# Proximal Suspensory Desmitis and surgery - experiences please



## BlueFire710 (11 September 2013)

Hi there,

My horse has just been diagnosed with proximal suspensory desmitis (with bone involvement) in both hind legs and the vet has said that surgery - denerving the proximal suspensory ligaments - is the best course of action as shock wave therapy won't be enough in this case. 

I am concerned about the risks of surgery and also the prognosis - I have been told an 80% success rate but would like to know whether this is the reality, whether this is recovery that lasts long term and what level of return this involves so if anyone has gone ahead with the surgery for this issue I would be very grateful to hear your experiences (pm great too if preferred). Also, if anyone was told the same as me but decided not to do the surgery I would be very grateful to hear how this turned out to.

Many thanks!


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## Tiffany (11 September 2013)

A friend of mine had same problem with her dressage mare. She had the op and is now back competing very successfully. I think the success rate depends on extent of damage to start with together with conformation and how you bring them back into work.

Good luck with whatever you decide.


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## mjcssjw2 (12 September 2013)

mine was done 10 years ago, recovery absolutely no problem. no problem with them since (touchwood), shockwave didn't work for mine at all, he also had a fasciotomy I believe - it was a long time ago.
Worst thing that happend to mine is that he got ringworm - I assume from vets and as he was stressed as he had to have 2 operations - one on each leg, one day and then the next.
Has the vet given you a prognosis? mine gave a poor prognosis at the time. hope that helps


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## BlueFire710 (12 September 2013)

Many thanks for both of your replies! Great that they are so positive as well. Prognosis currently is just that if the operations are successful (80% chance they will be) then we will go from there but hopeful that he will at least return to current level - Newcomers BS - and possibly be able to go on. I have been told that it is a case of one step at a time though and not definite how long he would remain okay for so your case especially mjcssjw2 is very hopeful. And Tiffany that such a full return is possible is also great to hear. 
Thank you both so much for taking the time to reply!


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## Gorgeous George (12 September 2013)

Hi, my horse is 9 weeks post neurectomy and fasciatomy surgery for hind leg (both) PSD. I was shocked when I discovered he had to have an operation, the vet told me that shockwave therapy would probably have a 40% success rate, but the surgery would be more like an 80-85% chance of a return to full work and if I was happy with just hacking (which I would be if it came to it), then more like a 95% chance of success.

So far so good, George did come round badly from the op and made a mess of one of the incisions which took a long time to heal so he ended up on box rest for 8 weeks instead of 4! However after 2 weeks strict rest I was walking him for 10 mins twice a day. Last thursday he was given the ok to go out in a small paddock for a few hours a day, and is now being walked once a day and when I get back from hols I will be building the walk up by 5 mins a week and once we are up to 20 mins I am allowed to get back on 3 x a week. However the walking has to be done on hard ground and mostly in straight lines, so it is going to be fun as it gets dark! I have decided to take the rehab really slowly in the hope that it will give us a better outcome, and the vet was happy about my decision to do this.

I'm sorry I can't tell you about the future as we are only at the start of the rehab, but the vet did ask to see George briefly trotted up last week and he was at least sound at that point. George means the world to me and we have had 6 years of relatively trouble free riding (he's 13 now), I would love to carry on competing on him (jumping & dressage), but if I can only hack I will be terribly disappointed but happy that I still have him. So I will have to wait and see.

Good luck with yours and whatever you decide.


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## BlueFire710 (12 September 2013)

Thank you for your reply Gorgeous George! I will have my fingers tightly crossed for you that George's rehab continues to go well!


