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Degenerative Suspensory Ligament Desmopathy / Desmitis (DSLD)
Degenerative Suspensory Ligament Desmitis (DSLD) and Equine Systemic Proteoglycan Accumulation (ESPA) in Horses
Introduction
In the 1980's there began a spreading perception that Peruvian Pasos (PP's) suffered from an unusually high incidence of chronic suspensory disease that seemed unrelated to acute injury. Though the rear limbs were most often effected the disease can effect all four limbs and rarely is seen in only the front limbs. Since that time this condition has been described in Peruvian Paso crosses, Arabians, American Saddlebreds, American Quarter Horses, Standardbreds, Thoroughbreds, and some European breeds. There also seems to be a familial association. While in the non-PP breeds the condition is often associated with hard work and the onset is in the later years, this is not true in the case of PP's. Together these suggest a genetic predisposition in PP's for DSLD. More recent research has found that the condition in PP's is frequently not just localized to the suspensory ligaments but a defect in the connective tissue of other ligaments, tendons, and organs and labelled Equine Systemic Proteoglycan Accumulation (ESPA). This article covers the current information and controversy on the defects, clinical signs, diagnosis, and treatment for DSLD and ESPA.
Clinical Signs
A Controversy Over DSLD/ESPA and Peruvian Horses Exists
Before we begin we should note that there is controversy over the predisposition of the Peruvian Paso with DSLD/ESPA. The North American Peruvian Horse Association (NAPHA) feels there breed has been unfairly singled out as having a predisposition to this condition. Frankly it seems to Horseadvice.com that there is some strong information to suggest the breed is predisposed and that there is a genetic associated cause and that it may be do to a defect in proteoglycan elaboration in connective tissue. That said NAPHA presents a coherent argument to the contrary and put out an official position paper that should be read to get a balanced view of this subject, The Misdiagnosis of DSLD and Injury in the Peruvian Horse. A NAPHA SUB-COMMITTEE REPORT.
Anatomy
An excellent review of the anatomy of the suspensory and the surrounding structures can be found in the reference section, click here.
Early to Middle Age DSLD/EPSA
There appears to be no age or sex predisposition to DSLD in PP's and other breeds. Early in the disease there may be little localizing signs of suspensory desmitis. Instead a vague stiffness or mild lameness may be present most often, but not always, in the rear limbs. Swelling of the suspensory or "dropped fetlocks" are not present early. This lameness will be most often be intermittent and improve with rest. At this point the best localizing signs will be a fetlock flexion test on the lame leg(s) that leads to a remarkable lameness that persists for a minute or two. As the disease progresses the lameness becomes more pronounced and swelling may be found in the distal suspensory, particularly the suspensory branches that are painful on palpation. Usually the front legs will become involved. In the later stages there will be remarkable swelling of the distal suspensory and suspensory branches and in some individuals the fetlock will drop as the suspensory loses function.
Older Horse DSLD
Other breeds effected with DSLD have similar clinical signs but the disease develops later in life in hard working individuals. DSLD in other breeds appears to be a chronic suspensory desmitis, induced by hard work and bringing the suspensory to a point that the suspensory can no longer maintain its normal architecture, gradually breaking down with further work.
Causes
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