# Suspensory Ligament recovery success rate



## Flibble (18 January 2008)

I posted previously on here about Suspensory Ligament as my horse became lame again after I started trot work. I had followed the vets instructions to the  letter and have now been advised to take a step back and to walk in hand twice a day for the next 4 weeks. Its a front suspensory and the injury is high up.
I have several questions:
My horse has a history of intermittent lameness  which disappeared after a couple of days off. Could this injury have been lurking around for some time as in a couple of years ?

What are the chances of recovery ?

If he doesnt recover what will his quality of life be if just turned out?


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## star (18 January 2008)

it is usually a chronic injury which gets better with rest and then recurs with resumption of exercise so may well have been around for a few years - the longer it's been going on, then the worse the chances of coming sound unfortunately.  assuming he's onyl mildly lame then i'm sure he'd be fine retired if he's the type of horse to like that.  front suspensories normally carry a much better prognosis than back ones - have you just had shockwave or has he had surgery?


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## Flibble (19 January 2008)

He hasnt had surgery or shockwave just :-
2 months box rest 
7 weeks walking in hand
4 weeks walk work ridden in which he cantered on the road twice (so I stopped going out) and bucked me off once hence an anxiety to get to trot work which he did for 3 days before we called a halt and went back to 4 weeks walk in hand.


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## star (19 January 2008)

he is unlikely to get better without shockwave or surgery - it's been proven in many studies that pure rest does sod all for high suspensory injuries - they need one of the above treatments otherwise they just come sound with rest and go lame on starting work again.


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## Flibble (19 January 2008)

Can shockwave at this late stage make any difference?


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## star (19 January 2008)

possibly, but it works less well on chronic injuries.  if you want a sound horse then i would suggest getting an opinion from one of the suspensory specialists like Sue Dyson or Andy Bathe.  I actually dont know much about surgery as an option for front legs - it's normally hindlimbs so you need to get a specialist opinion.


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## Booboos (21 January 2008)

I looked into this as well when I thought my horse might have a higher suspensory ligament injury (turned out to be the wrong diagnosis, but there you go).

Rest is the first course of action. Shockwave is used and has a mixed bag of results. To be fair it is primarily used for suspensory ligaments so if it is going to work anywhere it is going to work there. At least it can't cause any harm, but it will be costly. 

I got contradictory advice about surgery to de-nerve the area. The specialist surgeon said it had no negative side-effects, my local vet said that because horses can't feel the leg in that area anymore they are much more prone to injury. I Googled a few studies on the surgery and the results sound really positive: 80% full recovery (to previous level of work). However, and this is a big however, the interesting bit is that the 20% failure rate is due to mis-diagnosis, i.e. the horse never had a suspensory ligament injury in the first place and the surgery was unnecessary and did not resolve the problem.

I was about to ask for a referral to Sue Dyson when we found out that my horse had a back problem (this is after numerous visits, nerve blocks, scintigraphy, physios, etc.), so would agree with Star that you need an expert's opinion.

Good luck!


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## rcm_73 (21 January 2008)

My mare had a suspensory injury to her off hind last October. I was recommended by the Equine Specialist in our area to give her 3 months box rest then turn away for 6 to 12 months. She came off box rest in December and was kept in a small paddock to start off with. When she went out into the big field she went only with a quiet pony and an old boy and was given sedalin for the first few days. Now she goes out and comes in happy as larry, doesn't pull or tear about (she's a TB). Since the injury I've had one sneaky 20 mins hack  
	
	
		
		
	


	




 which was last week and apart from that she hasn't been ridden since before the injury. She did her usual jogging but I did my best to keep her walking and she has remained sound. I plan to only light hack her like this max once a week for the foreseeable future as really she is meant to be turned away 6 to 12 months. I have a feeling you have started work again too soon and the trouble is with these type of injuries is they take a long time to heal and remain considerably weak for a long time too (advice of my vet) as the ligament is still weak it is very easy to tear again.


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## molehill (21 January 2008)

My mare done a hind suspensory ligament a year ago,and some days she will trot across the field sound and others a little unsound.I dont think she will ever be able to ridden again,but she is enjoying being retired and turned out with the others and is soon to be a mum.To be honest she is the best horse i have ever had,one in a million and i dont want to ride her again for fear of loosing her totally


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## star (22 January 2008)

just want to add that there is a whole world of difference between treating PSD and treating injuries to other parts of the suspensory ligament.  rest alone doens't work for PSD yet is the only real option for other suspensory injuries.  PSD treatment is either shockwave or surgery.  shockwave does have varying results, but is a good first option for the right cases - cost me £400 for 3 lots and my horse was sound after - much better option than £1500 for surgery and the risk of future problems with nerves re-growing and the risk of death either under GA or in recovery.


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## Flibble (22 January 2008)

Stupid question what is PSD ?


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## dieseldog (23 January 2008)

[ QUOTE ]
just want to add that there is a whole world of difference between treating PSD and treating injuries to other parts of the suspensory ligament.  rest alone doens't work for PSD yet is the only real option for other suspensory injuries.  PSD treatment is either shockwave or surgery.  shockwave does have varying results, but is a good first option for the right cases - cost me £400 for 3 lots and my horse was sound after - much better option than £1500 for surgery and the risk of future problems with nerves re-growing and the risk of death either under GA or in recovery. 

[/ QUOTE ]

But Shockwave only works if you spot the injury quickly enough.  The problem with PSD is that it is so slight that most people don't really notice it and by the time it is properly diagnosed it is too late for shockwave.

So do you do Shockwave and have all the required time off and rehab, but all along the injury was too old to respond to shockwave in the first place?