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## soulfull (12 September 2013)

Sorry but mine isn't good news.  Both mine and a friend have lost horses to this
Mine had surgery on right hind only to find out he had it in front legs too. He should never have been operated on. But I didn't know about the degenerative disease then

Friends dr horse had it in both hinds. After what happened to me she insisted fronts were scanned too, unfortunately although mild it was there. She too lost her horse

I would never again have surgery without scanning other legsfirst 

I hope it works out for you


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## jessieblue (13 September 2013)

Hi, my boy had surgery for bilateral hindlimb psd 2.5 years ago.  My vet did make it sound a very straightforward fix and the prognosis was expected to be very good with a 90% chance of returning to his normal level of work which was BE90/100.  The surgery went very well, no problems at all, recovery was straightforward and the incisions were tiny and healed amazingly well.  I wouldnt worry too much about the surgery, I was terrified, but he coped no problem didnt seem in any pain and there is no sign of the incisions at all now.  He also had sacroiliac strain and this was medicated just after surgery.  Im not sure which came first but both things seem to go hand in hand and both were addressed at the time.  His back has been fine ever since as far as I can tell.  Due to being sent to a special rehab yard, who really held his rehab back for reasons best known to themselves, he spent 5 months on box rest just walking in hand. Once I got him home he had really lost all his supporting muscle.  This is probably why it has been a long road back for us.  However, 2.5 years and he is sound, back in work although I dont jump him.  This is maybe as much my fault as anything because I am just too afraid I will break him!  My vet didnt tell me I couldnt legally compete him BE once neurectomised.  If I had known this I may have tried shockwave and barefoot first, but I didnt really know anything about the injury at all.  I also wasnt told that there is an expected 2 - 5 year period for the horse to remain sound.  I found this quite worrying and obviously the operation doesnt stop the repetitive strain type of injury from continueing, it merely stops them feeling it.  I think it is really important to address all issues that may be a factor in why the injury occurred to start with during the rehab period.  Pay attention to foot balance and conformation, back issues, straightness/crookedness in work, physiotherapy can be useful to make sure they move correctly and dont put any undue strain on the ligaments.  Also it is advisable to have regular scans done to check for any deterioration to the ligaments during the years after surgery as he wont be able to tell you if they are deteriorating.  There is another form of PSD I think Soulfull referred to above and the prognosis for this is not so good.  Degenerative PSD can affect all four legs and it tends to affect horses from an early age.  Surgery is not usually considered for these cases but of course they are not always identified at the time.  My story is cautiously positive, its more my worrying holding me back than the horses injury!  He is doing really well and in work schooling/hacking etc.  I would do dressage but the ****** wont load so I have really given up on competing!  You are doing the right thing by getting as much info as you can before commiting to anything.  There is a discussion group on facebook, try PSD discussion group, very useful and full of experiences good and bad.  Most people seem to manage it and get back to a good level of work, but do expect setbacks and a long slow return.  It seems the faster retunrs to work can have a weaker recovery and more setback.  If you can address the reason why he has the PSD in the long run this will stop further deterioration.  Also be very cautious working in menages unless the surface is tip top.  PSD horses do find surfaces more difficult and this may also play a big part in the development of the condition.  Limit work on soft surfaces when you can.  Good luck I know how you are feeling right now!


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## BlueFire710 (13 September 2013)

jessieblue thank you so much for your reply. It has raised a number of extra points for consideration - i had no idea that it was illegal to compete BE afterwards - I imagine this may well be the case BS too which would be a huge problem for me. Also, my vet didn't tell me the 2-5 year expected okay period despite me asking this exact question and that is also a big factor for me. I will look for that facebook group also as that could be a great resource. THANK YOU! 

Soulfull thank you for your reply also. Possibly it is a slightly different type but I will be sure to consider the front legs before proceeding with anything too.


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## pollygbaker (13 September 2013)

hi please could u tell me the symptoms of the hind suspensorys and sacrilliac. i am having problems with mines coffin joints. someone has mentioned his suspensorys and he always is very tight and has spasms in his back even after back treatments. he is not lame but has short choppy strides behind, finds it hard to move forward and canter work is bad. thanks.
he is being looked at tomorrow by the way.


