My 9 yr old OTTB was just diagnosed with chronic, inflamed RH proximal suspensory - no tear, no lesion. He was a 3/5 on the lameness eval- doesn’t pick up right lead anymore. Surgery was recommended for possible compartment syndrome- fasciotomy and neurectomy on both hind legs (LH only mild) with a 85% success rate. I just want him back to do low level with…
I know it sounds silly to say I don’t want to do surgery right now, but I am hoping some shockwave treatments will break up the scar tissue and a long time off will help his entire body (front feet are sore, mild back pain).
ANYONE have any experience with therapy and turnout for inflamed suspensory ??
From an article on Vetstream discussing this surgery: Hind suspensory problems are supposed to be difficult generally and more prone to recurrence than front legs. I would consider a second evaluation and opinion given the other body issues.
[h=3]Prognosis[/h]
- Fair.
- Some controversy exists about the rate of return to soundness after this procedure, with initial reports suggesting up to 100% success rates.
- In general, most surgeons believe that 65-75% of carefully selected cases will improve to workable soundness.
- In a recent study, the outcome for horses with a >80% response to analgesia of the deep branch of the lateral plantar nerve and no concurrent orthopedic or conformational problems had a 77.8% return to full athletic function, at their previous level, for more than one year.
- Prognosis is influenced by careful case selection and is significantly reduced by presence of concurrent sources of pain or orthopedic problems.
- In a recent study, only 44% of horses undergoing surgery that also had other orthopedic problems, returned to work at their previous level for more than one year.
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I have one with the same. she’s more of a 2/5. We did stem cell treatment per our lameness vet.
Back story: It was enlarged in Sept last year. vet (not ours. she was in training) said rest tack walk 60 days, shock wave re evaluate. THey said ok to go to work in Dec. By Feb jumping and then lame again. Obviously she was rushed, but unfortunately we often learn at the expense of our horses, and she was not with me. She has always been away at trainers so I don’t actually know her well.
Local vet and the vets who actually do stem cell (and also part of practice that saw her in FL) disagreed PRP vs. Stem cell treatment. she has no lesions or tears. Scar tissue. LEading to our decision to do stem cell, she had 6 weeks of shockwave and hot laser with no real improvement to it. Still had ugly scar tissue. add insult to injury, we can’t properly stall her. if horses are out, she has to be out. if horses are in she has to be in. so she’s in small turnout. had reserpine after stem cell treatment to keep quiet. worked for about 4 - 6 weeks. our plan is give her off until April. they had advised not to look at the leg after stem cell for 6 months (which would be feb, but i am in florida through Marchl and don’t have an indoor anyway).
So while i don’t have an outcome yet, we can compare stories in the spring? but, my local lameness vet has seen a ton of these, and he says stem cell best success rate. he didn’t say surgery while others said surgery next step. So maybe ask your vet about other therapies? Definitely do the shockwave if you haven’t. Also, Furlong has this hot surgical laser (i don’t get it), but that’s supposed to be amazing (although we didn’t have great results, i know others who have). Not sure who else has this laser/how common it is.
Good luck. let’s compare notes in the spring.
The only success stories with chronic hind suspensory problems I can share involve extended time off-as in OFF, not rehabbing. OUT as well. Like a year or more followed by loooooing rehab to return to work…many, many months. Not a few weeks.
I can share some misdiagnosis was involved in but none were my horses (thank heavens) so don’t have exact details…gist was they weren’t properly rested and rehabbed going back in work too soon for earlier problems.
I don’t know about a double neurectomy for this chronic inflammation. It won’t fix anything, just mask the pain and could allow further damage. IME, it can be a decent option for some chronic navicular or ring/sidebone but even that’s not 100% successful and even with a good result it can reverse itself.
Know you want to do something but, IMO, jumping in the surgery bandwagon for this might not be in this horses best interests. Certainly would want a second opinion based on new diagnostics and evaluation by another practice.
