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Discussion on Chronic Proximal Sesamoiditis
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New Member:
Cpetrach
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Posted on Monday, Apr 25, 2005 - 4:02 pm:
Hello Dr. Oglesby:
I have a 13 year old Han/TB gelding (Alli) who was working towards 3rd level Dressage up until last fall. In November, he was diagnosed with chronic proximal sesamoiditis in his left-fore.
The issue actually started last May when he slipped in the arena, went suddenly lame, but recovered a week later. The vet was out to look at him quickly the next day, noted edema in the area of the suspensory apparatus, and recommended stall rest until he could ultrasound the next week. When he came out and flexed the horse sound, we ended up not doing the ultrasound as Tino said Alli flexed 100%, and there was no edema (and the horse wasn't on anything, such as bute). (Now I'm kicking myself for not going ahead with the ultrasound.)
Well, after that, every once in a while throughout the summer, Alli would go 'off' during a ride but would be fine the next day. (He wasn't reaching forward in the left-fore...to everyone who watched, it appeared muscle-related.) Also, he frequently appeared off in that leg while out in the field. In the fall, it got more regular. As I wasn't sure what was going on, I tried a different farrier, a saddle restuff, and chiropractic and massage. Nothing helped, so I consulted with a different vet and the sesamoiditis diagnosis was the result. The treatment prescription was paddock rest, light riding with no small circles and wrapped legs, bute, load him up on glucosamine and MSN, and apply DMSO.
I've fiddled with many treatments and am currently using ice and a liniment each night. I've also recently put him on a product called RecoveryEQ.
He was doing well all winter to the point where I was riding him a little harder and introducing some canter (much to his delight, with much snorting and head shaking). But, the lameness has returned twice this spring...once when I stupidly let him roll in the arena and he and took off running and bucking and snorting for five minutes; and the other when he spooked in the arena, cantered on the right lead (his worse side) with me pulling him up into too small of a circle, head-bobbing lame, (but not too bad about an hour later). The funny thing about the latter was that I had him on bute as it was a clinic and I wanted to make sure that the trotting we were doing didn't irritate anything (his trot was beautiful until the spook). It seems odd that the bute doesn't seem to help.
Also, the edema has moved from the outside of his left-fore fetlock area, to all along the inside of the cannon (where all the tendons are). The edema is reduced with gentle work and the icing and liniment. It definitely settles back into the leg when he is in his stall at night...I'm trying to get him into a walk-out stall.
Currently, we are working with a good barefoot farrier because I'm quite sure that his feet could be improved as he has a history of a low heel on the opposite foot. No one I've spoken to thinks that shoes would help, however, we haven't tried them yet.
Now, after looking into sesamoiditis a little further, our vet found that there is very little consensus on what effective treatment comprises. It seems that there are a number of treatments available, none of which have been evaluated with a good randomized, controlled clinical trial. Which, she said, only complicates the choice of treatments, and with that, recommended we seek other consultation (specifically, the Washington State Vet hospital, who I have also emailed due to the distance between us).
This is very depressing and frustrating for us. Alli is an active guy and likes to work and is depressed when he can't 'play'. He looks great so much of the time but as I know this is lurking in the background, I'm afraid to do anything with him (though, I'm selfish and I ache to ride him more).
I joined this Web community specifically to find out more about this condition. I have attached his xrays in hopes that you may be able to shed a little light. I was also provided with the xrays in .dcm format, which seem to have a file size too large for the Internet. If you would like, I could also take digital video of his movement and the leg itself.
The xrays are located here:
https://www.sendpix.com/albums/05042512/vjw7jzhhhr/
I look forward to your reply.
With kind regards,
Cassandra
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Moderator:
DrO
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Posted on Tuesday, Apr 26, 2005 - 9:17 am:
Hello Cassandra,
Though I see a bit of roughening along the proximal edge of the sesamoids, the soft tissue swelling on the radiographs and your description is more consistant with a suspensory desmitis with or without involvement of the flexors. Are there other reasons these have been ruled out? Yes posting good photos might benefit us.
DrO
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New Member:
Cpetrach
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Posted on Tuesday, Apr 26, 2005 - 10:53 am:
Thank you for your reply, DrO. 
No, other reasons have not been ruled out or even discussed. I'm not sure why...I feel I'm not getting proper vet care/advice even though the second vet we saw that made the diagnosis is fairly fresh out of school and consulted her profs on the issue. (This tends to be the problem here as I'm stuck on the large rock that is Vancouver Island).
How does one check for the problems you mentioned? Would an ultrasound suffice, or is an MRI required? I believe I would definitely have to travel to Pullman, WA for more sophisticated diagnostic tools.
