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  Discussion on Surgery for supensory injuries
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New Member:
Jamie111

Posted on Tuesday, Feb 21, 2006 - 1:21 pm:

Hi, Dr. O. My 15-yr.old TB gelding has desmitis in both his hind suspensories. Our local equine hospital has presented me with an option of surgically splitting the ligament to help the healing process. They said that they've found it to be a fairly successful procedure. What are your thoughts on this type of surgery and chances of recovery? Thanks for any shared experiences.
Moderator:
DrO

Posted on Wednesday, Feb 22, 2006 - 11:10 am:

Welcome Amy,
It depends on the type of desmitis. We have an article on suspensory desmitis that talks about the various types of injuries and the therapies which have helped at Equine Diseases » Lameness » Diseases of the Lower Limb » Suspensory Desmitis, Strain, & Sprain.
DrO
New Member:
Jamie111

Posted on Wednesday, Feb 22, 2006 - 3:04 pm:

Thanks, Dr.O. Yes, I've read the article, and it was helpful. However, I don't recall seeing anything on surgery for treatment. The following is the report given to me after our initial visit and ultrasound in September '05:
Ultrasound examination of the right hind suspensory ligament revealed increased cross section area (2.25cm) at the origin of the suspensory ligament. A hypoechoic area corresponding with shortening of the fiber pattern between 16 and 24 cm distal to the point of the hock was also found. The left hind suspensory has increased cross section area with a hypoechoic area between 16 and 20 cm distal to the point of the hock.

Also, let me give you a condensed background history. The initial lameness exam was performed because my horse was having what I considered to be a back problem that was only evident to me when I was riding him. He felt as though his whole back end would DrOp out and would stay like that until I got up off his back for a while. Normally, I could work him out of it. It became a more consistent problem over the summer, and he was worse when traveling to the right.

The vets watching him at his initial lameness exam could see a lameness while he was jogged in hand. He wasn't (and isn't) head-bobbing lame, or clearly favoring one leg, but rather he's crossing over his legs in a tightrope manner. He apparently looked worse on his hind right, so they began by blocking parts of that leg, starting with the ankle, then hock, then a low four point. Based on their assessment of him improving with the low four point block, they ordered sonograms of both hind suspensories and found that there were indeed problems (as described above)

I've since learned from further exams, that he also does have stifle problems, as seen on an abnormal x-ray of the left stifle and increased uptake on a radioactive scan in both stifles. So it appears as though he has multiple issues -- both stifle and suspensories. As of this week, he's still lame, and I'm questioning whether his problems are actually more from his stifles rather than his suspensories, and whether or not you feel that surgery is an option if indeed his suspensories are the source of his lameness. Do you feel that scoping his stifles would be worthwhile?

Sorry, because I know my post is a bit all over the map. Please let me know if my questions or descriptions are unclear -- I'm new at this, and it's harder than I thought it would be to be concise!
Moderator:
DrO

Posted on Thursday, Feb 23, 2006 - 8:33 am:

Hmmm an odd history for the diagnosis. It is my opinion that if the lameness blocks out with a low 4 pt (this is done at the level of the distal cannon) neither the proximal suspensory nor stifle are involved with the lameness despite the fact there are abnormalities on radiographs, ultrasound, or scintigraphy. For more on this see, Equine Diseases » Lameness » Localizing Lameness in the Horse.

Surgery is not mentioned for proximal suspensory desmitis because I do not think it is indicated as it is with main body chronic desmitis.
DrO
New Member:
Jamie111

Posted on Thursday, Feb 23, 2006 - 11:03 am:

Thanks for your response. I know, the diagnosis doesn't make a lot of sense to me either. What would the low 4-pt. positive block be indicative of if not the suspensories? In your experience, what would be causes for a horse to 'DrOp out' in the hind end when under saddle. I don't believe it's a bad saddle fit, as I've had him saddle fitted and tried different saddles with no change in his performance. The radiograph of his left stifle shows a 'subchondryl bone defect'. It's just a slight flattening of the bone, and the vets don't feel like that would be significant because he improves so much with a combination hock/low 4-pt block. Also, they found 'old OCDs' in his hocks that they don't feel would be causing his lameness. Do you think that his 'rope walking' in the back would be a sign of his suspensory problems?

