Conservative care for possible bi-lateral suspensory injury/disease

My 20 yr old PRE mare has come up with her first serious case of rear-end lameness. It is bi-lateral and was subtle at first, so it took me and my local vet a while to progress from (new) saddle adjustments to bodywork to starting Equioxx for arthritic changes to full clinical lameness work-up.

Clinic vet found that she was positive to lower joint flexion and hoof testers on both hinds (without pain medication on board). Lateral hoof radiographs showed no serious bone or cartilage changes but soles were thin (trimmed for first time by a new farrier 3 weeks before x-ray). She will be on a couple of weeks of stall rest before we progress to leg imaging and nerve blocking. The vet wants me to take off some spring grazing weight before any potential steroid treatment. We are also re-testing for IR and Cushings.

I am concerned that perhaps there was some initial suspensory/tendon injury that I made worse by continuing to ride her after it occurred. We were doing mostly short trail rides throughout the winter and early spring with a couple of 6-milers in there, mostly walk with a bit of trot. There were a couple of slips in the mud, but I never saw any swelling or felt any heat. First she was irritable to saddling (hence the saddle adjustments and a course of Gastrogard). Then I felt, and subsequently observed with lunging, her getting a bit short with her hind steps at the trot. Then her low back began turning up sore after the very few rides I’ve gotten in over the last month, and most recently she became a little hesitant to shift her weight to pick up a back foot. She has had known minor arthritis for the past couple of years in her stifles, but has required pain relief only after longer rides. Our ground was particularly hard this winter due to a long dry spell from Jan to late March, and she is normally on full time turnout in a large dry lot. She has great feet and never worn hind shoes, but I do put hoof boots on her hinds for longer rides.

Hoping dearly at this point it’s treatable vs. DSLD. I am looking for any and all tips on how to make her more comfortable while we wait for the next steps of diagnosis. She is now on daily Equioxx and I have started the loading dose of Adequan. She has shavings to lie down and a buddy nearby to keep her quiet. Should I consider hosing, wrapping or icing even though there is no notable swelling or heat? What are best techniques/products? TIA!!

I watched someone do what you are doing. Eventually the horse was diagnosed with DSDL (and it was a PRE or Lusitano?). IMO, if you see a bilaterial set of suspensory injuries (and those are in the hind legs), I am sorry to say that I’d put my money on DSDL.

That said, I wouldn’t ask the horse to do any forced exercise, but that’s just me taking the DSDL diagnosis very seriously. I think of that as akin to fraying a rope: The ligaments will never get stronger/can’t be made stronger, so I’m not sure what can be done therpeutically (perhaps other than shoeing the affected limbs so as to provide more biomechanical support for the suspensory apparatus, and keeping the horse entertained so that they don’t make dumb decisions that frays those ligaments even faster. Keeping the horse comfortable is another part of managing DSDL.

Sorry that you are having to consider this problem.

My old mare had DSLD. Pain management was very important towards the end. We started with Equinox. Eventually that stopped working and I switched her to Aleve (naproxen). That was an improvement because the Equinox was no longer working.

I did not see any improvement with Adequan. Turnout was the best for her. She also benefited from giving toddlers riding lessons at a walk. She loved children and was the best babysitter. I think the light exercise helped her keep going. I put her down last year at age 28.

We had to stop giving lessons as she had leaky valves in her heart. Not sure if that was DSLD related or just old age. When she bowed a tendon in the front I knew there was no recovery from that.

She was a great horse. Introduced so many children to riding. I bought her as a 7 year old. Their toddler would walk under her stomach and she would just stand there.

Her DSLD was very slowly progressive. Eventually you will see heat and swelling and need to use ice packs. I used ice blankets with polo wraps. The swelling does subside and the fetlocks will drop but appear normal, then the swelling will return especially if the horse runs around in turnout. Secondary arthritis and ringbone may develop. It is incurable.

Very difficult to watch it progress, but all animals age and eventually face some sort of degeneration. I probably waited too long to saw good-bye. It would not have been wrong to euthanize earlier. I did trim her hooves with her laying down. She was àlways so good about laying flat out if asked.

Hopefully you can keep your horse stable for a long time and not have to make any decisions anytime soon. Difficulty with the farrier is common as these horses are painful and flexing the leg for the farrier hurts. Consider using a stronger painkiller like Banamine for the farrier.

First - sorry to hear - sounds like its not entirely clear what is causing her discomfort so personally I would just keep her in, maybe a hand graze walk if she behaves. Has the vet mentioned DSLD ? The equioxx will help inflamation and comfort level. But with no clear diagnosis, anything you do is just kind of shooting in the dark.

I also have a mare, (oldenburg) now 20, diagnosed maybe 5 years ago with bi-lateral suspensory branch desmitis. She was in moderate work at the time, seemed fairly suddenly to be mildly NQR. vet ultra sounded, measured the branches, etc. Said I could do the traditional stall rest, hand walk rehab but that in his view the prognosis was not great re riding career. Added that the bilateral presentation made him suspect degenerative…
So I promptly retired her; she’s now out roughly 12 hrs per day and wears fancy support shoes in back, barefoot in front. Fetlocks have dropped some; and thickened. she is more post legged behind. Hard to know if she is sound as she mostly walks and eats, lol. This mare has a history of making me crazy and broke from medical stuff, so once she shows real signs of not comfortable, she’s done.

