After years and years of trying to pin down what is going on with my mare(chronically short behind with absolutely perfect joint radiographs) clinic identified enlarged and one ugly (mineralization and scar tissue on the right) high suspensory. I’m debating surgery but also cautiously approaching as this is not an obvious tear or recent injury. She is also not overtly lame but this does obviously impact movement and jumping. Anyone have a similiar situation or thoughts on this? She is 14 and otherwise extremely healthy and talented. Alternatives to surgery that work for what appears to be ligaments with wear and tear that work?
Curious - what would the surgery entail for this?
They suggested fasciotomy and neurectomy
Clarity I’m thinking this may be extreme but I’m just not sure. I want to know it’s worth it and safe before I put her through it
This is pretty much exactly what happened with my mare – one chronically inflamed rear suspensory. She eventually became quite lame on it. She was 12 when she had the same surgery, plus PRP to help with healing, at Fairfield Equine in Connecticut. She did not get better 100% but certainly enough for my generally casual uses (low level dressage, trail riding, the occasional little jumps.)
My vet advised surgery because he had not seen this sort of injury get better with stall rest. In my mare’s case, getting the surgery uncovered a bunch of other issues, but this is absolutely not typical. Her rehab was quite long; I did not ride her at all for about 7 or 8 months and it was probably another year before she had healed as much as she was going to. There was a point, about 14 months in, where I was seriously considering giving her a year off with Dr. Green at her breeder’s farm. But she did continue to improve.
She was insured at the time, which of course helped with the cost, but did not cover 100% of what she needed.
She is now almost 21 and semi-retired, meaning we aren’t doing any intense training, and dressage is a tool rather than a discipline to be mastered. When the weather allows, I mostly trail ride, mostly at the walk, but she’s up for a good trot or a little hand gallop or popping over little logs when the trail footing is good. But much of the limitation comes from me, as a more or less permanent advanced beginner rider with some physical issues that interfere with progress.
There is an old thread on the Eventing section you should be able to search for. It has several hundred entries from maybe 15 or 20 people whose horses had this issue. Outcomes are all over the map, from 100% return to high-ish level eventing, to pasture pet status. (Both of these extremes were rare.)
Good luck!
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Thank you Quietann! Can I ask the other issues they found? This is what I’m worried about making a small issue a bigger one!
I did the surgery on one (also at Fairfield, they are my regular vets). Time will tell whether he can come back or not. A year after surgery he was still NQR, so I turned him out for a year. Planning to bring him back in March '19.
My educated guess is that the horses with injuries heal much better than horses with chronic issues. I suspect mine had low grade issues for some time, likely covered up by hock injections.
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What drove you to do the surgery joiedevie? Did anything shown up on us or just thickening? Did you try anything else before surgery?
There was no core lesion on ultrasound, but plenty of irregular fibers, thickening, and a few spots of potential detachment from the bone.
Original injury appeared very mild - only slightly off in steep lateral work. We did 60 days of tack walking with shockwave treatments. When we started trotting a bit, he looked quite a bit worse than when originally diagnosed. Vet thought surgery was our best option, so we went for it while we were within the insurance coverage window. We also put stem cells in during surgery. In the year following surgery, we did more shockwave and PRP. He’s now been on Dr. Green since April 1.
The biggest problem was with her SI joints. Right after I started riding her again, she was just not quite getting under herself and the vet said she was using her hocks, but looked ouchy. His test for SI issues is to press hard on the area above the SI joints and see what happens… My mare almost sat down! The SI injections helped a lot, but became a yearly expense for a while. She was already having her hocks done about once a year and this also went to twice a year. Her hind legs are super straight, so much of this was probably comformational issues just becoming known.
The other thing that helped was putting rear shoes on her. She’d had front shoes since shortly after I bought her, and still does. This was a couple of months after the first SI injections, when her rehab stalled out again. She still has rear shoes; any time I’ve tried to have her go without and ridden her, she’s become sore.