Thanks again for your help.
Member:
Lilly

Posted on Thursday, Feb 23, 2006 - 1:03 pm:

Hi Amy,
What do you mean by the following? :

"In your experience, what would be causes for a horse to 'DrOp out' in the hind end when under saddle."

I am very curious because my horse has degenerative suspensory ligament desmitis.

Ann
Moderator:
DrO

Posted on Friday, Feb 24, 2006 - 7:32 am:

You are going about the problem wrong Amy. You don't start with conjecturing what might be wrong, there are hundreds of possibilities. The first question to pursue is where is it at. The lameness observed by the veterinarians during lunging is a likely cause of the problems you observe or feel while under saddle.

The exam as you describe it above, strongly suggest that the lameness is below the point the low 4 pt was done. Now they need to discover whether it is the foot, pastern or ankle using more precise blocks.
DrO
New Member:
Jamie111

Posted on Friday, Feb 24, 2006 - 4:44 pm:

I mistakenly said low 4-pt -- he actually blocked out 60% with a high 4-pt.

Yesterday, he had the procedure (desmoplasty sp?). I was told that by making small incisions in the suspensories, it will alleviate some of the swelling and bring blood to the area to promote healing. I am going to do my best to follow protocol for his injury by keeping him in his stall for 6 weeks, adding in the hand walking, etc. I will post updates to let you know how he progresses, and if in fact when his sonograms are better and his lameness goes away, his back end problems under saddle also are resolved.

Ann, by DrOpping out I mean that he will go from a normal trot, where he's using his back end, and I feel a good, upward thrust out of the saddle, to suddenly feeling like there's no upward thrust from his back end. My daughter and I also describe it as feeling like a flat tire because everything just becomes flat. If we get up in a very forward 2-point position, often we can 'push him' through the bad steps and get him to resume using his back end. It feels worse than it looks from the ground. What are you horse's symptoms? Is he rideable? What treatments have you tried?

Thanks, again for your help Dr. O.
Member:
Lilly

Posted on Friday, Feb 24, 2006 - 7:39 pm:

Hi Amy,
The "DrOpping out" that I experienced was at the trot while I was posting. I was posting up and down with no problem. I would rise out of the saddle and then sit lightly and then rise. All of a sudden when I expected to feel the saddle brushing my butt - it wasn't there. It was like the saddle was much lower than it should have been, like it DrOpped or something.

Sebastian has DSLD. His ultrasounds show significant thickening all the way to the proximal suspensory. The maximum cross section that I could find in his ultrasounds is 2.98 cm squared. His fetlocks are very DrOpped. So far he isn't showing any other DSLD symptoms like the weight loss, bunny hopping or leaning on buckets or fences for support. The vet said he is in mid to late stages. There is no treatment that isn't highly controversial and questionable. Some horses are shoed with Patton shoes which elevate the heels very high and are gradually lowered. I wrap Sebastian's hind legs with pillow wraps and polo wraps every night and keep him in 4 steel shoes. The back shoes are slightly extended. There is also some thought that a low carb diet may help. To make matters worse I need to ship Sebastian 1200 miles this fall to his new home.
Moderator:
DrO

Posted on Sunday, Feb 26, 2006 - 8:56 am:

It certainly sounds more reasonable with the block results, so keep us appraised as to the results.
DrO
New Member:
Jamie111

Posted on Monday, Feb 27, 2006 - 12:10 pm:

Ann, I'm really sorry about your horse. How long has he been affected by his condition? Was his 'DrOpping out' your first indication that he was having a problem, or could you see an obvious lameness or problem on the ground? Dr.O, how would one know if suspensory problems are degenerative in nature, or a result of trauma or injury? Or can one lead to the other?
Member:
Lilly

Posted on Monday, Feb 27, 2006 - 1:11 pm:

Hi Amy,
Sebastian has had DrOpped fetlocks since at least 2000. He was first diagnosed with DSLD in May 2003 via ultrasounds. I noticed in his records that he had Legend injections a few months before the ultrasounds. Maybe the injections did not help and that's what led to the ultrasounds being done. I did not obtain these medical records until after I had him ultrasounded in Dec 2005. At that time the diagnosis was the same. I am just the first person to take this condition seriously and make an effort to do the research and find ways to make him more comfortable. The "DrOpping out" sensation was one of the first hints that I may need to stop riding him. From 2000-2003 he was chronically lame for his owner (dressage rider) but he has never been lame for me. At least I don't think he has ever been lame. It is possible that I can't tell because both hind legs are effected. I am not riding him because the vet suggested I don't.

