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  Discussion on 3 of 4 legs with Suspensory Desmitis - Questions on rehab
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New Member:
babyzeke

Posted on Sunday, Aug 1, 2010 - 10:00 am:

Hello all, am a first time poster. I did read all relative posts, and I think my questions are somewhat unique and would appreciate opinions and advice from Dr. O. I'll try to be brief!!
History: 13 yr. TB Gelding with intermittent lameness, injected hocks, still not relief so went to clinic for exam. Did blocks and Ultrasound to come to diagnosis of chronic PSD, bilaterally behind. Decided to proceed with having the neurectomy/fasciotomy surgery on 3-30-10. Surgery successful - or as expected, and I proceeded with rehab plan of hand walking.
Then in the beginning of June I was up to 40 mins of hand walk and was told I could do some of the walk work while mounted. He was fine with the first 2 ten minute sessions, but the 3rd time ridden, he balked and kicked out and was uncomfortable. I put him on a lunge for a quick 1/2 circle of trot to see he was lame to the right. Went back for recheck on 6-18-10, he was sound on the straight and hinds looked great - but when ridden to right we saw lameness. We did blocks and US and Xrays and determined diagnosis of Bilateral forelimb lameness (was off a bit on LF, but nothing on US)/ Right fore proximal and mid body suspensory ligament desmitis.
Opted for PRP treatment, vet felt shockwave not the best choice for the location described as areas of hypoechogenicity and irregularities in fibre pattern of the RF SLig from levels 1B-2B with the most prominent enlargement in cross sectional area seen at level 2A.
Hinds showed immature fibre pattern as expected.

Ok - so here are my questions and concerns!

1)When first experiencing the lameness issues, it all seemed to come from the rear, and I certainly did not have a "lame" horse to the right. He had been on 2 months of stall rest with graduating hand walk when he went lame on RF. It is thought he had the issue all along, but is it possible it is all a compensatory RF Suspensory injury? Or that it flared up so much due to all the surgery and pain in the hinds?

2)He has been downgraded from an 85% chance for full recovery to only a 50% chance with the discovery of the RF issue. It is felt the older the damage, the less likely it will recover completely. Do you think PRP is as likely to work as well in an older injury as with a new one? Has anyone had this type of foreleg problem and had successful rehab and return to work?

3) It is thought if the next US (Aug. 17th) is good, he can have some hand trot and ridden walk work (straight lines/firm surface) I am really afraid to get on him again as it seems he "fell apart" last time I tried ridden work. My question here is - Is ridden work preferred in the sense that it is an important part of beginning to strengthen the suspensory by adding weight? I dont' want to rush anything, but I understand too little excersize will inhibit healing.
Would just hand walking with some straight line trotting (me jogging down the long side of arena I am thinking) be as good or better? I was thinking along the lines of following your guide for rehab, and doing more hand walking for a while and putting off the riding, since the RF is only 60 days since diagnosis. (will be at time of next US)
Any suggestions are really appreciated.

I also have the dilemma that I need to either find a safe stable with an indoor, to continue the rehab properly, or be limited keeping him at home. I will be a wreck putting him in someone elses care, (there is not a small paddock off the stall, in a controlled, quiet environment like I have now) I worry he may act up and get loose being walked out to his paddock (plan to only go to a 30x30' with a nearby pasture mate) Or that something will excite him being that it is a new place and he is fresh and still basically on stall or paddock rest and he'll re injure.

I watch him every second he is in his outdoor stall now, and feel much better having him safe at home, but we have no indoor or outdoor arena, only a small gravel paddock and a stretch of flat drive way. The paddock is about the size of a small dressage arena. (2ox60 meters at most)

4) Is that big enough to do my rehab work in, if I keep him here? ?
Will the trade off of assuring he is safe and calm, be worth giving up an indoor arena for the long cold winter? If I have days that it is not safe to ride or walk him due to ice or snow, will it adversly affect his outcome?
I will do all I can weather permitting - but am wondering - could he have the winter off (with some daily hand walk at a minimum) or does he NEED to be ridden and worked thru the winter to assure proper healing and strengthening.
I don't plan to just leave him alone, but would a light excersize program and having the winter off maybe be the right thing to do? I also worry I may do too much if I have a nice big indoor to ride him in.
I have come this far and patience has already been proven on my part - my gut tells me to go slow - but what is too slow?

5) Lastly - Dr O, in another post you mentioned that a person could look for visible or palpable lesions on the suspensory (I think that was your wording) I am wondering, if at this stage, can I see if there are areas? - if there are thickenings felt, what does that mean?
Also is there any massage that can be done to stimulate healing of the suspensories? I did scar therapy for the hinds and just enough on fronts for circulation, but would love to do more.