Far as the shockwave? It might get him back sooner but he’s liable to continue to have future problems since you are not removing the cause of the inflammation.
I’d throw him out and leave him alone until next spring, then evaluate…and bring him back to work SLOWLY, standard reference is 2 weeks rehab for every week off. Most don’t want to take the time so reoccurrence is common.
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I am rehabbing my horse for disruption of fibers and a small amount of scar tissue in a left hind suspensory. Around 5%. I was told that once you get scar tissue it’s there. That is why you want an early diagnosis to minimize scar tissue. Mine was the same as yours, no tear and no holes in his suspensory. Initially we thought it was his hocks. So we injected and he was sound for 6 weeks and then went lame again. Apparently the steroid injection site is also the site of the suspensory injury so it cools down the inflammation, but does not heal the suspensory fibers. Apparently horses can cope for a long time before they actually tear, so many hind suspensory injuries go unnoticed. Fortunately for me, my trainer has an excellent eye and would not let this go. I actually didn’t know he was lame. He just felt lazy behind. It was subtle. But the trainer wouldn’t let it go and insisted that I have it checked again after the initial return to soundness.
This is no picnic if you want your horse to heal properly. And as much as I love turnout, this is not an injury to turnout and hope for the best. Whatever is inflamed and disrupted will turn into scar tissue. But you want the scar tissue to line up systematically and not end up as a gnarly ball of scar tissue that will easily tear if stressed. The best way to do this is controlled exercise program and lots and lots of time! If you turnout, you cannot stop the horse from running around and further tearing the fibers. Even if the horse is mostly quiet, something can spook him and he runs and you can get tearing.
You need to look up Carol L Gillis and follow her program. It’s a long program. I am approaching 8 months even though the ultra sound showed my disruption was healed at 3 months. The program gives you gradually and systematically putting stress on the scar tissue so that it strengthens and does not tear. There is no way of getting around it. It has be stressed gradually in a controlled exercise program. In the beginning when there is a lot of inflammation its hand walking 2x a day for ten minutes. I couldn’t come 2x a day so I did 20 minutes. Then you work your way up to 1 hour of hand walking. Yes it’s a lot of work. From there you go to tack walking if the ultrasound shows improvement. And you work your way up to one hour of tack walking. (Totally boring) from there you start straight line trotting starting with 5 minutes and increasing it gradually. My vet had me start at 2 minutes because with all the stall rest, he developed a stifle problem. He was sound the end of April but lame behind the beginning of June at which time his suspensory had healed on the ultrasound but it was now over 3 months of stall rest and controlled exercise. (That is not good for the stifle) I am now trotting him 40 minutes a day and he is improving but he still is so slightly hitchy behind with that hind leg and it’s from the stifle. But I cannot do the things you would do to improve a stifle because it’s too early to stress that suspensory.
At a little past 7 months I was allowed to turn him outside. He could have gone out earlier in a small paddock, but he would not stay outside by himself and jumped the metal fence and demolished it. He is now out with his friends in the big field and remaining fairly quiet. I am continuing his trotting and will introduce poles to help build his stifles. And I will start cantering soon.
It’s a very cautious schedule but I was told to follow the Carol. L Gillis program for best results and her program is slow and cautious. I do not want to have a set back and have to start all over again. I have seen and heard of many horses that were pushed to quickly and ended up re-tearing the suspensory again. So why rush to a setback. Slow controlled exercise program is your friend and while it’s difficult, it’s the best way to return for soundness. I understand the turnout and hope for the best route, often creates gnarly scar tissue. Its chancy, but less labor intensive.
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Yeah, if you have a tear, you don’t start by turning out but it will be involved further down the road to recovery. And this is one place where drugs do way more good then harm, eventual return to at least some level of work can be a literal lifesaver, much as we might like to, most cannot support an unusable horse for 15 years in a boarding out situation and continue to ride. Or support it for those years at all.
