT trying too hard to keep a box resting horse busy doing stuff. The lower you can keep his energy, and the quieter his environment, the better - or he'll stay revved up. Horses that aren't over-stimulated tend to settle better to a period of box rest.
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Interesting, thank you. In terms of a quiet environment - in terms of not giving him stable toys etc? I can't really make the stable any quieter, he's bang in the middle of the yard, and everyone passing has to go by his box.
 
No advice I'm afraid but I just wanted to send you some positive vibes and hugs - what a nightmare for you so soon after all the trauma with Buzz. I really wish you the best of luck and hope it all comes good for you again xx
 
_EVS_ said:
No advice I'm afraid but I just wanted to send you some positive vibes and hugs - what a nightmare for you so soon after all the trauma with Buzz. I really wish you the best of luck and hope it all comes good for you again xx
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Thank you. Even the vet said I must be the unluckiest horse owner he knows. There is a part of me that thinks that however bad this is, it's just common or garden lameness, and while it's awful and so sad for me and Harley, it's not as evil as cancer, and I'm not dealing with life or death decisions for him (touching every piece of wood going).
 
I'd imagine the fact this is trauma related will be far more positive than a progressive injury due to training/confirmation.

I have a friend with a top level event horse who last year had a fairly serious tendon injury (I appreciate this is not ligament). Initial clinical care was provided by her own vet (well know SW referral centre) and then care/2nd opinion was transferred to the owners Newmarket vets.

Although both vet opinions weren't 100% aligned both were in full agreement of box rest, in hand grazing and walking (started 2 x 10 mins a day and went up to 1hr +).
Now 9 months down the line and it is only just reaching the stage where field turnout is being considered. The horse is working under saddle.

There is no doubt this has been quite a tough period for both horse and jockey, but the vets were pretty adamant this was the way to get greatest chance of competitive comeback
 
ihatework said:
I'd imagine the fact this is trauma related will be far more positive than a progressive injury due to training/confirmation.

I have a friend with a top level event horse who last year had a fairly serious tendon injury (I appreciate this is not ligament). Initial clinical care was provided by her own vet (well know SW referral centre) and then care/2nd opinion was transferred to the owners Newmarket vets.

Although both vet opinions weren't 100% aligned both were in full agreement of box rest, in hand grazing and walking (started 2 x 10 mins a day and went up to 1hr +).
Now 9 months down the line and it is only just reaching the stage where field turnout is being considered. The horse is working under saddle.

There is no doubt this has been quite a tough period for both horse and jockey, but the vets were pretty adamant this was the way to get greatest chance of competitive comeback
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Thanks. The reasoning behind this being the best approach makes sense, and my vet does say tendon/ligament damage is the only thing he says to restrict turnout so heavily for. I'll keep at it for now.

Also looking at IceVibe boots - any experiences?
 
My now 19yo TB injured the medial branch of his left hind suspensory, on the inside, in May/June 2008, we were eventing at PN level back then. Initially he was 1-2/10 lame but inbetween the vet referring to hospital for full work up and him actually going (approx 7 days), he managed to prat about in the field and make it worse, 4-5/10.
His treatment was as follows, box rest with controlled exercise (i.e. in hand walking), month 1: 10mins a day, month 2: 20mins, month 3: 30mins (and so on). Month 4 he was rescanned, and although ligament was looking better, it was healing slowly. He did another 2 months box rest, so 5 in total. By the end of month 5 he was allowed a short trot. At this stage he was allowed into a small turnout pen, I increased this in size over a 2 week period and then, with vets agreement, turned him away for 3 months. During his box rest he also had a course of adequan injections and shockwave.
I got back on him end of March 2009 and slowly brought him back into work. Jumped again in the June and did his first ODE at the end of July. Since then he has been back eventing, and more - we team chased and drag hunted! He has been living out 24/7 since, and has been eventing since until July last year when he had a completely unrelated annular/sesamoid ligament unjury, which he is coming back into work from at the moment.

ETA: my vet was very cautious with his prognosis, he said he had seen lesser injuries meaning retirement, and worse ones making a full return to competition. I just had to play it by ear and pray, as I am doing at the moment!

Good luck with your horse's recovery!
 
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I'd certainly be in hand walking, we did from day one with a front suspensory branch injury. I'd be interested why one vet thinks not.
 
