suspensory ligament damage

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lensmith7

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Hi everyone

A few of you will remeber me from a couple of years back Josiejo. You all helped me so much with our unexpected arrival of baby Denver. Who is now utterly gorgeous, totally stunning and a credit to his new mum.
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Anyway. Josie has been diagnosed today with a great big tear in the main body of her right hind suspensory. Vet was quite surprised at how bad it was.
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He has offered me the neurectomy and also an injection of platelets (?) into the tear? Is that right.? I need to call him tomorrow as it's all a bit fuzzy.

I'd appreciate any advice/experiences people have had of this. He's given me 60% chance of being able to work again.
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It all feels like doom and gloom at the mo. Any one had any good outcomes?

Thanks
Lenny x

Oh poo sorry should this have been in vets? x
 
So sorry to hear you're having problems
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. The op and the stem cell treatment is about hte best you can get, and the one that offers the best outcome, though the op is usually quoted at 70% good outcome, i.e. back to work.

The op cuts the main nerve, so the issue is still there (it will never go away). You have to know that the nerve can grow back in x number of years time.

We didn't take the operation route, but in the end even that wasn't an option
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.

Who is the vet dealing with ned? The general concensus of opinion is that Sue Dyson at the Animal Health Trust at Newmarket is the expert in the field.

Hugs hunny.
 
Thanks loads for your reply MrsM. I think on my seach of the site your name was popping up quite a bit about suspesories.

My vets are Platt and Murrell. David Platt is regarded as one of the best surgeons in the South East. So keep being told? I'm just hoping I've made the right descision x x
 
From what I know the sooner you diagnose and treat agressively the better the outcome.
My daughters horse had problems with a suspensory a few years ago and rest, steroids and most importantly shockwave treatment were very helpful. He came sound. Stem cell treatment was not heard of then.
I would go for the treatment asap and wish you good luck.
 
[ QUOTE ]
So sorry to hear you're having problems
frown.gif
. The op and the stem cell treatment is about hte best you can get, and the one that offers the best outcome, though the op is usually quoted at 70% good outcome, i.e. back to work.

The op cuts the main nerve, so the issue is still there (it will never go away). You have to know that the nerve can grow back in x number of years time.

We didn't take the operation route, but in the end even that wasn't an option
frown.gif
.

Who is the vet dealing with ned? The general concensus of opinion is that Sue Dyson at the Animal Health Trust at Newmarket is the expert in the field.

Hugs hunny.

[/ QUOTE ]

Mrs M, you aren't actually correct. The operation may have changed since your horse had PSD? What happens now is that they normally do a neurectomy along with a Fasicomotmy (sp). The neurectomy does sever the nerve to the ligament. This nerve only feeds that bit of the suspensory, it does nothing else, so your horse will still have full feeling in the rest of its leg and foot. A fasicotomy splits the fascia that surrounds the ligament. The fascia is a very tough and fibourous tissue and when a tear occurs the ligament needs to swell to heal, the fascia prevents this, so therefore your horse will not heal. By splitting the fascia it enables the ligament to swell and therefore heal.

They sever the nerve so that while the ligament is healing the horse will use their leg properly and therefore increase the chance of the healing.

The damage will improve and heal. Vets can quote up to 90% success rate for this operation - not sure how true that is. The other option is Shockwave Therapy. This only really works on a fresh injury.

The one thing that vets do agree on though is that field rest will not heal it.

Fingers crossed for your mare
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[ QUOTE ]
Thanks loads for your reply MrsM. I think on my seach of the site your name was popping up quite a bit about suspesories.

My vets are Platt and Murrell. David Platt is regarded as one of the best surgeons in the South East. So keep being told? I'm just hoping I've made the right descision x x

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Is a hard call in some respects. I decided against the op (and in the end it wasn't an option), but many choose it and their horses go on to have good lives; although obviously some don't, hence the percentage success rate.

I don't know of David Platt, but I'm sure others will do. I went with Sue Dyson at the AHT at Newmarket as she was so highly recommended at the time.

PM me if you want to chat/rant, etc. and I'll tell you what I can.
 
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DD - last October. Sue Dyson at the AHT, Newmarket.