I believe that the only way to determine if suspensory problems are degenerative is by ultrasound or necropsy. When a horse injures its suspensory it should heal in a certain way that can be identified by ultrasound. If a horse has DSLD, the injury will not heal correctly and that produces a pattern that can be picked out by a vet who knows what to look for. Please correct me if I am wrong here Dr.O.

Before I invested in ultrasounds for Sebastian, I had his iron tested. For some unknown reason, a large percentage of horses with DSLD have an iron overload. Sebastian's test came back indicating an iron overload so I decided to get ultrasounds and go from there. If you think there is a possibility that your horse has DLSD then go back to the website I mentioned earlier. They would be more than happy to help you. They may even provide funds to help pay for ultrasounds if you need them.

Ann
Member:
Jamie111

Posted on Monday, Feb 27, 2006 - 1:51 pm:

Thank-you for sharing your horse's history with that disease. I'm sorry. Sounds like you've done / are doing your best for him.

I will check out the web site, and keep my fingers crossed that my horse is not inflicted with a degenerative disease. His fetlocks are not at all DrOpped. I'm pretty sure his problems at this point are closer to point of origin and are not thickened or injured down towards his fetlock.

I have my horse on stall rest now. I'll post with his progress after his 6 week re-check (which will be at the beginning of April). I feel so sorry for him being in his stall I can't stand it! They gave him an injection of fluphenezine upon my request. I can't really tell if it's helping him or not.
Member:
Lilly

Posted on Monday, Feb 27, 2006 - 3:40 pm:

Hi Amy,
I just realized that I didn't post the DSLD website on your thread, I posted it on another thread. Here it is: www.dsldequine.info

Ann
Moderator:
DrO

Posted on Tuesday, Feb 28, 2006 - 7:35 am:

Hello Amy and Ann,
Clinical signs and history of the 2 can be quite similar early in the disease. The number one factor I would look for early is that DSLD is bilateral while traumatic desmitis rarely presents this way.
DrO
Member:
Jamie111

Posted on Tuesday, Feb 28, 2006 - 1:14 pm:

I am worried now, since my horse 's problem is bilateral. My vets never mentioned the word degenerative, so maybe they have a reason to think that it's not the case. I'm putting a call into them to see what they think.

Ann, thanks for the link. Some of the symptoms match up to Major's, but most don't. I suppose he could be in the early stages. I'm worried.
Member:
Lilly

Posted on Tuesday, Feb 28, 2006 - 1:53 pm:

Hi Amy,
I am sorry that you haven't been able to pinpoint exactly what is wrong with your horse. I really hope that it is not DSLD. It's definitely a bleak prognosis. I thought of DSLD immediately after I read your first post but I decided not to respond right away. I don't want to turn into one of those fanatics who suggests every horse with a leg problem must have DSLD - just because my own horse has it. My horse is a thoroughbred and was officially diagnosed in his teens.

DSLD is very frustrating to deal with because there are MANY different opinions about it. I met with my vet this morning to go over Sebastian's ultrasounds from 2003 and 2005. He would not say for 100% certainty that it's DSLD (He is not convinced it effects all breeds). I have had one other vet (very qualified)refuse to say it was for sure DSLD (he said to wait for the necropsy!) and three other vets say yes it is DSLD (based on ultrasound reviews). The only thing that they can all agree on is that the suspensories are quite thickened and his fetlocks are very DrOpped.

I believe that Dr.O is much more up to speed on DSLD than a lot of other vets. He should be a lot of help for you. By the way, where do you live?

