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  Discussion on Suspensory ligament injury
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Posted on Tuesday, Jun 18, 2002 - 7:56 pm:

We have a 7 year old quarter horse gelding with a right front suspensory ligament injury. We have no history on this injury and took the horse in for rehabilitation. He is knuckling over, but is able to walk. I can find no information on knuckling over associated with this injury. Would you recommend immobilizing the leg to prevent the knuckling over? Thank you.

Posted on Tuesday, Jun 18, 2002 - 8:32 pm:

Hello Phil,
You are correct knuckling over as I understand the term is not a sign of suspensory ligament injury but usually one of extensor tendon disruption.

Since there is a conflict between the clinical signs and the diagnosis I am slow to recommend treatment but usually extensor tendon disruption will heal without support but if it is a real problem I see nothing wrong with a heavy bandage or light splint to keep the toe extended.
DrO

Posted on Thursday, Jun 20, 2002 - 7:56 pm:

We added a similar message last night, but it didn't get posted - if this is a repeat, please ignore.

We are very unsure of this diagnosis because we have very little history information on the horse. We were told that the injury occurred about a month ago, and that a veterinarian had xrayed and injected the leg. We have been unable to get the veterinarian to return our calls to get more information.

After our first posting, we had information that there was a 'gel pack' applied to the leg for about 10 days, but 'did no good'. We were wondering what kind of splint or heavy bandage might work. We have tried an ace bandage, but it is not strong enough. Is there a boot which would keep the toe flexed that you can recommend.

We are in a very small town with no large animal care. Thank you very much for your help.

Posted on Friday, Jun 21, 2002 - 8:22 am:

Normally what I would do to prevent knucking of the fetlock is put a pressure bandage (see Equine Diseases: First Aid and read all the articles on bandaging) and then add a splint to the front. I would use aluminum bar or possibe pvc piped that I had bent using heat. I think it is critical that before you begin treatment that you learn what is wrong with this horse however Phil.
DrO

Posted on Wednesday, Jul 3, 2002 - 4:03 pm:

We took the horse in today for an ultrasound and found that the external flexor, deep flexor and suspensory are all involved. It appears that there was a wound which severed the tendons/ligaments, probably about 6 months ago. Just below the knee, for about 3-4", the tissue consists mostly of scar tissue, with a lot of cross-hatching. We are going to try butazolidine for 6 days to see if he responds and I am going to continue the physical therapy. He is also on MSM and glucosamine. Based on this new information, do you have any other suggestions? Thank you for your help.

Posted on Friday, Jul 5, 2002 - 9:40 am:

Boy this post gets odder and odder. Phil complete disruption of the structures you mention results in a horse's fetlock falling to the ground and walking around on the bakc of his pastern and fetlock. Is this what your horse is doing? It is not an injury that will heal without some very heroic and expensive measures that usually fail.
DrO

Posted on Monday, Jul 8, 2002 - 10:22 am:

When walking, the front of the fetlock bends forward - I have seen this referred to as 'knuckling over'. With the knee bent, we can straighten the fetlock, but cannot extend the foot to its natural position. He is reluctant to, but can bear weight on the leg with extreme encouragement. Motivated by some neighboring horses running in a nearby pasture, he actually cantered rapidly for about 300 feet, then trotted for about 100 feet. It all happened too quickly to see how he was handling the bad leg and he didn't seem to be adversely affected afterward. If it's possible to post an image, I could upload a photo of the leg in both standing and walking positions.

Posted on Tuesday, Jul 9, 2002 - 7:38 am:

When you used the term severed above did you mean they appeared to have been lacerated but not cut all the way through (severed)? Your descriptions actually are very good the only confusion is between them and the diagnosis you have offered. It continues to sound like either extensor disruption or flexor contracture. I would like to see a picture of the horse, see "Formatting" under the Help topic on the navigation frame on the left.
DrO

Posted on Wednesday, Jul 10, 2002 - 9:51 am:

Here are two images of the leg. Both show the position he prefers in the standing position. During movement, the fetlock comes forward to the ground. This has greatly improved over the past 3 weeks; previously, he touched only the point of the toe to the ground. The first image shows the swelling just below the knee, on the lateral side of the right leg swelling. The second shows the back of the leg where the scar is; the leg was shaved for the ultrasound. It is difficult to see, but is just below and medial to the swelling. It is approximately 2 inches long and about 1/4 inch wide and not straight. shaved leg. I will do a second posting to upload the image of the ultrasound.

Posted on Wednesday, Jul 10, 2002 - 9:56 am:

This is one of the ultrasound images; we have several, showing both normal and abnormal tissues. I did not label each image as they were taken, so cannot be sure which tissue he was showing on this; I believe it was the deep flexor.ultrasound

btw - really good job on the web page

Posted on Thursday, Jul 11, 2002 - 6:24 am:

The ultrasound is highly abnormal and assuming the 2B designation is correct I think it shows from top to bottom:
1) a marked thickening of the skin
2) enlarged superficial (between the x's) and deep digital flexors
3) and the large hypoechoic (darker) area deep to the DDF is where the suspensory should lie, but doesn't.
4) at the bottom is the back of the cannon

I don't think that is the deep flexor based on its shape, it looks more like the SDF because the deep surface is concave with respect to the cannon. So the structure on top of it is the thickened skin, probably the scar visible in the photo. If the skin is not thickened then all bets are off on the above description.

