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Discussion on Desmitis of the straight sesamoidean ligament
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New Member:
hebrides
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Posted on Monday, Jun 18, 2007 - 1:31 pm:
My mare was diagnosed with the above 6 weeks ago and was given a course of shockwave treatment and is being rested. She had a follow up scan today which shows no significant improvement. She is still lame.I know that this type of injury is slow to heal but no improvement is worrying. My vet is to get back to me regarding the next steps but he mentioned plasma extraction and stem cell treatment. Would love to get opinions from people with any experience of this injury and its treatment. Dr O?
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Member:
cgby1
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Posted on Monday, Jun 18, 2007 - 8:27 pm:
Margaret, just checking, have you looked at the information under diseases of the pastern? If you click on the anatomy of the pastern there is some information on Desmitis of the Sesmoidean Ligament. It mentions casting as a possible treatment for difficult cases.
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New Member:
hebrides
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Posted on Tuesday, Jun 19, 2007 - 2:36 am:
Thanks Cynthia, I did read the section on DSL. One of the difficulties I have is that this mare is very stressy in the stable at the best of times...weaving etc. so we have compromised by allowing her turnout in a small pen. I don't know how practical casting would be in her case but I will mention it to my vet and see what he says.
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Moderator:
DrO
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Posted on Tuesday, Jun 19, 2007 - 4:08 pm:
Hello Margaret,
How severe is the desmitis or what lesions do they see on the ultrasound. For help with stall resting horses see, Training & Conditioning Horses » Behavioral Problems » Stall Resting Horses.
DrO
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New Member:
hebrides
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Posted on Tuesday, Jun 19, 2007 - 4:29 pm:
Thanks Dr. O.
She has a 30% core lesion of the proximal half of the ligament.There is not nor has there been any heat or swelling. She is lame just over 12 weeks, diagnosed 6. It took a lot of diagnostic tests to arrive at the diagnosis.
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Moderator:
DrO
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Posted on Thursday, Jun 21, 2007 - 9:30 am:
Hello Margaret,
Somehow I missed you yesterday. 30% core lesion does not sound so good, what is the nature of the lesion, do they think it represents a tear or simple edema? This is usually determined in the nature of the change in the ultrasonographic appearance. My congrats to your vet for a good diagnostic workup. It should be noted that on some horses with short pasterns this can be a difficult exam, do they feel pretty confident about the diagnosis and feel they got a good look around at the adjacent structures?
In general with proper extended stall rest uncomplicated SSL desmitis has a fair to good chance of returning to work but tearing, avulsion of the insertions of the ligament, or complication with other damage (not that uncommon with SSL desmitis) the prognosis worsens.
DrO
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New Member:
hebrides
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Posted on Thursday, Jun 21, 2007 - 11:10 am:
My understanding is that the lesion represents a tear. It looks like a black elliptical hole on the scan. There has been no mention of damage to the adjacent structures. My vet said that this is an unusual injury, one that he has not seen in this ligament before( he is one of the top lameness vets in this country)but he has no doubt about the diagnosis and has consulted with a colleague in the UK about it. I am not sure about avulsion of the insertion point but I think the lesion does extend towards the insertion point.
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Moderator:
DrO
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Posted on Friday, Jun 22, 2007 - 6:33 am:
Yes this is a rarely diagnosed but well established cause of lameness in horses. With every post things sound a little worse. What is your veterinarians prognosis and treatment plan and what are your goals for this horse?
DrO
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Member:
hebrides
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Posted on Friday, Jun 22, 2007 - 8:01 am:
I am waiting for the vet to get back to me to discuss this. he did mention cartrophen injections, plasma extraction treatment, or stem cell treatment as being possible courses of action. This is a third/ fourth level dressage mare that was schooling PSG.I had hoped one day to compete at PSG with her,but I also had always hoped to breed from her. If I did this now or next year would that compromise her ability to heal this injury? I hope to speak to my vet later today so I will let you know what happens.
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Moderator:
DrO
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Posted on Friday, Jun 22, 2007 - 10:01 pm:
Pregnancy could represent a significant stress to the healing so I would wait until next year.
