suspensory ligament - inconsistent swelling

Birker2020

Birker2020

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A bit of background: my 15 year old WB gelding was diagnosed with a slight sprain of the lateral branch of the suspensory ligament June 2011 in his near fore - the lateral branch itself runs from the suspensory ligament (when the horse is stood its the hard bit that feels like bone behind the cannon bone on the outside of the leg but goes soft when the leg is bent) and then splits in two and travels across the fetlock joint on the outside of the joint.

The vet advised cold therapy (which I'd already been treating him with) box rest and controlled exercise. Its taken three lots of shockwave treatment, ultrasound treatment and pulsed magnotherapy treatment to help the leg. He has also received PRP which is like stem cell therapy but they use the plasma from the horses blood and inject back into the ligament. The horse went back into full work (bar jumping) in January 2012. The last scan showing pleasing results and the vet said he was happy the horse could continue with its work. I had the scan as I was worried as his leg kept coming up everytime I rode him.

My horse three weeks ago received hock fusion (with ethanol the alcohol injection) and fusion will take place anytime between six months and two years although the pain killing took immediate effect. So now he is not overloading the near fore due to pain from spavin in the hocks.

However every time I ride whether it be a hack or schooling in the menage his leg comes up with puffiness. It goes down immediately upon the application if ice and the vet says providing this is the case the horse will be fine to continue. But what I don't understand is why this is happening? Is this just synovial fluid or what? Sometimes I don't ice it and a couple of hours later it goes down, and its always down 24 hours later.

I thought puffiness went down with exercise not up. Sorry for long post but wanted to get everything clear. The horse is not lame and upon trot up WITH flexion the vet was very happy that he was sound.
 
'BUMP'

I know its probably a boring post but please...... anyone got any idea why a leg should swell with work and not go down with work and yet the vet says this is okay.
 
Hi, I have had one horse with a front suspensory tweak and my other has damage to both hinds so I have some experience.
Just as an example I had a ligament injury myself as a teenager when a horse fell on me trapping my leg, this leg now swells up in all sorts of situations, I'm not lame on it and it causes me no difficulties except with shoes! Its effectively the same thing, the injury means his ability to drain any type of fluid from this area is slightly compromised, it may improve over time or it may not.
 
My experience is more of the normal kind- my mares hinds fill very slightly overnight but go down after walking for a minute. Interestingly tho, even after she got the all clear the vet recommended smbs to be worn for all riding & any turnout where she was likely to race round. Now she only needs them on hard ground or situations where she is likely to be a prat. She did actually damage her annulars at the same time so slightly different to your horse. I now wonder if the smbs are the reason they didn't fill when worked, & never did turned out.
 
Thank you for your comments. Sunday I rode in the school for 20 mins and hacked out for an hour in the afternoon. He was very naughty on the road and we had a few spins as he planted his feet and wouldn't walk past the farm as the turkeys the other side of the hedge were making a dreadful noise! I eventually got him past walking him backwards past them but when I got home his leg was up again. I gave him Monday off, hacked out with a companion tuesday night and got him past the turkeys again! and tonight rode in the school and his leg has stayed more or less down.

I guess I will have to keep monitoring it closely. I just wish it would stay down, I seem to spend my life worrying about it and constantly feeling it - I feel like I am becoming slightly paranoid!
 
It gets you like that I know, as long as he is not lame and it does come and go would try to relax a bit more..I can talk I watch my new horse like a hawk convinced I can see lameness when there's nothing there.
 
Is it possible that work is breaking tiny adhesions trying to form in the tendon, creating fluid which then takes time to drain away? I know that it's important to work tendon injuries as soon as they are able to be worked safely, so as to stop the formation of adhesions, so that would make sense to me. Does it come up less if you ride him every day, that would fit the theory?
 
Have you experimented to see if there's a difference between just road work (once a day) and school work?

Did the horse only return to work in January?
 