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Sue Dyson basically invented the Fasciotomy so not sure why she would tell you that the ligament doesn't heal.
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[ QUOTE ]
[ QUOTE ]
DD - last October. Sue Dyson at the AHT, Newmarket.

[/ QUOTE ]

Sue Dyson basically invented the Fasciotomy so not sure why she would tell you that the ligament doesn't heal.
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No idea or rememberance of the ins and outs. It's not really an area I want to delve back into unless I must. My mare could not walk properly at the end, despite being on three Bute. She was PTS at the end of October. No-body quoted a 90% success rate to me (certainly not that I remember; 70% is the figure that I remember and is the one I've seen since then).
 
Can I beg to differ and suggest that perhaps a trial of conservative treatment might be appropriate, though it's your choice of course. My old boy, advanced medium dressage horse, now 25, did his hind suspensory in, but on the bit where it branches into two. He was not insured, so conservative treatment, box rest, limited turnout was the order of the day. He didn't like it much, but now he is fine. He will not be able to do consistent high level work, but we can still do the odd flying change for fun.

A friend had a youngster who was very expensive, bought for dressage. At 6 did both suspensories at hock level, operated, came back, broke down again and retired as a brood mare at 8 or 9.

Could you afford the time to try more conservative treatment with surgery in reserve if it doesn't work? I suppose ultimately you have to be guided by veterinary advice as we're not vets; we just know how our particular horses worked out.

Best of luck.
 
Hi
I am the friend referred to in the above post!
My mare did indeed do both hind suspensories at 6. She went to Andy Bathe at Rossdales & that the neurectomy & fascioctomy in both, as this was going to give about a 70 to 75% chance of success, where as shockwave was only looking at 20 to 30%. And box rest alone was felt to be of no benefit – she’d already had 2 months of box rest & was actually getting worse, so some form of intervention was required.
We did have the op & all was well for 3 years until she slid through an electric fence on a down hill slope on both back legs! This was aged 8.
We tried shockwave & yet more box rest, but after 9 months, when she was 9 the fetlocks had dropped & she wouldn't be ridden again. So in consultation with 3 vets we agreed to put her in foal - which is due 18th May (Fingers crossed).
Before anyone jumps on me - all 3 vets, Andy Bathe, the receiving vet & mine were in total agreement that her suspensory problems were not die to conformation problems. She had excellent hocks & conformation; her problems were just sheer bad luck.
Platelets were very new & not an option when my mare was operated on, so can’t comment on that. I am happy that we tried & did what we did, but sometimes sh*t happens.
Hope you have a good outcome.
 
I'm a success story
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My pony had the neurectomy and fasciotomy in October 2007 at Oakham Vets. It was a complete success, he was stable rested for two weeks after the op, then had a small paddock for a couple of weeks, then back out with his mates for 6 months ( this was my decision, he could have started work after around 6 weeks) started to ride him in walk for the first couple of months , then introduced trot, and the rest is history
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He has been sound as a pound for 18 months and is fitter and a lot more forward going than he ever was. I even achieved my life long dream and took him on holiday to Holkham beach last September!
 
[ QUOTE ]
Can I beg to differ and suggest that perhaps a trial of conservative treatment might be appropriate, though it's your choice of course. My old boy, advanced medium dressage horse, now 25, did his hind suspensory in, but on the bit where it branches into two. He was not insured, so conservative treatment, box rest, limited turnout was the order of the day. He didn't like it much, but now he is fine. He will not be able to do consistent high level work, but we can still do the odd flying change for fun.

A friend had a youngster who was very expensive, bought for dressage. At 6 did both suspensories at hock level, operated, came back, broke down again and retired as a brood mare at 8 or 9.

Could you afford the time to try more conservative treatment with surgery in reserve if it doesn't work? I suppose ultimately you have to be guided by veterinary advice as we're not vets; we just know how our particular horses worked out.

Best of luck.

[/ QUOTE ]

Its worth saying that all the evidence suggests that for Proximal Suspensory Desmitis (PSD), conservative treatment and/or shockwave have a very poor prognosis indeed. PSD simply doesn't respond to rest
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. Unfortunately.
 
Thanks all for your replies.