Ann
Member:
Jamie111

Posted on Tuesday, Feb 28, 2006 - 3:54 pm:

Hi, Ann. Yes, I can now see why DSLD would have struck you as a possible cause for my horse's bilateral suspensory desmitis and odd lameness. I'm extremely worried now, and I'm wondering why it never occurred to me earlier, considering I've read all the articles on this web site regarding suspensory injuries.

I talked to my vet earlier today and let him know my new concern about possible DSLD. He says he doesn't think Major has presented in such a way that would lead him to believe that is his affliction. He's a very nice doctor (a resident at Leesburg, but very knowledgeable), and I've sent him the link to the web site.

I'm guessing that if Major has DSLD, it's very early stage. We're going in for sonograms at our 6 week check following surgery. I will just keep my fingers crossed that he shows much improvement at that point, and maybe we'll be able to rule out the possibility that it's a degenerative condition.

From what I've now read, I'm surprised that your vets are so reluctant to diagnose Sebastian with DSLD, because it sounds as though he has all the classic symptoms. However, regardless of their definitive diagnosis, there doesn't seem like there's much to be done other than what you're doing. How old is Sebastian now?

I live in Maryland outside of DC. He's been being treated at the equine hospital in Leesburg, VA and I think the doctors there have done a very good job. (His surgery was performed by Dr. White, who I saw in another post was an old professor of Dr. O's). However, if his condition worsens, I might consult with one of the vets listed as experts in DSLD diagnostic protocol. I saw there are a couple in my area.

I think I'll try not to panic yet, and just wait out this period of rest with him to see how he does.

Thanks, again, Ann. Your information has been very helpful. Good luck with Sebastian. Please keep us posted and I'll do the same.

Amy
Member:
Lilly

Posted on Tuesday, Feb 28, 2006 - 10:35 pm:

Amy,
You live in a very good part of the country as far as equine medical facilities are concerned. I had Sebastian's ultrasounds (Dec 2005) done in Northern Virginia by Dr.Kent Allen. He is located in The Plains area. Back in the 1990's he had death threats from Peruvian Paso breeders because of the research he was doing into DSLD. It affects PPs very hard and the breeders didn't like what the vets were saying about their horses.

If your horse has DSLD, then it should reveal itself during the surgery. The suspensory ligament will not be of the right consistency. DSLD horses do not heal right. The collagen is replaced by cartilage like material. There are some vets that believe any healing to the suspensory can prove to be helpful, even it is a "wrong" type of healing. The horse is not cured but may be kept comfortable for a lot longer. I recently had the opportunity to look at and feel a healthy suspensory ligament in a cadaver leg. It is so thin and slippery and shiny white in color. I can now understand why a cross section of 2.98 cm squared is unhealthy!

Good luck and please keep me posted. Oh, by the way, Sebastian is 20 and Dr.Allen gives him 2-3 years before he will be in severe pain and will have to be put down.

Ann
Moderator:
DrO

Posted on Wednesday, Mar 1, 2006 - 7:27 am:

DSLD is a diagnosis that should be avoided until it becomes clear but once the fetlocks DrOp for me that is it. I have not seen a horse that did not get progressively worse from that point on. Amy despite the bilateral finding the lack of characteristic US lesions are encouraging.
DrO
Member:
Jamie111

Posted on Wednesday, Mar 1, 2006 - 9:22 am:

Thanks Ann and Dr. O. I'll remain positive about his chances of a full recovery. You're right, Ann. I'm lucky to have access to so many good vets (plus the good advice of Dr. O!). Best of luck to you and Sebastian. Keep us posted and I'll do likewise.
Member:
Jamie111

Posted on Wednesday, Apr 12, 2006 - 6:29 pm:

Hi, Dr. O and Ann. I took my horse back for a re-check sonogram after his desmoplasty on Feb. 23 and six weeks of stall rest. I was told that he looks better although there are still short fiber patterns (as opposed to the more normal long fibers), and that I can start hand walking twice daily, but that he'll need to be kept in his stall for at least 3 more months. My question for Dr. O: Other than a vague, "he looks better" are there specifics or quantifiable ways in which I can be assessing his progress? Should the doctors be giving me numbers and measurements each time he's sonogrammed? Should they be able to provide me with a report that states the various numbers from each of the 4 times since September that he's been sonogrammed? I'm assuming (but maybe shouldn't) that because of the fact that they've told me he's better that he does not have a degenerative condition. When I specifically asked my vet about that possibility, he told me that it's not often seen in TBs, but I'm not sure that's correct. I'd appreciate any advice on how best to proceed at this point. I don't want to blow his recovery, but 3 more months of stall rest seems like a long time for mild to moderate desmitis (which was his original diagnosis).