Its not a bad bad idea to investigate rehab boarding options near you. They are equipped and have experienced staff to deal with the complications of stall confinement and generally cheaper then a full service boarding barn with training available. Particularly a straight layup with no special medical needs, usually not expensive at a rehab but a real PITA at a regular boarding barn, even one with full time adult staff. At lower level boarding barns with sketchy help or boarders of varying ages with varying experience levels doing the work for a break in board, horse on full stall rest can be a nightmare. And a real liability.
The big full service show oriented barns often don’t want a non lesson/training income generating horse occupying a stall for an extended period of time. It’s not a bad idea for ALL who board out to be familiar with long term layup options in their area. Long term is generally over 90 days without participating in any income producing services. Some barns have a minimum service requirement that must be met whether the horse is rideable or not.
Be prepared, it could happen to you.
My horse did not have a tear. And it was only slightly strained fibers but those could turn into a tear if he were turned out. The safest option for reducing scar tissue and having the fibers line up in an organized fashion is stall rest and a controlled exercise program.
But it’s a PITA! I agree that rehab barns are probably the best route for a person to take if they are not committed to the care themselves. You cant just let your friend take your horse out of the stall when you are not there! My horse was a complete angel and he required no tranquilizer except the day I turned him out with his friends. But he had moments that he went from calm to a horse kite in a nano second. One time he was peacefully grazing as I did every day and he saw the cows on the property that were far away start running and bucking and he flipped his lid! Best thing was to get back to the barn as quickly as possible. But I can’t ask a friend to handle this. Neither could I ask a friend to ride him even though 99.9% of the time he was so quiet. A couple times he flipped his lid when a fox ran in the ring or someone started trotting and he was on the tack walk program. I learned to ride when no one else was riding.
I did take one day off a week so we could go down to our boat for the weekend. I felt badly, but my horse had to stay in his stall. I just could not trust anyone to handle him and get hurt or let him go and ruin all my hard work.
I was the lucky one. Most horses do need tranquilizers. Like I said, it’s a terrible time when your horse is diagnosed with a suspensory. The best advice I received was take one day at a time. Do not count the months ahead of you, because you will freak out! Had I know this was going to take over 7 months to turn out, I may have jumped off the bridge! I just kept my nose to the grindstone and accepted that this was my new routine and I had no idea when it would end. I am enjoying the freedom this fall of being able to go to our boat without stressing that my horse was in the stall for 24 hours.
I also treated myself to a new horse! LOL that’s another story! A lovely German import!
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I purchased an 11 yr old mileaged WB hunter with a torn hind, proximal suspensory. He returned to work (2’9-3’) for several years, before other problems led me to retire him at 19. His was also inflamed and chronic. He already had stall rest when I got him, but we kept in stall and riding at walk only while he was getting a round of shockwave rx. The ultra sound results were the same, not much change in the suspensory measurements. I was over spending money on ultra sound. I turned him out for 6 months and then brought him in. That helped immensely. I had an amazing diagnostician of a vet, who found problems in his right stifle and LF hoof. We treated those, and he was then able to use all of his body. I am sure that LH Susp. injury was because he was over using that leg due to the other “wheels” being flat. Make sure your horse is balanced in his body when you bring him back to work. His feet medio-laterally also have to be correct–this is huge. We also did a “rocker toe” behind the first year–so the toe broke over sooner than usual, relieved suspens. a little bit. In my opinion, I’d do all this again in a heartbeat without surgery. It takes patience and time.
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Horsegurl what did you do for the stifle? I think my horse got a suspensory from weak stifles.
right now I am trying estrone
Welllll…our horses could be very different from one another. My guy’s stifle joint was not put together very well, and was somewhat arthritic. We got him going again by injecting it, and just did that once a year as maintenance.