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## ReefurG (23 January 2008)

My TB has been on box rest and had 4 shockwave treatments plus injections into his ligament. He went for a scan yesterday and there was no improvement. I have been advised to start walking him in-hand for 7 days, horsewalker for 28 days and turnout in a small paddock for the last 14 days. He then has to have another scan. I am not feeling very optimistic. And I had planned to sell him before he injured himself.


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## _jetset_ (23 January 2008)

SkiHi... who has been dealing with your boy?

Grace is going for her final scan on Tuesday to Hird and Partners


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## star (23 January 2008)

[ QUOTE ]
Stupid question what is PSD ? 

[/ QUOTE ]

what your horse has by the sounds of it!
stands for proximal suspensory desmitis - proximal means top part of the ligament - ie. high up.  desmitis is inflammation of a ligament, in this case, the suspensory.


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## star (23 January 2008)

[ QUOTE ]
[ QUOTE ]
just want to add that there is a whole world of difference between treating PSD and treating injuries to other parts of the suspensory ligament.  rest alone doens't work for PSD yet is the only real option for other suspensory injuries.  PSD treatment is either shockwave or surgery.  shockwave does have varying results, but is a good first option for the right cases - cost me £400 for 3 lots and my horse was sound after - much better option than £1500 for surgery and the risk of future problems with nerves re-growing and the risk of death either under GA or in recovery. 

[/ QUOTE ]

But Shockwave only works if you spot the injury quickly enough.  The problem with PSD is that it is so slight that most people don't really notice it and by the time it is properly diagnosed it is too late for shockwave.

So do you do Shockwave and have all the required time off and rehab, but all along the injury was too old to respond to shockwave in the first place? 

[/ QUOTE ]


that's why i said it should only be used for the right cases.  those with changes on xray and obvious changes on ultrasound have likely been too long-standing to respond well to it, but the subtle ones who aren't really lame and have been picked up quickly can respond very well to it.  personally, and that's just my opinion i'd rather spend £400 and 3 months and see if the horse comes sound than leap straight into a surgery with all its risks and potential complications and the risk it might not work at all at the end of it, not forgetting the huge cost - BUT, only for the right case.  Case selection for shockwave should be careful, certainly not all cases will respond, but if you pick the right ones then you avoid surgery.  It is a good treatment for the right horses and my final year dissertation on it certainly showed a lot of good results.


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## ridewell (17 September 2008)

Well 5 months treatment and rest later, several shock wave therapies, 9 weeks corral rest, then field rest....my gelding is still lame diagnosed with psd....lame now from  march. ( vet never advised box rest as more chronic degeneration than acute) Our last option is surgery, I so didnt want to go down this route, but my insurance wil run out in new year for this lameness, PSD doesnt respond well to rest, and there was no improvement after shockwave. My horse doesnt have obvious tears, hes more of a chronic case that he obviously handled for a while, before showing lameness. 

I am fully aware of the risks of surgery, I feel sick to my stomach having booked the op for next thursday.I know chronic cases have the worst chances, hes also a huge horse and at 14 not so young. Hes happy in the field, but bored and looks`sad when his friends get worked. If he could just be a quiet hack then he could pad around quietly with a small job for the rest of his years, but I cant afford to just keep him if he has no job at all. Im very sad, terrified and sick, but there is a small chance that the surgery could help, he might get sounder if not sound, maybe then he could hack, he would so love that I want to give him a chance to work lightly again. 

Hope whoever is reading this forgves my rumbling here, it helps to talk. thanks for listening. ;-)


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## dieseldog (17 September 2008)

Fingers crossed for you both that it works.

My mare was 12 when she had the op and she came back sound - only to do her front leg - so lame again.  But I would do it again if I had to.


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## ridewell (5 October 2008)

hi 
my horse had his susp op last week, on box rest now. Now we just have to wait and see... nerve wracking, but Albie (the horse) is loving the 5 star box rest hotel he has !!


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## angiebaby (5 October 2008)

How is your horse Ridewell?
Mine was operated on last October, and is sound as a bell, started working him in May this year, and he's better than ever!!
After the op he had two weeks box rest, 2 weeks small paddock rest then turned out from middle November to middle of May this year. I bought him back into work very slowly, 6 - 8 weeks of walking, and only just started to canter a few weeks ago 
	
	
		
		
	


	




Good luck!


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## ridewell (20 November 2008)

Hi 
well my boy has the susp op 8 weeks ago....was trotted up for first time last week, and hes virtually sound, maybe one tenth off, but much much better.  hes been out on corral rest in day, boxed at night, and hes just starting to feel well and be a bit tricky in corral. 

We are not going to ride him till 12 weeks and then only walking on flat ground, plan is to build walk for 8 weeks, with a few steps of trot on soft ground towards end. 

So now the scary bit, tryng to bring him back very very slowly to work.  hes a calm chap most of time, i have him in a corral in a field on his own, but when he sees the others gallop he stillwants to join in...sigh..horses will be horses....the goal is proper  work by April......hope thats slow enough....;-)..jakesmydog did it much slower?...my vet would have had me do it slightly faster than I plan? ;-)

worry worry...phew....I need a second horse to distract me i thinklol ;-)


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## angiebaby (20 November 2008)

ridewell, it was my choice to do it slower, my vet says he should have been back in work sooner, but my pony can be a goon, so I thought it safer to do it slowly!

good luck!


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## maybedaisy (24 February 2009)

Ridewell, how is your Horse doing now.  

My Mare has PSD in both hinds. She has had Shockwave but hers is more Chronic than acute so I'm worried that the recovery won't last.

Would you advocate the surgery.


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## sandrajane (21 September 2009)

I have a horse with hindlimb PSD in both legs. Our vet reckons rest alone will give a 50% chance of recovery. Do you have details of the studies that show rest alone does not work as I have been unable to find anything on the internet ?


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