Suspensory injury in horses and operations

charlie76

charlie76

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Our event horse was diagnoised with bilateral supsensory injury yesterday and the vet has reccomended it is operated on, he is 2/10th lame and he blocked out sound following nerve blocks.
Has anyone had the op done and what is the prognosis?
What happens after the op?
 
Um. Now my vets are trying to tell me (after scans and nerve blocks) that mine has bilateral suspensory damage too. I am sending her scans to a second vet for his opinion. Vet # 1 has also recommended surgery. There are billions of ramifications to this, though.

For one thing, it's FEI/BS etc illegal to compete a neurectomised horse. Ok, so no-one will be able to prove it (as things stand) but there is clearly evidence that a horse has had it (insurance claims, vets' records) so if FEI decided to really clamp down, they'd be able to find out fairly easily. Also, how would you feel about deliberately breaking the rules, each time you compete? I'm not yet sure where I come out on this.

How would you sell the horse afterwards - you'd have to disclose it to a potential purchaser, who would then need to decide whether they wanted to break FEI rules!

The operation involves cutting the nerve. Sure, that will stop the pain, but then are you still doing further damage to the suspensory by competing it?

Pain is a signal to stop doing something. Remove the pain, say the horse develops a secondary problem in a now-numb area, will it know it's in pain, or will it not know, and continue to work and do further damage?

My vet has reassured me on all of the points, and says it's absolutely the right answer. But.... I'm just not sure.

In terms of what they said the prognosis was, he was sure that she would return to competing at her current level (PN/Novice/Disco/NC). He told me three weeks of box rest post-op, followed by six weeks of building up through walk in hand, under saddle, trot under saddle, then she'd be ready to resume work. So allow some time for fitness etc, you'd be competing 3-4 months after the op.

The reason I am not in a panic is that she also has other things wrong with her (which shld be easier to fix!), so I'm hoping that, in the melee of all her ailments, she's exhibiting lameness behind which he thinks is suspensory damage, but which may be improved once the rest of her has been fixed!! Be interested to see other peoples views on this.
 
Front or hind? and where abouts. The specific type of injury holds different prognosis I'm sure.

One of my horses had mild hind bilateral PSD and was operated on by Andy Bathe at Newmarket who was very confident of a good recovery and future working life.

The operation itself involves making a tiny incision a couple of inches below the hock. The bone fascia is opened up and a local nerve is cut. The benefits of this is that it allows the ligament room to expand and heal properly. This type of neuroctomy shouldn't really be compared to the old fashioned navicular type neurectomy which is what I am sure the FEI rules are targetting.

I could not believe how well my horse came out of the operation. He was bright and appeared completely pain free immediately (he only had 1 x bute a day for 5 days post op). He stayed in the hospital for 3 days post op with pressure bandages, and then I took him home and had 3 further bandages changes every 2-3 days afterwards. When I took the bandages off I could barely see the tiny scar and now you would never know he even had the operation.

Post op they need approx 1 month box rest and then increasing levels of controlled / in-hand walking. The advice I was given was that at about 3 months he could look to resume work, I played safe and did the box rest with controlled walking and then turned away for 6 months.

I wouldn't hesitate to operate again for hind limb PSD if I was ever in that position in the future.
 
I'm sorry I don't have a good experience of this. My lad was diagnosed in March 2009. Had surgery in May 2009. Unfortunately, due to bad luck and his fairly active attitude to box rest, his wounds broke down, such that he had to spend 5 weeks cross-tied, followed by turnout 24/7 in a tiny pen from mid-July onwards. It was September 2009 when I was finally able to start the walking out in hand, and he was lame still. Lots of physio later, including a very specific ridden, long-rein and pessoa work programme which I stuck to religously (poor friends riding with me had to put up with my alarm going off every few minutes telling me to change pace), by February 2010 he was near-as-dammit sound. Finally got the go-ahead to resume normal work and my god he was better than he'd ever been.

Sadly went lame in August 2010, and the scans showed massive deterioration in the suspensory ligaments. It is possible that being cross tied caused adhesions to form which led the suspensories to tear themselves apart. The vet also suspected that the nerve had grown back in one leg.

He was PTS on 27.08.10.

I know of 3 other horses who have had the surgery. One was PTS after as it didn't work and he broke down. One is sound but in the very barest minimum of work (occasionally ridden gently). The other is absolutely fine and doing brilliantly. Prognosis should have been good - I was told Ronnie probably wouldn't event, but may be able to be a low-level RC type.