You are doing the right thing using the Arc Equine. That should cut down the recovery time, and keep him sane in the box, I found it very good for that. Have you spoken to Ian Thirkell for a rehab plan? That's what I did, and he gave me a 3 month management regime.
 
Auslander said:
Re entertainment, I'd actually recommend NOT trying too hard to keep a box resting horse busy doing stuff. The lower you can keep his energy, and the quieter his environment, the better - or he'll stay revved up. Horses that aren't over-stimulated tend to settle better to a period of box rest.
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I agree with this my plan is to keep them as level and calm and toys tend IME to irritate them and wind them up .
Company from others 24/7 .
Forage of lots of different types given ay different times of day.
Radio I like classic fm for them seems like the right thing I use an internal box for box rest I find they settle better when they can't see stuff going on .
I hope it all goes well .
 
Goldenstar said:
I agree with this my plan is to keep them as level and calm and toys tend IME to irritate them and wind them up .
Company from others 24/7 .
Forage of lots of different types given ay different times of day.
Radio I like classic fm for them seems like the right thing I use an internal box for box rest I find they settle better when they can't see stuff going on .
I hope it all goes well .
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He has lots of different forage, spread all round the stable....
Not sure it's practical to have company for him, he's on a livery yard with amazing turnout - there's no chance of other horses being kept in for his company. He has people around a lot of the time.
 
Twiglet said:
Does anyone else have any experience with this sort of injury in a competition horse? Am I being utterly naïve to hope that he may return to (grassroots) eventing and dressage? My vet seems relatively positive, but his approach is somewhat vague generally....

(But please no PTS disaster stories, I've already lost one 8 year old in the last 6 months, I can't face the prospect of losing another young horse :( )
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My horse who is rising 19 has had three suspensory branch injuries, one near fore lateral, one off hind medial, and this current one off fore lateral over a period of about six years. Only one was caused by jumping, the first one was caused by fast work on a deep surface and the last one by galloping around on the lunge like a headcase whilst having a half sprung shoe which caused him to go over on the branch and strain it.

My horses injuries were superficial insomuch as they were classed by my vet as 'slight sprains'. The first injury healed very slowly to start with despite intensive cold therapy and a course of shockwave treatment initially. In the end he was given PRP. My horse was different to most with this injury as he has to be kept moving due to arthritis; he cannot tolerate box rest so was turned out from the word go. THe PRP was very effective and he went back to weekly unaff jumping and dressage comps without worry. Then 18 months later following a traumatic injury to the same leg after getting stuck in a wheelbarrow whilst I was at work and nearly breaking the leg, he had huge setbacks. THe leg took ages to heal and the slow healing was compounded by conditions at the yard at the time meaning he was very stressed in the field and the leg was continually being worked.

The second injury took about four months to heal and he was back in work doing low level dressage and jumping. He had about 2 years and then got this third present injury. He is on week 13 or 14 of trot work, straight lines, hacking and school, and can be evaluated mid April with a view to starting canter work. The vet says very good prognosis for going back to jumping and dressage. Thinking I will only do the odd jumping competition at max 2ft 6, or fun ride and mainly keep him for dressage and hacking now. Think eventing is out of the window. To be honest I've had many years of pleasure with him, so if I do give up these things its not as if he owes me anything.
 
Twiglet said:
Stem cell, no, but I don't think it can be used in conjunction with the plasma replacement therapy?
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Have a look at the rvc lectures, they had one last year that I went to on suspensories, very interesting and certainly will give you a lot of the answers you are looking for, you can view online with a password if you call them they will give it to you. I found it so helpful and where you are being given lots of info from peoples personal and often isolated view points this will give you much more insight into the whole thing, I came away feeling like I knew exactly what needed to be done and what I shouldn't bother considering!
 
Twiglet said:
Thanks. The reasoning behind this being the best approach makes sense, and my vet does say tendon/ligament damage is the only thing he says to restrict turnout so heavily for. I'll keep at it for now.

