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Discussion on Medial oblique sesamoidean ligament
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New Member:
spinosa
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Posted on Sunday, Jan 27, 2008 - 3:33 am:
My 6yo TB has been off and on lame for 3 months. The first month, my vet thought it was a stone bruise. The lameness went away but came back with increased exercise. Since then we had Xrays, which indicated slight pedal osteitits and nothing more. So, we put pads on him. The vet also recommended the 147 series of adequan in case his joint was sore. we have completed the Adequan series.
A few weeks later he was still sore when walking uphill, but sound at the walk and trot going on the flat. I finally had different vet do an ultrasound and was diagnosed with a tear at the origin of medial oblique sesamoidean ligament. He thought it was about "25%." So, we did our first round of shock wave treatment. We are doing two more treatments, two weeks apart.
Can you please give me a good rehab program for my TB? He has had no noticable swelling ever, but slight warmth on the inside left pastern. His lamess at this point is only seen when walking on an incline. His stall is located up a slight hill. We surpentine up the hill now.
I wanted him to be a medium level jumper, but I am wondering if I will be lucky to have him work as a low level hunter now. Any advice would be greatly appreciated.
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New Member:
spinosa
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Posted on Sunday, Jan 27, 2008 - 12:08 pm:
I should also mention that the lameness is on his left front, which previously had a higher hoof angle than his right front. Since the ultrasound we lowered his left to approx the same angle as the right. My farrier made this decision and my shockwave vet agreed. Should I keep it lowered indefinitely?
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Moderator:
DrO
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Posted on Sunday, Jan 27, 2008 - 12:33 pm:
Welcome Michelle,
I see you have posted in the Rehab topic and with your vets approval the recommendations in the article should be applicable. However with a tear of the ligament you should consider starting at the severe injury point. How you proceed depends on how well the injury heals on follow up ultrasound exams. Be patient as at least 6 months of rest and rehab are needed. Though not well documented Michelle, the prognosis for return to jumping for a partial tear of this ligament would be guarded in my opinion.
DrO
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New Member:
spinosa
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Posted on Sunday, Jan 27, 2008 - 5:59 pm:
Oh dear that's terrible to hear. I have really bet the farm on this horse. :-(
Dr O, if I rehab him well and the shock wave tx seems to help, what do you think of the idea of having him in light dressage training by the summer...that would be about 7 months post injury. Is that pushing it? I guess what I am asking is, during the flatwork stage of his rehab(7-12 months post injury) would it be reasonable to have him in dressage training with the trainer continuing to follow the rehab program? Seems like that would help teach him how to carry himself more safely and balanced.
Thank you so much for your time.
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Member:
dres
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Posted on Sunday, Jan 27, 2008 - 7:00 pm:
Michelle, why push it.. rest / rehab and wait till next summer.. ??? He will be much stronger on it with slow proper careful rehab by then..
I tend tho to take things very slowly and to the letter on rehabbing... i have a saying... WE ONLY HAVE ONE CHANCE.. if they re injure it, it will only make it weaker..
I am currently rehabbing one of those "" i bet the farm on ""
On the first day God created horses, on the second day he painted them with spots..
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Member:
amara
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Posted on Sunday, Jan 27, 2008 - 8:00 pm:
Dr. O will have to comment on the rehab, but even though dressage training teaches a horse to use himself better, if he's not already there, sometimes the process of getting to that "using himself better stage" can be stressful. I would think it would be better to wait for any sort of real training until he is completely ready for work.
Dont give up hope. A guarded prognosis does not definately mean no hope at all.
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New Member:
spinosa
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Posted on Monday, Jan 28, 2008 - 1:03 am:
Thank you for your comments. It is all helpful. I need to hear it because I will try anything to convince myself that this isn't as bad as it seems....it is so heartbreaking for me.
One other quick question, is the "medial oblique sesamoidean ligament" the same as the inside anterior branch of the suspensory ligament?
Thanks.
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Moderator:
DrO
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Posted on Monday, Jan 28, 2008 - 7:53 am:
It is impossible for me to guess where he will be then Michelle. Note that the rehab program is based on assessing progress every 3 weeks then making decisions on how to go forward. That is because there is such a wide range of healing rates with very similar injuries so let's take it 3 weeks at a time. Concerning your specific question on following the "rehabbing dressage" as long as you are following the recommendations of your veterinarian I don't see that it matters what you label it.
DrO
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Member:
dres
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Posted on Monday, Jan 28, 2008 - 10:01 am:
all tho this is not the same injury it is as grave as they get.. and i can say as of this week, my mare will be riding sound.. she is moving out at a trot for 20+ mins with no limp or babble!~ I have walked thru fire hoops keeping her calm and quiet during this long lay up.. and will continue to do so, as i know it will just take one stupid act on her part to ruin the whole deal.. 
Hang in there and take it one day at a time... or 3 weeks at a time.. I know i counted Mondays , don't know why it just seemed to help make the time go by..