He gets Adequan (weekly for 7 weeks), Smart Tendon, MSM, Vit E/Sel/Mg/Cr supplement and about 2 cups of ground flax seed daily. Anything else I can be doing or giving?

THANKS SO MUCH!!
New Member:
babyzeke

Posted on Sunday, Aug 1, 2010 - 10:38 am:

I should add to the above: I had this horse stabled (with an indoor and sand outdoor with footing that was too deep) and decided to move to a different stable, and planned to go there after the vet check. When I got the PSD diagnosis, I took him home instead to barn I manage, which is a nice place on the horse trails - but too hilly for what I need to do for rehab.
I ride him dressage and have done a little jumping. He was in great condition at time of diagnosis.
I would like to return to dressage work as he can handle - he is not going to be a trail horse, a bit too hot!
Moderator:
DrO

Posted on Monday, Aug 2, 2010 - 3:50 pm:

Hello Lori,
Taking your questions in order:
1) Yes it is possible that your horse has a RF suspensory issue because if he has been very lame bilaterally behind.
2) No, it will not work as well with chronic injuries.
3) Walking or jogging in hand will certainly be easier on him than if ridden.
4) I am not sure working on gravel is a good idea even with a sound horse.
5) I am not sure of this question, you should be telling me whether you can see or palpate swellings. If you do and they are soft this is fluid, if firm it will be scar tissue.
DrO
New Member:
babyzeke

Posted on Monday, Aug 2, 2010 - 4:29 pm:

Hi thanks so much for your input.
So, if I take the word "if" out of question #1- to clarify: you do feel that he could have gotten a LF suspensory injury from having issues in the rear?
Would you think I could gleem a bit of hope from this, as it would be considered a more recent than chronic issue?
#4) Do you think it ok/better to just hand walk on the gravel lot over winter, or would you encourage more work in an indoor arena for proper rehab? Not fully content with the answer, only because I am trying so hard to make the decision to leave him here or move him. If I dont' ride him on the gravel, and just hand walk, could you give your opinion on that vs ridden arena work thru winter, and which may better help heal him?
thanks, all opinions from any readers welcome too, but Dr O, I truly appreciate your input.
Moderator:
DrO

Posted on Tuesday, Aug 3, 2010 - 7:31 pm:

Lori you are asking for answers that I have no way of knowing. Ultrasound is likely to give you the most information and chronic changes suggest a degenerative process while acute changes might suggest injury from overwork. What do your veterinarians say and what reasons do they give? Either exercise is likely to be helpful and one not clearly better than the other. Will the horses feet stand up to the type gravel you have and the type work you want to do?
DrO
Member:
babyzeke

Posted on Tuesday, Aug 3, 2010 - 7:56 pm:

Hi, sorry if my questions are not easy to answer. My Vets are helping a great deal, but it is a busy vet school and they are busy vets, so I 'd like extra opinions. He has eggbar shoes on all 4. The gravel is actual limestone, that is worn down to not much cushion and has a few stones, so to go "worst case" I say gravel.
I think they are moving us along quickly and I may want to tend toward a more gradual or conservative progression and am looking to get opinions on the level of work it takes to heal, without doing too little. Does that make sense? When they say I can go to ridden walk, then ridden trot work, what happens if I just continue hand walking? Will I be doing him a dis-service by NOT getting going on the ridden work? I thought this was a vague enough question, but I know you are trying to help my specific issue. I have the reports and cd's of US's, but am just trying to keep it general. I have heard of people just giving a year off. Am wondering what they do inside this year. Hope this helps you to answer me, I did also open a new discussion earlier, so please look to that so as not to have to duplicate, I imagine you are taking in the order given. Thanks again!
How do others get so much input to thier questions? Must be on the site more than I have time to be!
Moderator:
DrO

Posted on Wednesday, Aug 4, 2010 - 6:35 pm:

If you continue walking the tendon will continue to heal however the more the stress is without reinjuring the tendon the better the healing will be. That is the tough part no one knows exactly where that point is.
DrO
Member:
babyzeke

Posted on Wednesday, Aug 4, 2010 - 8:01 pm:

Ok, thank you. So, maybe one could say that a good lot of handwalking (45 mins to an hour a day) is a good way to gently stress the ligament to promote healing and reduce likely hood of scar tissue, and anything (ridden and trot work) above and beyond may be beneficial to conditioning but may or may not be too much stress to the healing ligament?
So you feel handwalking is enough? (taking the safe way?)
Moderator:
DrO

Posted on Thursday, Aug 5, 2010 - 5:57 pm:

Sooner or later I presume you are going to have to ride this horse and that would best be done by starting easy Lori.
DrO
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