One interesting thing about all of this: I moved her in 2017 to a different barn with a much flatter turnout area and a stall for about 16 hours a day. The place before that, her paddock was not level and she was out there 18 to 24 hours a day. I was really worried about giving up so much turnout time on an obviously arthritic horse, but she’s needed fewer injections since I moved her. Just her hocks about every 8 months, and one try at coffin joint injections when we were trying to figure out why she was footsore in front. (That was made much better with a different farrier who trims her differently and put her in larger shoes.)
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Your horse sounds like mine! And mine is scheduled for neurectomy/fasciotomy on the RH next week.
He has been 3/5 lame on his RH since September. after injecting both hocks and front coffins to get him ONLY lame on the RH (he was lame all over before) we were able to block, xray and ultrasound and find that the RH suspensory was very enlarged and there was a ton of bone changes on xray at the insertion point of the suspensory. No tears, no lesions etc. so my vet said it would be a waste of time and money to do PRP etc. as judging by the xrays it was clearly a chronic issue. We let him have field rest for 2 months and lameness did not improve AT ALL which was the solid Yes answer I needed to schedule the surgery. My surgeon said it helps 80% of the time, so I’m not totally optimistic, but without it I figure we’ve got no chance.
He was schooling 2nd level dressage this summer. Now I’m hoping I’ll have a trail horse. But he’s one heck of a guy and I love him dearly so fingers crossed. PM me if you’d like to chat about it.
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This is so helpful. I talked to New Bolton Center yesterday. They basically said if the surgery does not work it will not make her any worse. That makes me feel a bit better. Quietann interestingly enough I have kept her in hind shoes for years as I have found she stays much more sound. She is also the only one of my horses who comes in every night. I have found that the more opportunity she has to stomp at flies etc she is more off. We are doing blocks tues under tack. If that goes like I think surgery will be scheduled. I’m looking now for a rehab barn because there is no possible way I can handle it on my own with my job. TakeAChamce I’m so happy to have a friend with a more chronic situation to go through this with! Best wishes and jingles on the way!!!
Adding to this - my horse is home from his surgery and everything went just fine. Time will tell, of course, but the 80% odds with surgery seemed way better than the 14% without. Now just to get through stall rest and limited turn out until follow up ultrasound in 6-8 weeks.
Take a chance interestingly enough we did the blocks with marked improvement. It was hard because her rh foot was painful likely because she had a huge abscess blow on that foot a couple months back. Also suddenly she became lame up front which I’ve heard can happen. I’ve had her front feet radiographed before and everything looked great but now I’m worried something else is going on up there. Or hopefully it’s just pain from compensating. I’m wondering if I should do more diagnostics or just get the darn surgery done and see what happens? Anyway so happy to hear things went well! All my positive thoughts and love coming your way for quick recovery!!
Also can you let me know what the instructions were for stall rest etc? I’ve heard so many different protocols and that will def impact whether I can keep her home or not
I had a horse in my barn with a long-standing low-grade mystery RF lameness. (Multiple top vets have tried to sort that out at different times, long story, remains a mystery.) Anyway, that was managed pretty well for a while, but he never really wanted to get under himself behind. Eventually it devolved into a subtle left-hind lameness. Once half the horse was blocked (LF PD, RF 4-point, LH proximal suspensory) it became apparent that he had a bilateral hind limb issue. Ultrasound showed thickening of both hind proximal suspensories. He had neurectomies on both hind legs, which rehabbed well. The hope was that helping the back end would reduce the stress on the front end issues. Rehab went well, he healed great, but it turned out that the bilateral hind limb lameness had been masking the front limb lameness. He remained more lame on the RF after rehab completed, so was retired to occasional walking trail rides.
We have another in the barn who had a more severe injury (core lesion on one suspensory, just thickening on the other) but no other issues. He rehabbed very slowly, but is now in lower-level work and sound. He was originally intended as an FEI dressage horse (but was schooling Training/1st at the time of the injury) and that won’t be happening, but he’s happy and comfortable doing lower level stuff.