On the first day God created horses, on the second day he painted them with spots..
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Member:
stevens
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Posted on Monday, Jan 28, 2008 - 10:11 am:
Michelle,
I'm in the process of rehabbing my dressage horse who has a tendon tear. It's hard to be patient, but Ann is right, any set backs during rehab can be career ending.
Your vet can help you come up with a rehab plan that is suitable for your horse, since they are the ones that will be seeing him during his recovery and assessing his progress. Dr. O's guidelines are consistent with everything else I've read (Check out "Back to Work" a book on rehab that has some great inspirational stories to cheer yourself up, just keep in mind lots of other horses don't recover).
My mantra on my horse's recovery is that if he doesn't recover, it's not going to be because of anything I did or did not do. My job is to give him every possible chance, only he can heal.
I had "planned" to be further along than we are at this point in time, but had to readjust. We have our next recheck in 2 weeks.
Regarding "rehabbing dressage", I would suggest that you get very clear guidelines from your vet on what is and is not acceptable work for your horse. Specifically, it is my understanding that any kind lateral work (travers, revers, leg yield, etc) is "right out" until the horse is back to cantering under saddle which could be as early/late as 5 months or so into recovery.
Good Luck,
Chris
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Moderator:
DrO
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Posted on Monday, Jan 28, 2008 - 11:22 am:
I missed one of your questions Michelle and will answer it here. I cannot find a reference for the "anterior branch of the suspensory ligament". If this is a term I have used somewhere if you will give me the reference I will see if I can clarify it. This would not be an appropriate anatomical description of the obliques which are known as the "middle distal sesamoidean ligaments". If I had to guess is refers to the extensor branch of the sesamoidean ligament as this is the most "anterior" branch of this ligament. I will add to our list of articles needed one on the anatomy of these ligaments as they are growing in importance as a diagnostic consideration with the ability to visualize them with US and MRI.
DrO
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New Member:
spinosa
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Posted on Monday, Jan 28, 2008 - 12:07 pm:
If you go to the UC Davis veterinary website, they have a brochure that you can view online about "suspensory ligament injuries in horses." In the diagrams, the distal sesamoidean ligaments are clearly labeled as the ligaments only in the back of the pastern. THey refer to the oblique ligament on the pastern as the "anterior branches of the suspensory."
This is the only publication I have seen that calls it the anterior branches.
My horse's injury is on the inside of his pastern. not the back. My vet also did not have trouble visualizing this ligament and I read that it is difficult to visualize the distal ligaments with ultrasound. So I am confused. Not that is matters...seems like rehab is all the same. But I would love to feel more confident with my diagnosis...
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Member:
stevens
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Posted on Monday, Jan 28, 2008 - 1:50 pm:
Michelle,
I understand your desire to feel confident about the diagnosis. In my case, it took an MRI to definitively diagnose the problem. My horse's injury (superficial flexor tendon tear) did not show up on any of the 3 ultrasounds he had prior to the MRI, nor has it shown on ultrasound since he had surgery and treatment. However, I know it's still there.
One vet did have a pretty pragmatic comment that has helped me and that is that you ride the horse and not the ultrasound. We know my horse has a severe injury but short of another MRI, I have to go with whatever information we can gleam from clinical exams and whatever the horse "tells" me every day. That sobering thought has made it much easier for me to manage my expectations and not try to rush things. I'll likely MRI again at the 6 month mark or so to try and satisfy my need for scientific data. It's a balance between what I want to know and how much money I'm willing to spend since his insurance is done with that leg.
Hang in there, you're in good company.
Chris
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Moderator:
DrO
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Posted on Tuesday, Jan 29, 2008 - 8:29 am:
Hmmm with your description of the location I am beginning to wonder if you are not discussing the extensor branch of the suspensory. Concerning the UCal publication I cannot make sense of the term "anterior branch". While true the obliques would be "anterior" to the superficial branches it would be "posterior" to the deep branches. The only truly anterior branch, the branch that is anterior to all other branches, are the extensor branches.
I do agree that MRI is the way to go for ultimate diagnostics but expensive and often involving a long trip.
DrO
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Member:
spinosa
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Posted on Wednesday, Jan 30, 2008 - 2:10 pm:
Weird update:
My boy has been on stall rest with 15 hand walk twice daily. About a week ago I started massaging him and he gave me a lot of yawns. Probably coincidently, he has not stopped yawning - at least when he sees me. I take him out, hand walk him, and when I tie him back up to cold wrap his legs and brush him he yawns constantly. There is some weird stuff on the internet regarding yawning. My biggest concern is that this means he is getting ulcers from stress. That is what a lot of horsey-sites are saying. None of the sites seem to have much credibility though.
My vet just happened to be out at the barn and she pulled on his tongue a while and looked around in there. He is still yawning.
Any input would be appreciated.