All I can offer really is the advice to prepare yourself for a lot of heartache. I wish I hadn't put him through all that. Had I known what the outcome would be, I would not have done.

I wish you all the luck available for your boy, and sincerely hope you have a happy story to tell in a few months' time.
 
Hum, good to hear from other people. IHW, what sort of work did yours come back into?

I've been doing some forum-searching and found some threads on this. It seems Mega Beast, Mrs Mozart and Rosiefan have all had some experience of suspensory damage, though I'm not sure whether any of them have had operations.

Here's a good Chloe post. http://www.horseandhound.co.uk/forums/showthread.php?t=363059&highlight=suspensory

IHW I completely agree with the differentiation between the types of neurectomy and my vet said much the same thing. BUT, them's the rules and they currently say that all neurectomies are no-go - even though common sense dictates otherwise!
 
Benn through it twice with different horses , the operation went well and was a success in both cases. However in both cases front feet issues have occured and horses had to be retired.
So if I ever have the misfortune to have a horse with this again I might check whats also going on in front as well.
1st horse developed navicular and 2nd has suspected ligament damage in front feet, out of insurance for an MRI.
Have to stress they only remove part of the branch of a nerve so the horse only looses feeling in the top of the suspensory ligament, so should there be major damage to the ligament they will still feel it and they can still feel everything else.
 
Alibear said:
Benn through it twice with different horses , the operation went well and was a success in both cases. However in both cases front feet issues have occured and horses had to be retired.
So if I ever have the misfortune to have a horse with this again I might check whats also going on in front as well.
1st horse developed navicular and 2nd has suspected ligament damage in front feet, out of insurance for an MRI.
Have to stress they only remove part of the branch of a nerve so the horse only looses feeling in the top of the suspensory ligament, so should there be major damage to the ligament they will still feel it and they can still feel everything else.
Click to expand...

Thanks Alibear - I'd seen some of your posts and was about to add you and Dieseldog to my list of HHOers who've experienced this! Do you think that your horses developed front issues as a result of the op? Because they were carrying their weigjht differently or such? What sort of things did yours do post op - could they continue at the same level as pre-injury?
 
The horse is being xrayed and scanned next week to confirm if that is his problem ( although I would assume it is if he blocked out there?)
We will never sell the horse so that doesn't really matter.
We then have the option of trying shock wave therapy or going straight down the operation route.
We have had him checked for any other lameness in front.
 
I suspect the first horse had been carrying his weight differntly to compensate for some time as his condition was chronic. So by mending the problem he switched (possibly suddenly) to more normal weight bearing and that caused the sudden flare up of navicular. In between the op and the navicular he came back to full dressage work and competed at elementary without any comments from the judges so I take that as sound!
That is only my pet theory though. I admit I think I caused the problem in the first place as I was novice and bought him as a school master, too much basic schooling on a different surface I suspect tipped the balanced.

The 2nd horse, phew I'm a bit of a loss with him 2 years 100% sound and happy and then 2 years of problems which all kicked off when he was doing very little as I was busy getting married.
He came back from the operation well but had been treated for mild KS and bruised front feet in the moths leading up to the PSD. Again I think he may have compensated for the other problems which caused the PSD and then by suddenly fixing it the original problems flared back up. Again there was a few months between the op and the front flare up that he was back to a normal level of work for him.

I have turned him away with a very vauge hope a year at grass may sort him out, I'm hoping a year of just moving around on his own barefoot may help everything settle down into a normal use kind of thing.

But I admit to grasping at straws.
 
One of my mares had the operation back in 2008 and I have been very pleased with the results. She went on to qualify four times for the regionals at Prelim and Novice and is currently working towards an elementary test at the moment. The only thing I have had issues with following this is her stifle on the side of the suspensory damage. She now has to have the stifle injected every 8-10 months as there seems to be some inflammation there as a result of how she used the leg when it was first injured. Xrays etc all clear though.
 
HotToTrot said:
Hum, good to hear from other people. IHW, what sort of work did yours come back into?

I've been doing some forum-searching and found some threads on this. It seems Mega Beast, Mrs Mozart and Rosiefan have all had some experience of suspensory damage, though I'm not sure whether any of them have had operations.