Thanks all for the kind words and sage advice. The vet said “somewhat” dropped fetlocks (why couldn’t I see this??) and bi-lateral lameness. He said keep her in for 1-2 weeks, then re-evaluate. We should have his diagnosis at our next appointment (in five days).

Like 2tempe, this mare was NQR in light to moderate work, and I have have a crazy/broke medical history with her. Retirement will be harder for me. We are a trail and horse camping team, and she’s literally carried me emotionally through so much. I am reconciling to a non-riding relationship for us, probably daily hand walks with the dogs, massages and just hanging out. I am barely starting to consider whether there could/should be a new trail partner. At age 60 with osteoporosis and high fracture risk from impact falls, it seems unlikely I have time to train and trust another horse as I completely trust her.

I did keep her stalled for a week. She was pretty miserable as she normally lives out 24/7. I could easily see the lameness when I let her out briefly - there was none of her normal trotting around on turnout, noticeably stiff in the walk and awkward in turns. It seemed worse in the right hind than the left. Put her in a round pen a couple of days later. She didn’t move for a few minutes, finally rolled, and then sat on her hocks and kicked out with her fronts getting up - full-on courbette movement. She frequently does this after a roll, but this time I could tell it was due to pain/irritation rather than joy. Normally there would be all kind of prancing around afterward. This time she just stood quietly and waited for me to tell her what was next.

I joined a Facebook group for DSLD. 100% consensus was that afflicted horses do better with turnout, most said 24/7. So I let her out. A day later she looked better - she mostly just walks around, eats and sun bathes, but is less stiff/awkward and her back is less sore. The lameness is visible as varyingly shorter rear steps, and the occasional odd positioning/resting of the seemingly worse leg. I am doing regular back massage and just got a pair of icing boots to try out.

The paddock we keep her in is a 1/3 acre natural dry lot with a soft sand pit for lying down/rolling and 2 large flat areas connected by a gentle grade. Her paddock buddy does not chase or herd her, but there is enough room to trot around if she feels like it. She has a typical baroque body type and is large for a PRE mare (16HH). Weight management has been and will likely continue to be an issue. She and her buddy are easy keepers so they are both on a diet right now with no grazing in the larger paddocks until the grass dries up for the summer/fall.

I had not even thought yet of farrier issues. But now that I recall, she was slightly irritable at her last shoeing(front)/trim(rear) 4 weeks ago. Will ask vet about rear shoeing and other pain management when it seems warranted.

I really appreciate everyone’s time. Will be back here to report when we have a diagnosis and hope our story will help others facing this type of symptom onset/disease.

What did the X-rays show as far as the angles in her hind feet? Negative plantar angles could cause or contribute to the hind end and back soreness you’re describing. If you’d like to post photos of her feet here, there are some very knowledgeable posters who might offer opinions.

FWIW I would have turned her back out too. Movement is better for the arthritis and back soreness, and she sounds fairly quiet in turnout. Personally once they’re past a certain age / activity level, I don’t do stall rest.

P.S. I have an old thread on DSLD here if you search. I sadly had to euthanize a 5-year-old for it a few years ago.

Vet took one lateral set of her rear hooves. He said angles looked “good” but soles were a bit thin. This was a trim from new farrier (sadly my long-time guy retired) 3 weeks before. I may have to shop around a bit before finding settling on a new farrier.

I don’t have the x-rays yet but should have them soon. Will post here when I get them. Thanks!

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Just to close the loop here, DSLD was confirmed by ultrasound. She also turned up mildly I/R and vet is running a Cushings/PPID test. Waiting for those results to determine what other supplements and diet adjustments may be indicated. Will start a new post with my hoof x-rays. Thank you.


I was afraid I’d come down to the last comment/diagnosis, it just all pointed to DSLD (more correctly now called ESPA as it’s a whole-body systemic issue, not just the suspensories :frowning: )

Which PPID test is being done? You really want the TRH Stim test right now. Has the vet already pulled blood?

Call your vet asap and tell them to get your horse enrolled here so you can get the testing done cheap (free?)
Testing Program | Boehringer Ingelheim IDPPID

Oh dang, I just realized the last comment was 3 days ago, so it might be too late for that enrollment :frowning:

As for diet - already turning up IR means there’s no waiting. I would manage her as if she’s full blown IR, which will also be suitable for PPID. Hay tested < 10% ESC + starch with starch < 4%. If you can’t test, then it needs to be soaked 30 minutes in hot water, or 60 minutes in cold, and use as much water as possible to pull out as much sugar as possible.

Given all the issues I’d remove soy from her diet. There’s no proof it’s harmful, but there’s enough anecdotal evidence that it doesn’t agree with a lot of IR horses, so it’s just one thing to remove and make sure.

What’s the current diet?

Hi, thanks for your comments and insights. I am waiting for hay analysis results to come back as well as PPID. She was tested for insulin and glucose right after being grazed for a couple days, so plan to get her re-tested shortly.

Getting quality hay here in N CA has been an issue for the last several months - we are into our second year of drought. Orchard has been better quality than Timothy. Teff has been horrible quality and is now unavailable til first cutting in July.

Diet is 80% orchard grass hay, augmenting with 3 lbs Teff pellets, 1/2 lb alfalfa pellets, soaked/rinsed beet pulp, Cal Trace Plus, ground flax, Thyro-L (her T4 runs low without it). No soy.

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