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Moderator:
DrO
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Posted on Thursday, Jan 31, 2008 - 6:41 am:
Yawning is not a symptom of ulcers Michelle. Most horses yawn as they relax and I believe this is a sign that he finds what you are doing pleasurable. One note is that yawning may preceed a "falling asleep while standing" episode. While in some cases it is thought this is mild seizure activity, narcolepsy, others believe this is because the horse is not getting enough sleep: they cannot or will not lie down. We have had many discussions on yawning and if you will put the term in the search field you will find lots of information on it.
DrO
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Member:
spinosa
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Posted on Sunday, Feb 17, 2008 - 3:42 pm:
Terrible update:
My horse has been in a box stall with hand walking twice a day for over a month now. I walked him in the arena for the first time today(as opposed to the roads) and he became very excited, started rearing and bucking and the snap actually came undone. He realized he was lose and galloped and screamed for a full two minutes.
I realize that we start back to day one with his rehab, but my question is, does this mean he is probably WORSE off than before? Someone who replied to this thread earlier said that "you only have one chance." "
Does reinjury really make it weaker and less likely to heal?
We have done two of three shock wave treatments. If it is freshly reinjured, should I postpone the 3rd SW?
Should I reultrasound him now to see the damage is worse? Or just keep handwalking and resting him?
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Member:
dres
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Posted on Sunday, Feb 17, 2008 - 4:06 pm:
Michelle, that 'only one chance' was me.. and IF they reinjure the same spot.. of course you have to start all over and 'chances' are it will compromise the healing... BUT do you know if he reinjured himself.? He could have had a nice scary to you, romp around but did nothing to exasperate the injury..
I can't answer the other questions but i know IF my filly had gotten away i would be icing and resting her, and backing down on her program till i found out IF she had done any further damage..
On the first day God created horses, on the second day he painted them with spots..
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Member:
caymie
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Posted on Sunday, Feb 17, 2008 - 4:29 pm:
Hi Michelle,
One of my horses is currently being rested/rehabbed for a straight sesamoidean injury. We are almost at the four month mark, and he has a recheck this Wedneseday. He too had three shockwave treatments and has been resting in his stall/run with daily handwalking. He is a horse I adopted from a rescue, and this was a chronic injury that he had prior to being adopted by me.
Anyway, he had a runaway episode early on in his rest/rehab period and it did not set him back at all. I realize this doesn't mean that your horse's episode hasn't caused a reinjury, but I thought you might like to hear of a similar experience that didn't cause any long term damage. His healing has been slow going but he is now almost sound. In fact, he may be sound, but I haven't been able to look at him due to the weather/slippery footing. I'll know more on Wednesday after the vet check.
Good luck and don't give up! Maybe your horse needs some sedation prior to being handwalked? Have you asked your vet about this?
Mary
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Member:
stevens
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Posted on Sunday, Feb 17, 2008 - 7:41 pm:
Michelle,
Boy do I feel for you! As mentioned already, it could be that the romp didn't cause a re-injury. While you may be exasperated, the injury may not have been exacerbated (Sorry Ann, couldn't resist  ). If the original injury was visible on ultrasound, you may want to do a recheck at 60 days anyway, then you'll know.
Regarding the 3rd SW, I have no idea as to whether it would be a problem or not.
My horse had a much more sedate romp after dumping me a couple of weeks ago. He's recovering from a tendon tear of the superficial flexor tendon. I hosed his leg afterwards and applied a pressure wrap even though I didn't feel any heat and there was no swelling. A couple of days later he had a recheck and was still on course for his recovery. I hope the same is true for you.
Good Luck.
Chris
P.S. Ace is my new best friend in the rehab process.
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Moderator:
DrO
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Posted on Monday, Feb 18, 2008 - 5:57 am:
Michelle are there signs he reinjured himself? If you are uncertain, yes you should have the horse examined.
DrO
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Member:
spinosa
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Posted on Saturday, Feb 23, 2008 - 12:11 am:
Great news - Even though my horse did seem sore after is two minutes of wild galloping freedom, the ultrasound did not show that the core lesion was larger, and actually my vet was stunned at how rapidly it had filled in! Maybe shockwave treatment really does work!
Thank for all your advice and support. Things are looking up. :-)
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Member:
ekaufman
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Posted on Saturday, Feb 23, 2008 - 12:13 am:
Hi Michelle,
Glad to hear no harm done, apart from the extra gray hairs for you. Hope everything continues to progress well.
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Moderator:
DrO
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Posted on Saturday, Feb 23, 2008 - 8:32 am:
I don't think it is clear that the shockwave effected this outcomes Michelle. Recent research on large numbers of cases has been more negative than positive lately concerning ECSWT and soft tissue injury, but congrats on the exam. It is an as of yet unexplained observation that given similar injuries that some horses heal soft tissue really well and others much less well. Sounds like you got a good one.
DrO
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Member:
stevens
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Posted on Saturday, Feb 23, 2008 - 10:29 am:
And there was much rejoicing!
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Member:
caymie
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Posted on Saturday, Feb 23, 2008 - 3:19 pm:
Great news for you and your horse Michelle!
Mary
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