Now to throw another spanner into the works. My vet refuses to do the Fasciotomy as there is a risk of the suspensory prolapsing through the wall during recovery.

he also stated very clearly, the ligament does not heal, ever, it simply toughens and for a course grissel type tissue.

This is what my vet said anyway.

I haven't a clue, she's never had a day lame before, now this. Poor Josie x
 
Can you get her referred to the AHT? Sounds like this might be the best course of action. What Sue Dyson doesn't know about the suspensory ligament isn't worth knowing!
 
[ QUOTE ]
[ QUOTE ]
Can I beg to differ and suggest that perhaps a trial of conservative treatment might be appropriate, though it's your choice of course. My old boy, advanced medium dressage horse, now 25, did his hind suspensory in, but on the bit where it branches into two. He was not insured, so conservative treatment, box rest, limited turnout was the order of the day. He didn't like it much, but now he is fine. He will not be able to do consistent high level work, but we can still do the odd flying change for fun.

A friend had a youngster who was very expensive, bought for dressage. At 6 did both suspensories at hock level, operated, came back, broke down again and retired as a brood mare at 8 or 9.

Could you afford the time to try more conservative treatment with surgery in reserve if it doesn't work? I suppose ultimately you have to be guided by veterinary advice as we're not vets; we just know how our particular horses worked out.

Best of luck.

[/ QUOTE ]

Its worth saying that all the evidence suggests that for Proximal Suspensory Desmitis (PSD), conservative treatment and/or shockwave have a very poor prognosis indeed. PSD simply doesn't respond to rest
frown.gif
. Unfortunately.

[/ QUOTE ]

This is exactly word for word what my vet said to me, thankyou x x
 
[ QUOTE ]
Can you get her referred to the AHT? Sounds like this might be the best course of action. What Sue Dyson doesn't know about the suspensory ligament isn't worth knowing!

[/ QUOTE ]

I guess I could. Hadn't thought about it. I trust my vet implicitly. Hadn't even thought of that as an option.
 
Has your vet come some kind of agenda with pushing for the stem cell therapy. This is a new treatment for PSD, is he pioneering the operation and needs horses to perform it on?

Sue Dyson is the leading expert on PSD, where are you based?
 
I'm in Essex

As I understand, and I'm probably completely wrong. He's not doing stem cell therapy, it's platlet rich plasma. As I say I may be completely wrong.

He gave me all my options. This did sound the best, with the best percentage of success. Which seems to be supported by evidence showing a more agressive treatment is more successful than more conservative.
 
[ QUOTE ]


Mrs M, you aren't actually correct. The operation may have changed since your horse had PSD? What happens now is that they normally do a neurectomy along with a Fasicomotmy (sp). The neurectomy does sever the nerve to the ligament. This nerve only feeds that bit of the suspensory, it does nothing else, so your horse will still have full feeling in the rest of its leg and foot. A fasicotomy splits the fascia that surrounds the ligament. The fascia is a very tough and fibourous tissue and when a tear occurs the ligament needs to swell to heal, the fascia prevents this, so therefore your horse will not heal. By splitting the fascia it enables the ligament to swell and therefore heal.

They sever the nerve so that while the ligament is healing the horse will use their leg properly and therefore increase the chance of the healing.

The damage will improve and heal. Vets can quote up to 90% success rate for this operation - not sure how true that is. The other option is Shockwave Therapy. This only really works on a fresh injury.

The one thing that vets do agree on though is that field rest will not heal it.

Fingers crossed for your mare
smile.gif


[/ QUOTE ]

My boy had all this done to and is now back to jumping 14 months after the operation. This is most certainly how they treat it at the AHT, we had many trips there
frown.gif
 
[ QUOTE ]
[ QUOTE ]


Mrs M, you aren't actually correct. The operation may have changed since your horse had PSD? What happens now is that they normally do a neurectomy along with a Fasicomotmy (sp). The neurectomy does sever the nerve to the ligament. This nerve only feeds that bit of the suspensory, it does nothing else, so your horse will still have full feeling in the rest of its leg and foot. A fasicotomy splits the fascia that surrounds the ligament. The fascia is a very tough and fibourous tissue and when a tear occurs the ligament needs to swell to heal, the fascia prevents this, so therefore your horse will not heal. By splitting the fascia it enables the ligament to swell and therefore heal.