I was only involved in the first rehab. The protocol was 30 days strict stall rest, then 30 days of stall rest + 15 min handwalking twice a day, then re-check. 30 days ride-walking @ 30 minutes, 30 days introducing trot @ 2 min/week, then re-check. At that point our rehab stalled out because he wasn’t sound up front, but I would have expected another 30 days of trotting, then adding canter @ 1 min/week. (standard soft-tissue injury protocol at this clinic)
Mine was stall rest with 5 min hand walk 3x/day until the stitches came out. Then increase 5 min/week up to 45 minutes. First jog was at 8 weeks. We opted to do another 4 weeks of hand walking and re-check at 12 weeks. At 12 weeks we swapped one of the hand walks for a 15 minute tack walk. Then we added 5 mins a week to the tack walk.
SundayFunday - my horse flopped back and forth from hind to front end lameness. I do think it was compensation… he was sore behind and made his coffin joints in front sore. When he initially came up lame, we injected hocks and he became significantly lame RF. We blocked both fronts and he was sound so injected the coffins. Once the coffins felt better he reverted to lame RH, which is ultimately where the suspensory issue was. He improved 90% blocking the RH and with the significant xray changes and obvious enlargement on ultrasound we didnt do any further diagnostics.
We field rested him for 2 months and saw little to no improvement. Part of my decision to jump forward to the surgery was also for insurance coverage as well, as I only have so much time to submit claims for the issue. If he was going to need surgery in the end, I wanted to just go ahead and do it.
My surgeon has said 3 weeks stall rest (sutures out at 14-16 days) and he can do some handgrazing/small amount of walking during that time. With the weather at the moment and my paranoia of the bandages staying secure I doubt he will really walk much until the sutures come out. At 3 weeks he can have small paddock turnout (on drugs to keep quiet, Im sure) and then a re-check ultra sound at 6-8 weeks to determine how to proceed at that point.
My vet will probably have a different plan as he prefers to do more work out of the stall, and I may be inclined to do that simply because of the weather at this point, any small paddock turnout is going to be a frozen mess or a mud bog, neither of which I’m sure will be good for him. So I think my plan will be strictly weather dependent. I may have to move him to a barn with an indoor in a couple weeks so that I can do consistent hand/tack walking until that ultrasound. We’ll see. At the moment I just want to get through all the bandage changes and antibiotics and then see where to go from there!
In my thinking, there seems to be a difference between a chronic enlargement of the suspensory and a tear/lesion/injury of it, which is where the difference in rehab can be quite extreme. Obviously with a tear or lesion, you are going to treat it typical soft tissue and go very very slowly. But in these cases, the suspensory is enlarged and always will be (hence the fasciotomy) so you are just rehabbing from the surgical procedure itself and some of the residual soreness from the chronic pain from the enlarged suspensory, which shouldnt be as bad (due to the neurectomy part). That’s my non expert theory, at least.
SundayFunday - did you end up doing the surgery on your horse?
My horse just had his follow up exam at 7 weeks post surgery. He is still grade 3 lame. Although we did not expect immediate soundness, both my vet and the surgeon were immediately concerned at the lack of improvement so we proceeded to search around for alternative causes. Turns out he has calcification of the long plantar ligament that was missed on the initial xrays (its in the area of the chestnut on his leg which affected how it looked on the films). Re-took films and was able to see it much more clearly. Apparantly its very uncommon and my vet has never seen it in a presentation like this before. (And he’s a lameness specialist at a top clinic!) He must have had an injury there at some point and it healed as calcification on the ligament. So now he has a non-elastic ligament that probably put strain on the suspensory which caused the chronic enlargement/PSD.
Not a lot we can do for THAT problem unfortunately. We are doing a few rounds of shock wave to provide pain relief and then will turn him out on Mr. Grass for 6 - 12 months. He is definitely pasture sound, but grade 2 to grade 3 at trot. Hoping, after a year or so of turnout, we can go trail riding.
Good thing he’s my heart horse and I love him dearly! But it was not the update I was expecting.
Here for the record is more than you will possibly ever want to know about hind suspensory surgery.