I can't see the logic of the Cartrophen (pentosan polysulfate) unless concerned about arthritis developing around the injury. The plasma extraction (platelets being extracted I presume?) and stem cell are experimental but have early work suggesting a possible benefit in real animals. I think the platelets have a bit of a nod for positive research on the possible anabolic effects in damaged tendons and ligaments but it is a close call. There is one other experiemental therapy that might be considered though it may be a bit early for recommendation in patients:
Vet Comp Orthop Traumatol. 2006;19(1):43-7.
Anabolic effects of acellular bone marrow, platelet rich plasma, and serum on equine suspensory ligament fibroblasts in vitro.
Smith JJ, Ross MW, Smith RK.
Department of Veterinary Clinical Studies, University of Pennsylvania, Kennett Square 19348, USA.
The purpose of this study was to investigate the response of suspensory ligament fibroblasts (SLF) to in vitro stimulation using acellular bone marrow (ABM), platelet rich plasma (in vitro PRP), and serum as potential treatment modalities for suspensory desmitis. Blood, bone marrow, and suspensory ligaments were collected from five horses. SLF were harvested, grown until confluent, and stimulated with various concentrations of ABM, PRP, equine serum, foetal bovine serum, and medium (control). The responses to the treatments were assessed using a combination of radio-labeling for total protein synthesis and an ELISA for quantification of Cartilage Oligomeric Matrix Protein (COMP) production. Addition of all of the samples resulted in significant increases in COMP and total protein synthesis over controls (P<0.001). ABM caused the greatest increase in both COMP and total protein synthesis by the SLF. Equine ABM, PRP, and serum contain anabolic factors that promote matrix synthesis by SLF in vitro, with ABM having the greatest effect. Application of bone marrow to injured ligaments may enhance healing by providing anabolic factors, other than or in addition to mesenchymal stem cells, which stimulate matrix production.
DrO
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Member:
nonie
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Posted on Saturday, Jun 23, 2007 - 9:20 am:
Oh, Margaret, my heart goes out to you. I have been dealing with a very similar injury to my 16 year old mare. She was diagnosed in January after several months of on-agian-off-again subtle lameness. The vet's report read: "chronic active desmitis of the collateral sesamoidean ligaments, the lateral oblique sesamoidean ligament and the collateral ligaments of the fetlock joint (minimally). We did a series of three shockwave treatments, and initially she seemed better but then worsened to a grade 3 lameness at the trot after flexion--I later learned that the shockwave treatment provided temporary analgesia. She too does terribly on stall rest, so we have ended up turning her out as she is quiet in the pasture. I am handwalking her under saddle for 30 minutes, followed by icing, four times a week, and she is still lame at the trot now 6 months after diagnosis. The vet is not particularly hopeful--he says he sees this injury a lot in older, high spirited mares, and "they just never seem to heal"--but I am prepared to follow this regimen for several more months, as it seems that ligaments can take up to a year to heal, but according to what I have been able to research, this particular injury has a hard time healing as every step puts extra stress on the ligaments. My mare has long, sloping pasterns and there is some indication her sesamoid bone has DrOpped, which makes the matter more complicated. I have not mentioned the stem cell injections to my vet, but plan to, as the results seem encouraging.
I wish you the best of luck with your mare and I will be interested to read of her progress. It's a long road, and I understand now why horseowners freeze when they hear the word "suspensory."
Zoe
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Member:
hebrides
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Posted on Tuesday, Jun 26, 2007 - 4:27 am:
Thanks Zoe,and Dr. O.,
I am still waiting to hear back from my vet who is awaiting a reply from his colleague in the UK. I will leave putting her in foal on hold, i want her to have every chance of the best possible repair.
Sorry to hear you are in a similar situation Zoe.
my girl certainly fits into the category of high spirited mares, but she is reasonably happy in her pen. She would definitely do herself worse damage in the box fulltime as she not only weaves but squats right down behind and paws wildly with a foreleg. The injured leg is a hindleg so this puts a lot of stress on it.