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## soulfull (13 September 2013)

Soulfull thank you for your reply also. Possibly it is a slightly different type but I will be sure to consider the front legs before proceeding with anything too.[/QUOTE]

I hope so. Unfortunately I didn't hear of it until after mine had the surgery


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## toomanyhorses26 (13 September 2013)

My mare had this in addition to a mulitude of other issues - si issues,kissingspines,arhritic changes in hocks and massive supraspinious ligament damage - I chose not to have her operated on as the damage was so severe. She basically had no normal suspensory tissue left so the operations that are available would have had a limited success anyway


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## jessieblue (14 September 2013)

No problem Bluefire.  Ask ask ask!!  Feel free to pm me I am only too happy to help.  I was so lost when it happened to me and no one had ever heard of it in my circle at the time, or at least no one admitted to it lol!!  I have seriously researched it for 2 years, now I catch my vet out on things!!  Im not an expert but a concerned owner who isnt just happy to take one persons word for anything where my boys are concerned.  I hope it all goes well and please let me know what happens.  Im sure it will come good, hang in and keep the faith, trust your instincts.

Polly, my boy had mainly back soreness, he wasnt lame, well vet said short behind, but actually I beg to differ.  He had a sore back for a long time, this then became more problematic, resistance in the school, bucking a little, hollowing all the time, no top line muscle.  Bucking into canter transition, going disunited in canter breaking canter.  They were vague sypptoms, many people told me there was nothing wrong with him.  I had three vets look at him in total before they listened to me!  I just knew he wasnt right and wasnt happy in his work.  Any of these symptoms could be back lumbar sacro iliac or hock/suspensory related, it is hard to tell.  If you know your horse isnt happy you will probably have to get a proper workup done to be sure.  Good luck with all your horses posters!


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## stencilface (14 September 2013)

BlueFire710 said:



			jessieblue thank you so much for your reply. It has raised a number of extra points for consideration - i had no idea that it was illegal to compete BE afterwards - I imagine this may well be the case BS too which would be a huge problem for me. Also, my vet didn't tell me the 2-5 year expected okay period despite me asking this exact question and that is also a big factor for me. I will look for that facebook group also as that could be a great resource. THANK YOU! 

Soulfull thank you for your reply also. Possibly it is a slightly different type but I will be sure to consider the front legs before proceeding with anything too.
		
Click to expand...

I'm not entirely certain, but I don't think it's illegal to compete BS post surgery, I think with BE the risk of hurting themselves on solid fences is just that much that they won't risk it (chance of rider injury goes hand in hand if horse can't feel legs) whereas with BS it might just mean that you have a pole, which is annoying, but not dangerous. Anyway, I'm not 100% sure but worth checking 

Mine had psd, but just had shockwave no surgery, 2 years on his psd leg is fine, but don't ask about the others lol


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## pollygbaker (14 September 2013)

thank you - having back lady/vet today - this sounds just like him though thanks so much


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## georgiegirl (14 September 2013)

you can compete BE and BS if you go for the fasciotomy on its own (sucess rates are slightly less) Thats our plan B with mine if conservative treatment doesnt work well enough.

good luck. Its a very annoying injury with slow slow progress


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## BlueFire710 (14 September 2013)

Hi pollygbaker, I expect you have had yours looked at by now but wanted to reply just in case not. The symptoms for mine were a deterioration of the quality of canter work to the extreme of not being able to get canter one way at all (very unusual for mine) as well as bucking in canter and extreme reluctance to do a flying change onto the bad lead. Mine doesn't look lame either as he's bilaterally lame.
I'm not sure what I'd say about your boy's symptoms as I don't know nearly enough to comment but hope that's helped a bit (if you've not already got answers from your vet).


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## BlueFire710 (14 September 2013)

Thanks for the other replies as well! That's useful as another option georgiegirl - I will ask my vet about it as it's not been mentioned (I don't think - I was a bit in shock!) and alot better regarding the legality of competing (though really its only a dream to get him back to that at this point). 