I think I see what is going on and the reason for the confusion above. Phil can this horse straighten its leg or at least while you are holding the leg up you can straighten the fetlock, or is the fetlock frozen in this flexed position?
DrO

Posted on Thursday, Jul 11, 2002 - 5:31 pm:

With the knee bent, and the cannon parallel to the ground, we can force the foot to a straightened position; that is, the front of the hoof is in line with the leg. However, it cannot properly flex to a normal front foot position. By backing or walking forward very slowly while working with the leg, we can encourage him to bear weight without knuckling over. The fetlock stays in this abnormal position, however. When he walks on his own, he always knuckles over.

Posted on Friday, Jul 12, 2002 - 4:45 am:

It still does not make sense then if this is not because of pain but do to mechanical issues: rupture of the suspensory should have resulted in a DrOpped fetlock so I am left with 1 of 2 possiblities:
1) The horse has always had this deformity and is not because of the injury.
2) The injury to the suspensory healed with either contracture of the supporting tissues or with the soft tissues around the fetlock scarred into this postion.

When the vet examines the legs what structures tighten up and prevent extension of the fetlock?
DrO

Posted on Sunday, Jul 14, 2002 - 5:46 pm:

The veterinarian who examined him believes that the involved tissues have so much scarring that it is preventing the toe from extending. He didn't believe we would ever get the fetlock back to its natural position, but gave us kudos for trying. We're just trying to determine if there is anything else possible we can do. Thanks again.

Posted on Monday, Jul 15, 2002 - 8:20 am:

I'm not sure this is relevant, but just in case: a friend of mine was recovering a severely foundered horse, and the horse started to walk on tiptoe on one foreleg. The vet came out and severed what was a rather contracted tendon, and this allowed the fetlock to come back down. His stance was returning to "normal", with steady progress (and some continual adjustments by the farrier). Then, it seemed to happen again, and this time the vet suggested there must be a tremendous amount of scar tissue, so recommended surgery. Unfortunately, the horse died of a post-surgical infection in that leg, but: they found when they went in that there wasn't any scar tissue at all! The tendon had merely healed, and in fact they told my friend the tendon had healed so perfectly that they'd never have noticed the original cut if they hadn't known it was there. All this to say perhaps there is something similar that can be done for this horse, and if there isn't in fact a lot of scar tissue causing the problem, perhaps something can be done without the costs and risks inherent in surgery.

Posted on Monday, Jul 15, 2002 - 8:43 am:

Phil,
Does he have a thought as to which tissues? If it is a matter of severing a flexor that is not too hard, but if it is the tissues around the fetlock there have been salvage operations that (fused) arthrodesed the fetlock and if money is no object.....during surgery the limiting tissues are transected then the fetlock repositioned and surgically fused.
DrO

Posted on Monday, Jul 15, 2002 - 12:29 pm:

When we asked about surgery, he said that usually he would sever the flexor or check ligament, but that in this case, there is such severe scarring that he feared he would not be able to separate the tissues. He thinks everything has fused into one giant mass of scar tissue with considerable cross-hatching. He didn't think the fetlock was damaged - only that it is being kept from flexion by the scarred tendons/ligaments.

I'm an acupunturist (retired) and have been doing deep tissue massage to try to release some of the scarring. We also pick up his good leg attempting to force him to stand on the bad leg and stretch the tissues. It seems to be helping. He can stand for about one second, several times, after massage. He also has, on his own, begun to voluntarily pick up the good leg and stretch the bad one.

Thank you again.

Posted on Wednesday, Jul 31, 2002 - 6:23 pm:

My last posting was on 7/15/02 and I have not heard back. My original question was whether you had any additional remedies/therapy you might suggest for this horse. He is actually improving and can stand long enough on the bad leg to get a quick trim on the good one. Progress!

Posted on Thursday, Aug 1, 2002 - 6:42 am:

Thanks for the wake up Phil, somehow I missed your last post. Lets review, this horse in the long distant past had a severe traumatic injury to the supporting structures of the leg. They healed with severe scarring that has contracted resulting in forced flexion of the fetlock. The examing veterinarian does not think surgery is an option (because all the support structures are involved?). Your goal is a horse that is just paddock/pasture sound and the horses biggest problem achieving this is that the leg knuckles because of the forced flexion prevents him from getting his weight over the pastern and foot. Does that sum it up pretty well?

If so I think the suggestions I made on June 21st are still the most logical. Using a PVC splint to help keep the leg from knuckling may help the horse achieve a stable situation where he can do the stretching himself. By heating the PVC you can mold a splint that closely fits the front half of the leg from the top of the cannon to the foot. Bandage the leg then tape in the splint. If you have continued stretching of the tissues the splint can be straightened as the horse improves. Only one caution if he ends up tearing the tissues further there is likely to be 3 legged lameness and increasing problems.
DrO
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