Also looking at IceVibe boots - any experiences?
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I successfully rehabbed a DDFT injury from strain using icevibe combined with arcequine - He had a horizontal & vertical tear just above the pastern of the off hind- Nov 2013 and the swelling was so hot & hard that we couldnt initially get a good scan of the problem, the icevibe obliterated the swelling in a few days yet vet was very gloomy about his longterm prognosis but we did complete box rest for 2 months then walking both inhand plus ride & lead up the steep hill by our yard followed by restricted turnout & a gradual return to work from April 2014. He was hunting again by the autumn 2014 on meets picked for good ground/minimal jumping & has just finished a hard seasons regular hunting with absolutely no sign of unsoundness or any trace of swelling :)
 
Darkly_Dreaming_Dex said:
I successfully rehabbed a DDFT injury from strain using icevibe combined with arcequine - He had a horizontal & vertical tear just above the pastern of the off hind- Nov 2013 and the swelling was so hot & hard that we couldnt initially get a good scan of the problem, the icevibe obliterated the swelling in a few days yet vet was very gloomy about his longterm prognosis but we did complete box rest for 2 months then walking both inhand plus ride & lead up the steep hill by our yard followed by restricted turnout & a gradual return to work from April 2014. He was hunting again by the autumn 2014 on meets picked for good ground/minimal jumping & has just finished a hard seasons regular hunting with absolutely no sign of unsoundness or any trace of swelling :)
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Gosh this sounds very similar - the hot hard swelling in particular (that sounds strangely rude!).
I can't use the Ice Vibes yet because he still has the enormous Robert Jones bandage on, but as soon as that's off the boots will be straight on.

Thanks for all the replies - this has certainly left me feeling a little more positive.
 
Farma said:
Have a look at the rvc lectures, they had one last year that I went to on suspensories, very interesting and certainly will give you a lot of the answers you are looking for, you can view online with a password if you call them they will give it to you. I found it so helpful and where you are being given lots of info from peoples personal and often isolated view points this will give you much more insight into the whole thing, I came away feeling like I knew exactly what needed to be done and what I shouldn't bother considering!
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Really interesting - thank you. I spent far too much time and money at the RVC with my other horse, so I will definitely be interested in their lecture on this.
 
Twiglet said:
Interesting, thank you. In terms of a quiet environment - in terms of not giving him stable toys etc? I can't really make the stable any quieter, he's bang in the middle of the yard, and everyone passing has to go by his box.
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It depends on the horse really. If he's coping with being in the middle of the yard, and not turning himself inside out every time another horse moves,then I wouldn't worry too much.
I'm thinking about expanding my current set up, to include box rest livery - and one of the most important considerations for me is having stables in as quiet a location as possible, with minimal through traffic. I'm not expecting to have "easy" box-resters though - as people wouldn't opt for sending a broken horse away unless it was being problematic!
 
Auslander said:
It depends on the horse really. If he's coping with being in the middle of the yard, and not turning himself inside out every time another horse moves,then I wouldn't worry too much.
I'm thinking about expanding my current set up, to include box rest livery - and one of the most important considerations for me is having stables in as quiet a location as possible, with minimal through traffic. I'm not expecting to have "easy" box-resters though - as people wouldn't opt for sending a broken horse away unless it was being problematic!
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Ah I think the opposite for him....he is very chilled in the box generally, and seems to enjoy watching the comings and goings. He's been in for two weeks now and haven't once seem him anxious or stressed - just a bit bored and inclined to nibble on me for entertainment. There are other stables in quieter places, but he would be without any kind of company - human or horse - for most of the day, which I can't see him enjoying at all, he's quite the sociable creature.
 
I would talk to Ian at Mushroom Matrix in regards to feeding one of the Mushroom Matrix supplements. I travelled out to Germany with a friend this week who was bringing some out to feed to a horse with a similar issue to yours. Ian is very helpful and knowledgable and will tell you if the supplements could help or not. I have heard great things about the supplements, including from people who take the human version. The horse in Germany with a similar issue is also having Laser therapy every 3 days which is also helping. He is a young dressage stallion who is expected to come back into work, there doesn't seem to be any doubt that he will become sound again.
 
Oh gosh Twiglet, I'm so sorry, what rotten luck. My gut instinct would be to do the hand-walking, although I must say I've got no experience of this particular injury. Really hope you can bring him back to full work, it's a long and difficult road ahead for you, I really feel for you.
 
Plenty of racehorses come back to race again successfully so there is no reason your horse won't. Ligaments fix quicker than tendons due to their size.

We've not had a ligament in the yard for a while but off the top of my head we did a month in the box, a month - 6 weeks on the horse Walker then a month or so's turnout before being brought back into work slowly. We very rarely do any treatments other than cold hose and ice for such injuries.

Good luck with him!
 
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