Stencilface that does make logical sense re the solid fences posing more of a risk to a horse (and so rider) that can't feel everything and I will confirm for sure re BS.

jessieblue thank you - I may well pm you (if you really don't mind being bothered) as more questions come into my mind. I feel so lost as although I knew he wasn't right he was jumping great just a few days before so I didn't think it would be as bad as it is - still trying to adjust to what it all means. I don't know a lot of horsey people to talk to and the ones I do know don't really seem to have any knowledge of the injury either so to have someone who's been through it and has looked into it as much as you sound like you have is a fantastic find! I'll be in touch!


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## jessieblue (14 September 2013)

I really dont mind at all!  I could bore the back legs off a donkey about PSD and navicular (another story lol) so feel free!  It is a strange one, most people who have been around performance horses for any time have had experience with suspensories.  Most professionals would have encountered it!  Its not always talked about because people do compete after the neurectomy as it is really not possible to police.  Vets never put it in the horses passport and in my experience they are complicit with "keeping it under your hat".  Strictly speaking the ruling under BE (this is my area as never BS d) is not based at all on this new much more targetted sophisticated neurectomy but still referrs quite rightly to the older procedure used on navicular cases.  In those cases the whole of the back of the leg and the hoof are desensitised and the horse cannot feel where he is putting his feet.  Obviously no one wants to jump a horse like this and this procedure is meant to give quality of life to a basically retired horse.  The PSD neurectomy only desensitises a very small area around the upper branch of the suspensory ligament, its a small area, my horse can still feel the majority of his leg and all his fetlock hoof etc.  Its literally just below the hock at the back and outside about 4 inches down the leg before he can feel you tap him.  This would no way affect his safety or judgement jumping, but the old BE ruling hasnt really moved in time with the progression of these operations although there is talk about it needing to be done.  It is probably only a matter of a few years before it will be changed and I think they may have already done this with BS, so you can check with them.  Yes one way of getting around the old competition ruling was that people claimed they had only had a fasciotomy done and that if a lack of feeling was discovered it was becasue the nerve had "accidentally" been cut during the splitting procedure!  Thats what I heard along the way, but dont quote me lol!  Again very hard to police.  Have a look at this site, its very contraversial amonst forum goers but its interesting and worth taking into consideration.  www.naturalhealingsolutions.co.uk I have had this guy out to see my horse but couldnt say if he definitely helped or not really, still his views are interesting.


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## pollygbaker (15 September 2013)

thanks bluefire. he was looked at yesterday - definitly both hocks and a bony lump felt on vertebre. more tests nxt week. we sorted out lame front legs which have now shown up lame back legs and bad back. i seem only to have a head, neck and tail left!!! the joys of horses, it gets u rather down. hope urs gets better soon


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## Dab (15 September 2013)

Hi BlueFire710, sorry to hear about your horse, if you are on FB there is a group set up with nearly 200 members https://www.facebook.com/?ref=tn_tnmn#!/groups/255267791160904/ each of which has a different story to tell with regard to PSD. Some have opted for surgery others have taken different routes, some with success and some not. It is a great resource and you can go and ask many questons and read about the different experiences before making a decision.


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## LeanneBaker (13 January 2014)

Hi, My horse has just been diagnosed with this.
he is six years old and competes dressage
The vet has given us the two choices of shock waves or the surgery. He only has minimal damage so the vet would recommend the shock wave although recovery is 6months and a 40% success rate, if that doesn't work then they will do the surgery which is 80% success rate. 
I was just wondering if you had any advice ?
Thanks


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## jumping.jack_flash (2 June 2017)

I'm googling and come across this thread. I'm sitting here in the office in shock. collected my lad from the Horse Hospital yesterday - to be told that my lad has 'proximal suspensory' issues on both hinds... I have the scans, but honestly can not understand what I'm looking at in the 'cross section'.. but gather I should be looking for black spots / gaps - of which there are none.. No bone damage.. no Sacroiliac issues in back, no bone degeneration in hocks or elsewhere.. so what's the prognosis for 'Shock Wave' therapy and a year off with heart bar shoes?


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