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  Discussion on Long term prognosis for LH suspensory injury
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Member:
nonie

Posted on Thursday, May 24, 2007 - 3:30 am:

Last summer my 16 year old mare started having mild, intermittent lameness at the trot. It came and went for several months and finally in January I brought her in for a full workup. The vet found "marked pain on passive flexion of the LH fetlock and suspensory branches appear slightly more prominent with LH fetlock in flexion. In motion she was 1 to 1 1/2 degrees lame in LH jogging on pavement. LH distal lim flexion resulted in a 3+ exacerbation of the lameness. Radiographs showed distal displacement of the proximal sesamoid bones indicating involvement of the suspensory ligaments. Ultrasound revealed chronic active desmitis of the collateral sesamoidean ligaments, the lateral oblique sesamoidean ligament and the collateral ligaments of the fetlock joint (minimally)."

We decided to treat her with a series of 3 shockwave treatments approximately 4 weeks apart and confinement to a small paddock (she does not do at all well at all on stall rest and we felt the stress would counteract any benefit). On March 14, the date of her final shockwave treatment approximately 8 weeks after her initial examination, the vet found "the distal lateral left hind suspensory ligament nonpainful to ddep palpation and there is minimal reaction to passive distal limb (fetlock) flexion. When jogged in hand, there is still a slight shortening of the stride and "up and down" stride to the left hind, but much better than previously. After left hind distal limb flexion, there is an early 2 degree out of 5 lameness but this quickly subsided. On ultrasonographic examination, the distal lateral left hind suspensory ligament was smaller, had a better fiber pattern and density. This was also true of the collateral sesamidean ligament, laterally and medially. The collateral sesamoidean ligaments were much more organized and smaller and the attitude of the left hind fetlock was no longer in a hyperextended position. "

Sounds good, eh? He then recommended continued turnout in the small paddock, and handwalking progressing to walking under tack for four weeks. This coincided with a very rainy period during which time the footing in the small paddock turned to thick mud. My mare did not enjoy turnout in the paddock as she could not see the other horses and often spun and whirled. On inspection I found deep holes in the mud the exact diameter of her limbs. When the vet came to examine her on site 4 weeks later her fetlock looked excellent from the outside, she responded minimally to deep palpatation, but was lame when flexed and trotted out. I prevailed upon the vet to permit her to be turned out in the larger field by herself, where she is much quieter, is beside her friends, and the mud is not an issue. Another four weeks of walking, this time under saddle, 30 minutes at a time, and today she is only very marginally improved, still quite lame when trotted out after flexion.

My thought is that she may have reinjured herself in the small paddock? The vet says to just go on walking her under saddle and check her every four weeks. I am disappointed because she seemed to be doing so well at the March checkup after her first two shockwaves. The vet says he sees this type of chronic problem frequently in this particular injury in older, hotblooded mares--his words were "They just never seem to heal." He drew me a diagram where he showed how the tension on the suspensory is exacerbated by the DrOpped sesamoid bone.

What are your thoughts about a long term prognosis, Dr. O? I am pretty distraught about this. The mare is my soulmate, and if I have to spend the rest of her life just walking her up and down the road, so be it. She appears to be happy and not in any discomfort. Does the fact that she seemed to heal quite well initially, and that despite the reinjury she is making some (albeit very minor and slow) progress now give any hope for the future?

Thanks for your input.
Moderator:
DrO

Posted on Thursday, May 24, 2007 - 8:42 am:

Hello Zoe, I am sorry to hear about this. Though the prognosis will be modified by the severity of lesions and desired use of the horse, in general chronic suspensory/seasamoid desmitis of just about any of the ligaments of the suspensory apparatus of the rear limb has a guarded to poor prognosis for anything more than short term very light work soundness. The combination of multiple ligament involvement and DrOpped sesamoids certainly worsens the outlook.

I would like to discuss your comments about shockwave therapy. The lack of pain immediately following the shock wave therapies should not be considered indicative of healing as SW therapy creates a temporary but fairly long term (weeks up to a month) deadening of the pain nerves in the treated area. It is not until after this period can you evaluate the results based on lameness. For more on this see, Diseases of Horses » Lameness » Treatment Methods » Extracorporeal Shock Wave Therapy
DrO
Member:
nonie

Posted on Thursday, May 24, 2007 - 8:59 am:

Thanks, Dr. O. Your response about the shockwave is actually comforting to me, as I was distressed at the thought that we somehow may have contributed to a reinjury by confining her in the small paddock when she had seemed to be progressing so well. Now I see it was a false assumption, it actually makes me feel a little better.

Can you clarify a bit for me what you mean by "guarded to poor prognosis for anything more than short term very light work soundness." As opposed to what in the long term? Does this mean that if she did return somewhat to soundness, she would rapidly regress if I put her in light work again?

I want to keep her happy and comfortable, above all else.

Thanks again for the speedy reply.
Moderator:
DrO

Posted on Friday, May 25, 2007 - 7:08 am:

Unfortunately Zoe I can make no prediction about your horse, this should be done by the one who conducts the physical and extended diagnostics. I can comment about sesamoid/suspensory desmitis in general. The statement "guarded to poor prognosis for anything more than short term very light work soundness." means that if you your goals are to do more than very light work for short periods of time there is a greater than good to excellent chance the horse will not meet your goals. Acceptable very light work may be as light as hand walked with a child on her back in an arena maybe more, it is impossible to know exactly even in specific cases.
DrO
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