Here's a good Chloe post. http://www.horseandhound.co.uk/forums/showthread.php?t=363059&highlight=suspensory

IHW I completely agree with the differentiation between the types of neurectomy and my vet said much the same thing. BUT, them's the rules and they currently say that all neurectomies are no-go - even though common sense dictates otherwise!
Click to expand...

I completely agree.

Mine came back into work in October 2010, so is now 7 months in and so far so good, although he is only really hacking and doing allround RC type stuff at the moment - he is in the process of being sold (not due to the op as I had planned to sell pre injury, although now unfortunately for a fraction of the price!)
 
i went for shockwave. surgery wasn't commonly done when my horse got PSD in his right hind (2002). he was sound after 3 shockwaves and back in full work 6mths later.
 
Hi, mine had PSD (proximal suspensory desmitis) diagnosed in her off fore last August. Had shockwave treatment (three sessions) and after two months box rest went on the walker twice daily. Was back in full work by mid Feb including jumping. Have since done an arena event, BD and been xc schooling. The scan showed a "blurred" boundary to the area where the suspenspry attaches behind the knee so relatively minor damage in the grand scheme of things (ie no tear/lesion) and she also threw a huge splint on the inside of the same leg three weeks after the intial lameness which may have been contributory.

Shock wave has to be commenced within three weeks of the actual insult in order to be effective then a controlled exercise programme started pretty soon after to encourage the ligament to reform correctly.

Have you looked at Roger Meacock's website? Pretty interesting reading.
 
How long do you think your horse has been wrong? Recently or for a long time? Shockwave works best on fresh injuries.

Its not illegal to compete BS. Their rules say

'Any surgical procedure that threaten a competing horse's welfare or the safety of other horses and/or competitors must not be allowed'
 
My mare had the shockwave and then surgery in March 2009. She was sound in trot briefly but is now retired at 12 because she is lame at trot and bunny hops in canter.

I think the success rate depends on whether it is an acute injury or chronic. I think Daisy's may have been rumbling on for some time.
 
Hey Tilly was diagnosed with bilateral suspensory injuries last October.:( She had scans, nerve blocks and xrays. She has been on box rest up until a month ago but I was walking her in hand for upto 40 mins aday. (Very hair raising through winter:eek:) She is now in a small paddock for 1 1/2 hours a day and I am riding her in walk...but she is still not sound.
The specialist came out last friday and re scanned so he can compare and has asked me to take her in to be xrayed and blocked out again. He is then talking about shock wave therapy and maybe an MRI depending on the insurance.
I don't think we will be eventing for a long time :(
 
Hi there,

Just doing a bit of a search for more information as one of my horse's has unfortunately damaged both hind suspensory ligaments.

A bit of history:
June 2009 he first damaged the right hind suspensory. He was put on box rest and shock wave therapy and injections ensued. From memory he had 8 sessions in total. He was given the green light after 3 months to start walking in hand, which gradually led to walk ridden work. And after 5 or so months was allowed to be turned out, but he didn't get much and we moved yards in January 2010.

Since then we've taken it gradually, hacking up hills to improve his fitness and turn out all day or night depending on the time of year. He was back in full proper work early last year, back to jumping and flat work, even did some good dressage tests.

But then started a front shoulder problem which we couldn't get to the bottom of without a general and investigation. Didn't really want to put him through that so we've been playing it by ear, if he feels fine then we carry on and rest him if he doesn't. He's been a happy hack since the middle of last year and progressed to a fun ride a couple of months ago.

Now he's got problems with suspensory ligaments in both hind legs. We've just had the vet out today and confirmed with a scan. They're not a complete mess, just come away and there's scar tissue around the original problem.

He's 18hh and his back legs are excluded from insurance because of previous problems.

The options put to us are:
1. Box rest and controlled walk in hand or under saddle.
2. Box rest and shock wave - 4 sessions, then build him back up gradually.
2. This operation that many of you have mentioned.
4. Turn him away for a year.

My thoughts at the moment are turn him away and see, the operation will still be an option at the end of it. I'm concerned that if we go for the operation, the shoulder will still be a problem and we will have put him through all that for nothing.

It's been good to read the positives and negatives around the operation from other people and I'm also interested to know of any successes from turning away. I think the shock wave could give us a head start on recovery but I'm not keen on putting him through box rest again and the controlled exercise and everything because of the other problem he has.

Interested in experiences.
 
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