****
I just read your article on desmitis and believe I've answered my question on diagnostics. Our symptoms sound most like Single Branch Desmitis. I've been afraid that it was suspensory-based...I should have listed to myself, I guess.
Regards,
Cassandra
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Member:
Suzeb
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Posted on Tuesday, Apr 26, 2005 - 11:30 am:
Hello Cassandra,
I don't know if this will help you or not, but you could try phoning this lady:
Lynn Brochu
Ladysmith, BC.
(250) 616-8351
She is a journeyman farrier who does wonders with lame horses. I don't know if she is accepting new clients, but she may be able to direct you to a vet or diagnostics without having to haul your horse over the border.
Hope this helps .
Susan B.
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New Member:
Cpetrach
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Posted on Tuesday, Apr 26, 2005 - 4:27 pm:
Thanks, Susan. Ladysmith is quite far for us to travel for regular trims. However, I have found a somewhat-local journeyman farrier who just did a fantastic job of rolling Alli's toes and getting his heels up. I'm having her come every four weeks.
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Moderator:
DrO
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Posted on Wednesday, Apr 27, 2005 - 6:53 am:
The question is what to do next Cassandra. A ultrasound to help define the severity of the lesion would help you know the prognosis sooner but not essential for treatment. If the horse is lame at this time you might consider putting him in the rehab protocol linked to in the article.
DrO
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New Member:
Cpetrach
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Posted on Wednesday, Apr 27, 2005 - 1:14 pm:
Thank you for all your help, DrO.
Thankfully, he isn't lame right now. Actually, he is well. With that I'm continuing with ground driving, riding in our large arena (double the size of a legal Dressage court) at the walk with a little trot and some trailriding depending on how he is. Or, do you advise I not trot at all? With his original diagnosis (which, I feel, is incorrect) trotting was fine as long as it wasn't on small circles.
I've always tried to take things day-by-day, depending on how he looked coming out of the paddock, the state of the edema, and his general attitude (which is usually spunky). The nice thing is that the edema actually is now reduced with some exercise and there is no longer heat in the area.
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Moderator:
DrO
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Posted on Thursday, Apr 28, 2005 - 7:36 am:
How long has the horse been sound?
DrO
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New Member:
Cpetrach
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Posted on Thursday, Apr 28, 2005 - 1:04 pm:
Alli's last bout was the afternoon of Sunday April 3. He did a massive spook, cantered on the right lead (his worse side) with me pulling him up into too small of a circle (my fault), head-bobbing lame. He was 'off' the rest of the day and much improved the next. He has been sound since, but really moving free and like his old self for the last week.
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Moderator:
DrO
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Posted on Friday, Apr 29, 2005 - 7:15 am:
My concern is that if you keep reinjuring this there will be a time that he does not come sound again and that a slower rehab might result in better healing. Consult the article Equine Diseases » Lameness » Treatment Methods » Rehabilitating Injuries to the Tendons and Ligaments and since this has been going on awhile consider picking it up after the second evaluation. You should OK this with your veterinarian.
DrO
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Member:
Cpetrach
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Posted on Friday, Apr 29, 2005 - 12:42 pm:
I highly agree and wonder if this should have been the course of action all along.
Thank you for all your help, DrO. The Internet is a wonderful thing!
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Member:
Cpetrach
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Posted on Monday, Aug 8, 2005 - 5:32 pm:
An update to our problem: the local vets still weren't of help but we finally found a somewhat-local (a ferry ride and a couple hours away) lameness specialist and had an appointment with him on August 5.
Alli has been now diagnosed with a detachment of the lateral suspensory at the sesamoid. Considering the amount of time since we first started having problems, there appears to be minimal scar tissue (thanks in part to the advice I obtained here). The prognosis for reattachment and a return to work is 75-80%, providing we are strict about his rehabilitation. Whereas I had him in a tiny paddock before and was walking him, we are now under strict stall rest and are undergoing three shockwave treatments before starting a formal exercise program, similar to the one posted on this site. However, I am able to walk him as much as I want, including lateral work to keep his brain busy.
Our new ultrasounds and old xrays are here:
https://www.sendpix.com/albums/05080814/0fubo61xjl/
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Moderator:
DrO
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Posted on Tuesday, Aug 9, 2005 - 9:20 am:
Nice images and thanks for making them available
Cassandra. We call such damage an "avulsion" and also from the radiographs we can see there is remarkable enlargement of the soft tissue in the area.