I had a 7 year old horse with the same issue. RH proximal suspensory inflammation with no lesion. 3/5 lame. Vet thinks it stemmed from SI or stifle issues. Had surgery, spent a year rehabbing and never came sound. Unfortunately he was PTS a few months ago from a freak pasture accident. It was a heartbreaking journey, sorry to be a downer. There is a mostly UK based Facebook group called PSD discussion group. That may be a good place to go for advice. PM me if you want more details.
I don’t see anything silly about being reluctant to do surgery on a horse with multiple soundness issues. I think that having other soundness problems in play decreases the chance of success. In determining whether to do surgery or not, I would look at how sound the horse was leading up to the injury. If the horse was sound and doing his intended job comfortably up until the onset of the suspensory problem I think that’s a better set up for a good outcome with surgery vs. if there were other problems going on at the same time. If I were making this decision, I’d want to know more details about the other soundness issues. Is he footsore because you pulled his shoes while he was on layup or footsore for other reasons before this problem developed?
It’s really tough because your horse is so young. Retiring a horse at that age is a big deal. But, with multiple problems it’s hard to say if the surgery would be a good value. I think your idea of resting the horse for a long period is a good option.
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Thanks for all of the replies! I appreciate them all…my gut continues to tell me shockwave and rest…first treatment is this Friday- (PT journals/research seem very high on shockwave to break up scar tissue…I may even invest in a therapeutic ultrasound myself for when the treatments are done- (I can treat feet, suspensory, back and stifles wth that! lol)
he was turned out fully on Saturday and I hope to pull his back shoes next week and work on maybe getting him barefoot before winter? with sore front feet, (chronic changes prone to sore heels), a sore back, and a bad right stifle (chronic maybe from racing per vet) it just seems silly to do surgery right now- let him rest, feel better and see what I have in 6-9 months…time is not a factor.
On a good note, his hocks were x-rayed and they looked great…its the little things, right? lol
I love this horse, I only want to do what is best for him, maybe time and patience are on my side because he’s all I have and the only horse I want…
thanks again for all of the comments, advice and stories!!
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Did you read the Carol Gillis report? Turnout was not the best option for acquiring good scar tissue. It was recommended to do stall rest and a controlled exercise program. It is labor intensive, but does seem to yield the best results. Turning out is a gamble.
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OP I was searching for something else and your thread popped up. My mare had this – chronicaly inflamed LH suspensory with no tears or lesions – and I had the surgery your vet is recommending done on her. My vet said that rest alone rarely improved horses with this condition, and since she was insured, I went ahead. This was in March 2010.
Recovery took a LONG time. I’d say at least a year to be sound enough for my purposes (very little jumping, low level dressage and trail riding mostly). Started with 4 or 5 weeks of stall rest, with handwalking multiple times daily, then turnout in a tiny pen made of 8 round pen panels, and building up the handwalking length while cutting back to once per day. By the time I got on her, we were handwalking 45 minutes per day with one day off each week. I did find it necessary to tranq her for a while… and still occasionally had a palomino kite! I learned a LOT about her during this time.
Got on her after 8 months off, went very very slowly, starting with riding 7 minutes at the walk. During this time we found that she had other issues like pretty bad SI pain, so she had joint injections as needed. Also put rear shoes on her when her progress stalled out at about 2 months into the riding rehab, when I’d introduced trotting. I did tranq her for riding for about 3 or 4 months… it was winter, she was very jumpy and hot and I didn’t want her reinjuring herself. She stayed in the tiny paddock for over a year. I would say she came back about 90% – and did quite well, with consistent work and a lot of maintenance injections, for about 6 years – though she always stepped a little short on the LH. Added daily previcox about 4 years post-surgery, which helps a lot.
Things have been a little more dicey with her recently, but I don’t really think it’s the suspensory at this point. She’s older (19) and her leg conformation is really wonky. So looking at possible navicular problems in her front hooves… and she has pretty stiff hocks.