If the consensus is that stem cell may help I am thinking of trying it. let me know how you get on.
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Member:
hebrides
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Posted on Thursday, Jun 28, 2007 - 3:14 am:
Update:
I spoke to my vet who has discussed my mare with his UK colleague. The consensus is not positive. no further treatment was offered. Stem cell with a casting was mentioned but dismissed as she would not cope with it. He will scan her again in October but is not expecting much improvement.
I am gutted!
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Member:
nonie
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Posted on Thursday, Jun 28, 2007 - 7:09 am:
Margaret, I am so very sorry. That is pretty much the same as they told me, but don't give up hope. I am several months ahead of you, so you can follow our progress to maybe give you an inkling of what to do. You don't say what your situation is--do you have your own barn and are you able to keep your mare regardless for a long layup/comeback? Do you have or desire other horses to ride?
I am in my second month of just walking under saddle. I am in this for the long run. The vet comes again July 11 to assess Molly. Ligaments do take a long long time to heal--months--and I am prepared to wait it out up to a year before I make any final decisions. I've had friends who say their horses' suspensory injuries did not start healing until they were worked lightly under saddle--this stresses the injuries just enough and then you ice them after work for 30 mionutes to reduce the inflammation. Talk to your vet about when he thinks your mare might be ready for this. I handwalked Molly for 40 minutes a day for a month before I put her under saddle.
Please feel free to email me if you like at zoeandted at comcast dot net. I know what you are going through--it is heartwrenching.
All the best.
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Moderator:
DrO
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Posted on Thursday, Jun 28, 2007 - 7:30 am:
I am sorry to hear that Margaret but a prognosis is only that and some horses appear to heal better than others under the same conditions so we will keep our fingers crossed.
DrO
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Member:
nonie
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Posted on Monday, Jul 30, 2007 - 4:31 pm:
Margaret, do not despair.
My vet was just here to check Molly--due to one thing and another our July 11 appointment got postponed--and he was pleased and surprised to find her much improved. He told me on his way in he fully expected her to be about the same as last time, so this was a welcome surprise to us both.
She is by no means 100% healed, but she is making definite progress. I am to keep walking her under saddle, for longer periods now, and keep icing afterwards, and he will come again to check her the end of September.
Suspensory injuries often take up to a year to heal, he tells me. She is on full turnout, and is happy, so I am delighted.
I'll keep you posted.
Zoe
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Member:
hebrides
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Posted on Tuesday, Jul 31, 2007 - 2:33 am:
Zoe, thank you very much for posting this. I am delighted that your mare is doing so well,it really is encouraging. My mare is out in a paddock with her shetland pal 24/7 now. There does not seem to be much change to be much change in the lameness.
My vet had said to not handwalk after the scan in June, as she was walking anyway in the paddock but she is very settled there so I think I will start a little handwalking and icing now. Please keep me posted!
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Member:
hebrides
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Posted on Monday, Nov 5, 2007 - 12:45 pm:
Well my mare had her follow up scan last week and there is some improvement. She is still lame, but the fact that there is some healing taking place is encouraging. she will be scanned again in January.
In the meantime we are researching stallions for her for next year!
Zoe, how is your mare doing?
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Member:
nonie
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Posted on Saturday, Aug 21, 2010 - 4:43 pm:
I wanted to update this. Margaret, I'm not sure you're still around.
Molly is now 100% sound. We are back to fighting over dressage and giving to the bit.  I ended up turning her out for two months on flat, dry pasture two summers ago as a companion to another horse on layup and that seemed to clinch it--she was mildly lame before she went (our pastures suffer from MUD and constant wetness due to underground streams) and perfectly sound when she returned. She has remained sound. I try to ride her about 3 times a week, sometimes less as I have my bratty little Arab filly to keep in line as well. My only concern is the possibility that her pasterns have DrOpped further (my farrier was here yesterday and mentioned he thought they had, though I personally do not see a difference). She bears weight equally well on both hinds. (Dr. O, I am going to try to remember to take a picture of her pasterns and post it here for your opinion).
Just wanted to let others know that there is always hope for aged and feisty mares.
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