My mare is also like this. She has had surgery on her hind suspensories and is now 6 mths post op. She can come in from the field with quite puffy legs, the same after work but standing in her box all night has them back to normal by morning. I have started turning her out with Bioflow boots on which definitely helps and the swelling is becoming less over time. I think what cptrayes says could be right. Something to do with adhesions breaking down and perhaps causing an inflammatory reaction. My vet is also unconcerned by the way.
 
cptrayes said:
Is it possible that work is breaking tiny adhesions trying to form in the tendon, creating fluid which then takes time to drain away? I know that it's important to work tendon injuries as soon as they are able to be worked safely, so as to stop the formation of adhesions, so that would make sense to me. Does it come up less if you ride him every day, that would fit the theory?
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Yes it does come up less with everyday work I must admit. Maybe that is the reason behind it. Thanks CPTRAYES.


amymay said:
Have you experimented to see if there's a difference between just road work (once a day) and school work?

Did the horse only return to work in January?
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There is no difference between road and school work. The horse has been on and off work since the injury initially started in June 2011 following his box rest and turnout. But its stopped and restarted a number of times because of shockwave therapy, and then the PRP treatment that he received, and then having his hocks fused, etc. So the work has been a little inconsistent. He doesn't feel lame in the school but sometimes its difficult to tell with him as he is very spooky and can shy at five or six things whilst riding round the school so doesn't ride particularly consistent if you understand. He also gets a little 'bridle lame' - he definetely isn't doing the slight hopping every few strides that he was doing last time. When he does pay attention he goes like a dream. I have dressage 31st March so will see how he goes then as I'm doing two classes but its only a small venue and I won't over do it wiht the warming up - I never do. The vet says to get on with things anyway, but its difficult not to worry.
 
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Just from reading your posts here - I wonder if simply the horse hasn't had time to heal properly.....

Have you considered turning away for 6 months?
 
Advised against that amymay as you need to put some the ligament under some degree of pressure with work in order to prevent scar tissue from forming. I'm afrain breaking down the adhesions is a necessary part of the process :(
 
Ilovefoals said:
Advised against that amymay as you need to put some the ligament under some degree of pressure with work in order to prevent scar tissue from forming. I'm afrain breaking down the adhesions is a necessary part of the process :(
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You are correct Ilovefoals. Its my understanding from speaking to the vet that the ligament needs various forces put upon it to help promote healing and stop scar tissue from forming and also to encourage the fibres to bed down flat the way they are meant to lie and not all haphazard which is when you get the scar tissue. I probably have explained it in very basic terms but I'm not a vet.

I think in even bad cases of tendon tears these days (which my horse is a long, long way from) they only rest for a short period and then do walking in hand/horsewalker.
 
Hi..I think you will find that there are different views on this, certainly in the racing world where these injuries are common it is quite usual to turn away for up to a year, in reality the constant moving around in the field would seem to be far more beneficial than periods of walk etc with a horse stabled the rest of the time. Since I have turned my horse with ligament damage out 24/7 I have seen a marked difference in his legs which now look clean and toned whereas before they seemed soft and with hindsight puffy, they used to swell sometimes, they never do now. I did however do a period of walking in hand and riding on a hard surface.
 
Just wanting to check that it is for sure the ligament that is coming up and not fluid/windgalls....sorry...not wishing to insult. If not the ligament, I would find a physio experienced in manual lympthatic draingage.

I would bandage at night, do mainly straight line work as otherwise you are putting torque on the lateral branch and straining it further.

I would avoid a horsewalker for the above reasons.

If you need cold, I would consider a Zamar.....as you can regulate the temperature.

I would make sure that his shoeing is 200% plus and whilst you may have every faith in your current farrier it does no harm to have a fresh pair of eyes cast over the horse as a one-off.
 
My tb did her left fore suspensory (proximal) and the exact same thing happened to her. I just used it as an indicator I had overdone the exercise a little but I think cptrayes comments are correct and I found the best solution was to alternate an easy workout with a more challenging one. We are now 5 months into ridden work and it doesn't really happen any more.

I would definitely keep an eye on foot balance too - I took mine barefoot during all this and she has done some major mediolateral rebalancing for herself!
 
Brownmare said:
I would definitely keep an eye on foot balance too - I took mine barefoot during all this and she has done some major mediolateral rebalancing for herself!
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Yeah need to get foot balance assessed again, since having his hocks fused a month ago he has started wearing his toes on his fronts!

Thanks for all your help and suggestions guys.
 
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