DrO
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Member:
Cpetrach
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Posted on Friday, Apr 28, 2006 - 2:55 pm:
After problems that started in May 2004, two incorrect diagnoses, many months of paddock rest and beating my head on the wall, and finally a proper diagnosis last summer but with much rest and work ahead, I'm happy to provide a wrap-up of our two-year saga...
Alli has been on rest in a 12' x 15' stall since August 5, 2005. He received three shockwave treatments and then started a nearly 7 month rehab program at the end of October 2005. We were told that a positive outcome was possible providing I adhered to a strict rest and rehab program. We just had an ultrasound that showed total reattachment of the suspensory (except for a bit of scar tissue which will require careful warm-up before work and turnout for the rest of his life). Alli is now finished rehab, back in full training and is back outside (albeit, a small paddock for now, gradually working his way up to larger turnouts).
The stall rest was ok; Alli only tried to jump out of his stall every other day for about the first month. But, he had a big stall with two dutch doors that opened into a paddock full of other horses that he could touch and chew on all day. Things settled down and we both managed without sedatives.
The daily rehab was quite an ordeal. It was stressful, I was emotional, Alli was spooky, and each time we upped the work (such as when we started trot, and then again when we started canter), he was a total pill - he was sooo excited to be doing something fun! We started the rehab with a series of 20 minutes walk + 1 minute trot + 5 minutes walk, and the intensity increased by 1 minute each week and grew to five sets of trot and canter with walk sets in between. The rehab finished with: 20w + 3t + 2c + 5w + 5c + 5w + 5c + 5w. When we needed a break, we went on trail rides on flat trails with good footing. We were allowed to do lots of lateral work at the walk, a little at the trot later in the rehab program, and to make sure my position didn't become too atrocious, I even had a couple lessons (the coaches were really good about 'sticking to the program').
His nutritional needs were easy at first with free-choice hay and little grain, but got more difficult as the rehab progressed. He's been quite fit the last month or so and started DrOpping weight so I had to up his food considerably (he now eats more than any other horse at the barn).
Some things I learned during this journey:
- Find a program and stick with it.
- Don't give up.
- You can never do enough or too much work at the walk. The improvements in your horse and your riding are amazing.
- With proper management and stimulation, it is possible to make a hot 1200lb horse stay in his stall and be happy.
- Watch the fit of your saddle as things change quickly when on rest and controlled exercise.
- Attach a strap to the pommel of your saddle for those 'oh sh*t' moments and you too will stay in the saddle.
- Don't let out the lead rope when the horse spooks as he'll kick and catch you in the stomach.
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Moderator:
DrO
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Posted on Saturday, Apr 29, 2006 - 9:09 am:
What a wonderful post Cassandra! Congrats on the good progress and I love the way you have it all summed up. The strap to the pommel idea is a good one, can you explain a little better how you rigged this so during an emergency it was easily found and held on to?
DrO
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Member:
Paul303
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Posted on Sunday, Apr 30, 2006 - 2:49 am:
Ooooo.....nice tips Casandra! I used to put a
( human ) belt arount the horse's neck on "iffy" horses under english tack.
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Member:
Canter
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Posted on Sunday, Apr 30, 2006 - 10:53 am:
You can buy a "bucking strap" thru the catalogs or tack stores. It's not long, perhaps 6 inches or so and has a buckle at each end that attaches to the little rings near the pommel. It's fairly stiff leather, so when you have your hands in the correct position (for English riding, anyway), the strap is right there for a quick grab. I think you frequently see them with children's saddles.
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Member:
Imogen
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Posted on Monday, May 1, 2006 - 2:39 am:
It is not exactly unknown for the wither strap on a hunting breastplate to be used in the same way... I've always believed this is why a hunting breastplate is preferred to a martingale by many cross country riders (you can get your hand underneath it a lot quicker, it's bigger/broader/closer to the hand position).
However bucking straps pull directly against the saddle as opposed to the horse's neck and if you can get your hand in there fast enough are more secure and less likely to provoke a reaction in the horse.
Imogen
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Member:
Cpetrach
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Posted on Monday, May 1, 2006 - 4:15 pm:
Like what was mentioned above, you can purchase a special strap that will attach to the D rings on the pommel of an english saddle. However, I used a strap that was the flash on one of my nosebands. I've also seen photos from some of my older pony club-type books that show riders using a special strap around the neck of the pony (probably an old stirrup leather).
Here's Alli during his final ferry trip to the vet:
https://www.flickr.com/photos/darwinsfolly/129920233/
And an older favorite for good measure:
https://www.flickr.com/photos/darwinsfolly/114752556/in/set-72057594089277601/
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