Suspensory Strain vs. PSD

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Halter_USA

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My TB Gelding was diagnosed with mild-moderate Proximal Suspensory Strain in his RH in Jan 2018. No lesions or tears. We did box rest and rehab, as recommended by the vet. Brought horse back into light work - mostly walking and trotting, and introducing a few strides of canter. Horse has come up lame again in RH. I have an appointment next week with the head of the vet practice.

I suspect he has aggravated the suspensory again. Or, the rehab program given by the original vet was too aggressive, and it never fully healed.

I have been doing a lot of reading on PSD and I am wondering - what is the difference between Proximal Suspensory Strain and PSD? Is there a difference? What are the long term outcomes for soundness? What are the gold standard treatments?

I could be getting ahead of myself, as I don't know for sure he has re-injured the suspensory. But I highly suspect that is the case, and I want to go into my appointment next week with all the information I can.
 
I could be totally wrong but I thought psd was what most vets called any damage or strain to the upper (proximal) area but I stand to be corrected but thought I would comment seen as no one else has.

my horse damaged his suspensory in the proximal area he basically had a hole in it, he had prp treatment then 5 months complete box rest, he was sound after 5 months my vet said the hole had virtually gone and he was really happy with the outcome, I started with short walks and gradually got up to about 45 minutes over a month then I started to introduce short bursts of trot I took it really slow and only really had him doing canter and normal work within about 3 to 4 months which was against the vets advice, he wanted him in full work in 2 months but I though it was too quick so I did what I thought he should do and his been fine and that was 3 years ago and his 14 now, I still show him and he does the same as he did before I just don't school hard and long on a surface.

so my horse is proof that it doesn't mean the end and his injury was pretty severe in terms of the damage he had done.

how long was your horse on box rest for ?
 
Pinkvboots - thank you for the reply.

My horse didn't have any tears or lesions present on ultrasound. The diagnosis was mild-moderate suspensory strain in the Right Hind, which presented as a thickening of the ligament, secondary to poor hoof angles behind. We box rested for 60 days, with handwalking 1x per day for 15 min on a hard, flat surface. At the 60 day re-check, the vet pronounced horse sound to continue rehab, tack walk, and introduce trotting. BUT --- did not re-ultrasound the tendon. I am kicking myself for not insisting on an ultrasound, but I trusted my vet. Also, the rehab instructions included work on the lunge line, which I DID question my vet on at the time, as I had always heard soft tissue injuries = no lunging or small circles. The rehab plan seemed too aggressive to me, based on what I had read, but my vet told me a more conservative rehab was not necessary.

In following 2-3 months, continued to feel like horse was NQR behind. At least 6 people told me horse was 100% sound - including 2 trainers and the same vet, who I sent follow up video to, on the lunge and under saddle. Vet said horse was weak behind, not unsound, and to keep working.

Last week, hired professional to get on horse so I can see for myself and video for my vet. Very slight, occasionally short behind on corners, with slight toe-drag (which never existed before). All in the same leg that the original suspensory strain occurred in back in Dec. Horse doesn't seem to want to go forward or push from behind. I am seeking a second opinion from another vet, as I am not happy with original vet's assessment.

I am trying to be as educated as possible heading into my next vet assessment. From what I have read, it appears that tears or lesions that occur as a result of an acute injury have a much better success rate for healing and long term soundness than does chronic inflammation that occurs as a result of conformation plus repetitive strain.
 
My 8 year old has PSD problems- no tears or major lesions but thickening in some places and some bone growth showing.

Prognosis is poor for recovery for my mare and we have opted not to do box rest of shock wave therapy, for various reasons, but instead just restrict her to a smaller paddock and see what happens. We aren’t hopeful of her returning to any sort of work and are just hoping to keep her comfortable for retirement.
 
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