Thanks very much for any advice you can offer.

Amy
Member:
Lilly

Posted on Wednesday, Apr 12, 2006 - 9:49 pm:

Hi Amy,
Thanks for the update. I know it is hard to keep a horse on stall rest but it seems like it is very beneficial for suspensory injuries. Every time I read an article or case study concerning a suspensory injury, it seems like rest is a major key ingredient.

I also question the vet claiming that degenerative suspensory problems are not common in thoroughbreds. Also, my good friend that had a thoroughbred with DSLD was able to improve his condition with patten shoes. Even though his situation improved, he still had a degenerative disease.

I look forward to reading what Dr.O has to say.

Ann
Moderator:
DrO

Posted on Thursday, Apr 13, 2006 - 8:48 am:

Acute injury usually causes swelling and as healing occurs the size returns toward normal. What capabilities your vets US machine has determines what measurements are available. Changes in the cross sectional area of the suspensory and lesions and the length of the lesions suspensory that it occurs is important diagnostic and prognostic information. Very good machines can actually convert the above information to the "volume" of the lesion.

For example how has the area or volume of the short fiber lesions compare with the last US?
DrO
Member:
Jamie111

Posted on Thursday, Apr 13, 2006 - 11:41 am:

Thanks, Dr. O. I'm planning on taking him back in 4 weeks for a re-check (it will be my last chance before my insurance runs out) at which time I'll ask those specific questions. I'm guessing since my equine hospital is a large, respected facility which seems to have all the latest and greatest equipment, that they should have the ability to give me those answers.

Other than me feeling a 'DrOpping out' under saddle, his lameness has been diagnosed when trotting him in hand as he crosses under himself with his hind legs. I've heard it described as rope walking. At our check last week, he seemed to be 'rope walking' more than before, although my vet said he thought he looked more comfortable to him. I know there's probably not a lot I can do other than wait this stall rest out, but if I don't think there's a chance of him improving, I'd rather not be forcing him to stay inside 24/7 (other than our short walks and grazing). It just seems so sad.

Ann, I consulted with my farrier--who I think is great--about taking his back shoes off for a while. He thought barefoot was definitely the way to go as long as his feet hold up. Since he's not going out or being ridden, he'll be fine for the time being. He felt like the way the horse's foot is naturally built provides the best support for the legs (which is similar to advice I've read on this web site as well). However, I know there are some who feel that special shoes can be helpful. So, I will keep the patten shoes you mentioned in mind down the road if his problem worsens or doesn't improve.
Member:
Lilly

Posted on Thursday, Apr 13, 2006 - 2:15 pm:

Hi Amy,
Actually I am kind of confused as to what to do with my horse's back shoes. The equine podiatrist recommended patten shoes but my vet was hesitant to lift his heels as much as the podiatrist wanted to. Sebastian's hooves crumbled away around the nails holding on his regular shoes so I decided to let him go barefoot for a while. Ever since I took off his shoes, he looks more comfortable. He is actually able to keep both of his hind feet flat on the ground at the same time. So, I don't know if barefoot is better or if shoes are better.
Member:
Jamie111

Posted on Thursday, Apr 13, 2006 - 2:49 pm:

It's always hard to know what to do. I guess if your horse's feet crumble and fall apart without shoes, you don't have a choice. I'd say if his feet are holding up without them, then I'd give barefoot a try for a while. My farrier explained how the horse's foot provides natural suspension for the leg, and when you add a shoe, it takes away that support. I'm not sure if I totally understood what he was saying, but based on his recommendation and what I've read from others on this web site, I really felt like barefoot sounded like a good thing to try. Not to mention less expensive! I'm glad to hear Sebastian seems more comfortable without.
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