They sever the nerve so that while the ligament is healing the horse will use their leg properly and therefore increase the chance of the healing.

The damage will improve and heal. Vets can quote up to 90% success rate for this operation - not sure how true that is. The other option is Shockwave Therapy. This only really works on a fresh injury.

The one thing that vets do agree on though is that field rest will not heal it.

Fingers crossed for your mare
smile.gif


[/ QUOTE ]

My boy had all this done to and is now back to jumping 14 months after the operation. This is most certainly how they treat it at the AHT, we had many trips there
frown.gif


[/ QUOTE ]

This is good to hear. Thankyou x x
 
[ QUOTE ]
Can I beg to differ and suggest that perhaps a trial of conservative treatment might be appropriate, though it's your choice of course. My old boy, advanced medium dressage horse, now 25, did his hind suspensory in, but on the bit where it branches into two. He was not insured, so conservative treatment, box rest, limited turnout was the order of the day. He didn't like it much, but now he is fine. He will not be able to do consistent high level work, but we can still do the odd flying change for fun.

Could you afford the time to try more conservative treatment with surgery in reserve if it doesn't work? I suppose ultimately you have to be guided by veterinary advice as we're not vets; we just know how our particular horses worked out.

Best of luck.

[/ QUOTE ]

As I understand from my vet a tear at the branch has a much better prognosis then a proximal tear which is possibly why your horse responded to more consevative treatment.

Most vets seems to agree that with PSD conservative treatment just doesn't work.
 
[ QUOTE ]
I'm in Essex

As I understand, and I'm probably completely wrong. He's not doing stem cell therapy, it's platlet rich plasma. As I say I may be completely wrong.

He gave me all my options. This did sound the best, with the best percentage of success. Which seems to be supported by evidence showing a more agressive treatment is more successful than more conservative.

[/ QUOTE ]

Sounds like your vet is talking about IRAP not stem cell.

I don't know David Platt but I do know he has an excellent reputation. My vet who is an orthopedic specialist rates him very highly.
 
[ QUOTE ]
[ QUOTE ]
I'm in Essex

As I understand, and I'm probably completely wrong. He's not doing stem cell therapy, it's platlet rich plasma. As I say I may be completely wrong.

He gave me all my options. This did sound the best, with the best percentage of success. Which seems to be supported by evidence showing a more agressive treatment is more successful than more conservative.

[/ QUOTE ]

Sounds like your vet is talking about IRAP not stem cell.

I don't know David Platt but I do know he has an excellent reputation. My vet who is an orthopedic specialist rates him very highly.

[/ QUOTE ]

This is also good to hear. thanks xx
 
My horse had severe chronic damage so we didn't get to consider a lot of the options - I did a lot of reading about it, until I learnt that Tiggy would not be able to undergo any treatment. In the end I took her back to the AHT to have her PTS, so that they could perform the pathology on the suspensory ligaments and hopefully further their research.

There are many horses that go on to have a productive life, so hold onto that thought hun
smile.gif
.
 
Final follow up on my horse who was operated on for PSD in september. The operation made him sound by End of October/November, he was corralled til January and allowed to go out with his friends in February. he was started with walk work in December, and built up very slowly til started tiny bit of canter work in Mid March, all went well until he was in schooling work again and he seems to be feeling his leg again now ;-(, so sad as he went to his first dressage test in mid April and he loved being back out there. Hes on bute now to see if it helps at all. its very frustrating though. He had the cut and denerve op and its only 6 months so surely nerve regrowth cant have occured by now, could they have misdiagnosed i wonder? Of course leg no longer insured, those of you considering op i recommend it despite its poss failure with my horse. My mistake was in waiting to do it, you only have 12 months worth of insurance, so operate and then if it goes wrong , you can at least find out why. I cant afford to have them evaluate my boy now, theres no money to go back to vets ;-(..my only hope now is that bute works and that he can have a quite life as a hack on bute or bute substitute. Terrible lameness PSD...my heart goes out to all of you with horses affected by it. Good luck.
 
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