It’s really a toss-up and there have been times I’ve considered retiring her entirely, or letting her have 6 months or a year with Dr. Green. Might be headed that way again now.
Taking the chance really depends on how the horse is otherwise. Good luck whatever your decision.
Had a good outcome with an older guy with a proximal suspensory tear. We did shockwave but no surgeries, and then did the very long controlled exercise program described above. Tons of hand walking and tons of tack walking, twice a day for months. He made a full recovery, but it was a long haul. I agree that turnout is not your friend for this type of rehab. But this particular horse would lose it every day when the other horses went out and was rearing and jumping around his stall–not good for this particular injury. We ended up making him a stall-sized turnout pen, so he could go out when his friends did and have a change of scenery, but not really move around at all. Worked for us, and kept him calm.
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Your horse is very lucky to have an owner like you!
My now 17 year old OTTB has chronic suspensry desmitis in both hind legs. He was first diagnosed with suspensory issues around 2010 after being misdiagnosed for quite some time (there was no heat or swelling, the lameness was subtle and then only at the trot, etc.) I had three different vets telling me it was everything from his hocks to stifles but there was no mention of his suspensory. We did the lengthy stall walking regime but he was still lame despite a clear ultrasound when we tried to bring him back slowly. We think the muscle loss from being stuck in a stall was what left him still looking off and messed with his stifles. The vet recommended continuing to bring him back into work to see how he looked after regaining some muscle.
He eventually came sound and we’ve had some very good years since then (and also lots of setbacks). While I opted to retire him from jumping when the issues first arose, we switched to dressage and over the years got him to work in solid 2nd/3rd level collection. During more recent “flare ups” we opted to turn him out instead of try to stall him because the muscle loss makes him worse and he turns into a fire breathing dragon on stall rest (he’s also required tack walking vs hand walking because it was safer).
We are now facing a similar dilemma to quietann. My horse is not a candidate for surgery because of the risk of complete suspensory failure. He has just gotten older and it is what it is. His fetlocks are now affected as a result of the chronic suspensory strain so I opted to do ProStride (a single injection that is essentially a combination of PRP and IRAP) in his fetlocks at the end of the summer. The ProStride eliminated the puffiness in his fetlocks and did seem to help. Unfortunately, job issues and life getting in the way has meant that he’s had some time off with Dr. Green for the past couple of months. While I also considered retiring him completely, his vets and I fear that he needs to maintain condition or else he will be worse off. So we will see where we’re at when I move him next month and really try to bring him back in January.
I had one with this… he had the faciotomy on both hinds and the neurectomy… his surgery was successful in one hind… the other had complications and we ended up injecting the susponsory and that worked great! I wonder if you could inject it now prior/instead of surgery?
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Ok. My horse had a hind suspensory strain last year. She’s has issues on-and-off ever since. I am so sorry you are going through this, that is so tough. From my experience, shock wave and red-light therapy (it’s a newer thing) DID help us. Box rest, wrapping, and cold-hosing as well. For us, it was a waiting game. It’s mostly about managing and finding ways to decrease the chances of a flare up. She’s sound now, but her hind legs will always need a little more care. I’m over protective and I wrap them whenever a sense of not-quite-right pops into my mind. It’s a hurdle you CAN get over, BUT without immediate repair with surgery it will be slow. And if you’re ok with that, it can work. I don’t always agree that invasive treatments should be the #1 go-to. Sometimes home remedies can help just as well, you just have to be prepared for a longer rehab.
The horse may never be back to 100% as far as jumping. A friend of mine has a horse with hind suspensory issues who finally had to be retired from eventing because his fetlocks were dropping, but apart from that he is sound enough to make a few laps round the ring and very sound for trail rides. I am someone who sort of finds a way to work for my horse instead of my horse working for me. Not sure what kind of rider/owner you are, but if you love this horse and are willing to sacrifice some show dreams, he will come around. Do some research on your own, there’s lots of DIY care if you know where to look 
Good luck <3
