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High hind suspensory tear - weighing options

My 13yo OTTB has a high hind suspensory tear with some bone changes and I’m trying to decide between shockwave or stem cell. The difference in cost is pretty great. We do lower level eventing and didn’t plan on going beyond novice, maybe training. Of course, I’d love for him to jump again, but is that realistic? Has your horse returned to jumping and which treatment did you use?

I think it’s very individual, depending upon the details of the injury. Friend’s TL mare had stem cell…ended up retired. Fellow boarder’s horse had shockwave, is sound for flatwork, no jumping. That horse was an eventer. My horse has low hind suspensory damage and is currently - and probably forever - walk/ trot only. He had three shockwave treatments with minimal improvement. My vet felt stem cell was contra-indicated if there was no actual large tear/gap, but could be helpful if there was such a tear. My previous horse had minor front suspensory damage and recovered 100% with only rest and rehab, but I did stop jumping him.


You could do Platelet Rich Plasma and split the cost difference. I did that on two branches on my mares patellar ligament and one branch healed, the other didn’t. I think the vet might have missed the branch that didn’t heal because she moved when he was shooting it. That was an old injury on a 10 yo horse, so odds were not in our favor. Haven’t done a suspensory though, so no help there.

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I had a proximal hind suspensory with bone involvement. We did surgery, stem cell, shockwave, and later PRP and more shockwave. He’s sound enough to hack around at the walk and occasional trot, but not sound enough to work. He’s happy retired now though. Sorry I don’t have a better story :frowning: FWIW, we believe his was not a single acute injury, but something that built up over weeks. That lowers the prognosis, as do his slightly too straight hocks.

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Sonny had that same injury. PRP and shockwave. He was never sound again. He was retired.

Sent PM.

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My horse had a high (at the branch) front suspensory tear - about 25%. We did stem cell and shockwave both. He is completely sound and back to full work, jumping novice height. We don’t plan to go above training. We also had a long, slow recovery, 4 months complete stall rest, another 6 working back up to normal flatting, and another 4 before we jumped again.

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My vet didn’t recommend PRP, not sure why. He also did not recommend surgery. I’m going to go forward with the shockwave and also rent a PEMF legging. Fingers crossed. I don’t think it’s a new injury. I went to the clinic planning on an SI injection! These high tears are tough because there’s no heat or swelling, but fortunately it was the first thing the vet thought of.

Wow, that’s great! It seems the fronts are easier to heal. We already have the clear to hand walk and ride walk, so it’s not so daunting.

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I had one with bilateral high hind tears. We did surgery and I think shockwave. He did return to work and was ready to go Training when he had an unrelated injury.


My dressage horse had swelling/injuries to both hind suspensories. He also is straight behind. I received a very grim prognosis from local vet school, was basically told he would only be a pasture pet. Consulted with Rood and Riddle, sent them all the xrays, ultrasounds and nuclear scan. They were more encouraging, designed a treatment program, and we followed that. Shockwave every six weeks, left him turned out in small paddock, PRP. Cleared to start rehab after 8 months, I promptly broke my leg, so he ended up having almost a year off. Slow, slow rehab and a year later he was back to third level. I am careful with him, twenty minutes of walk at the start, not too many repetitions of anything, regular shoeing, and making sure he is never in too deep of footing. But he is sound, happy and schooling 4th. I do think his story may be atypical.

My low level event horse came up with a high proximal lesion on the left hind suspensory. We treated with 6 shockwave treatments. He was on walk only from August to November (3 shocks 2 weeks apart). In December, we added canter work but had to drop back down to trot. Did another round of 3 shocks 2 weeks apart. Resumed canter in February and started jumping in August. He won a dressage year end champion last year and then just placed 2nd and 3rd this weekend at a jumper show. He hasn’t evented yet, but vet cleared him. He wears toe bridges on hind shoes to prevent him from digging his toes into the ground. Less flexion in the ankle that way so the strain on the suspensory is less. Whichever treatment you opt for, if you are patient on rehab, you will have better luck of returning him to work. I also had a small hunter that had a front end tear. It took a year of rehab (walk the first 6 months and then trot straight lines for another 6 months slowly building time up). Spent the 2nd year conditioning. He returned to jumping small courses and stayed sound. There is hope but every horse responds differently. Can be a long process though. Good luck to you!

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The more experience I have and the older I get, the more I think suspensories are not as often “freak paddock accidents” as we thought, but gradually accumulated damage resulting from being boxed in a stall, on feet that are not properly trimmed. Other factors come into play, such as the horse’s conformation and the degree of work (certainly, suspensories seem much more common in horses doing ring work vs out in a field). Of course there are freak accidents still, but just my general observation having worked in a rehab manner for many horses with various suspensory problems.

Hear me out – in my time on this board, and also my time handling horses with suspensory issues, it seems these two things are almost always present in an otherwise healthy horse - stalled overnight, and some strange angles behind. Barring PSD and/or suspensory injuries as a result of an existing pathology (EPSA/DSLD/PSSM/cushings, etc) it really seems that the health of a suspensory is put in jeopardy when there’s improper trim and lots of stall time.

I have had way better luck bringing horses back to their prior level of work from suspensories when I’ve opted for conservative management and lots of time. The best thing for them once there is healing is controlled gradual exercise. I personally prefer to keep them out as much as possible while addressing their hind feet. Of your options, I would do shockwave to help mitigate the inflammation and pain, and see if you can get this horse out as much as possible. Nothing conditions a suspensory better than turnout; we can hand-walk a horse until we are blue in the face but the type of gradual conditioning turnout provides is very valuable for recovery and staying sound.

Comparing suspensory success stories is apples/oranges until you know location and severity, whether or not there is bone involvement or other detachments… That being said, I’ve known several to come back now to their previous level of work… but I also know many that have had to be retired. The ones that have gone back to their previous level (including one of my own, who surpassed his previous level of work from BN to Tr eventing) all had 24/7 turnout available to them.

I gave mine over a year off on Dr Green. Legged up and avoided circles the second year. I spent about 6 months hacking at the walk only before I brought him into a ring. Suspensories tend to have trouble with repetition on circling… keep your ring work as light and as straight as possible that first year of rehab… and staying on top of their feet, which often need some therapeutic/remedial attention since it seems many suspensory cases I’ve seen come with NPA behind.


Great input! I am a firm believer in turnout. My guy has been on all night turnout for the 6 years I have owned him. He’s only stalled around 6 hours a day and he can been a nut in turnout. He’s very playful and energetic. I also have an amazing farrier and he’s always had good hind feet. I kept him barefoot behind, but did add hind shoes when he started getting very short strided on the RH (It didn’t help, but I’m keeping him shod all around). I think this is something that has been lingering for a while and we just don’t see heat or swelling with these high tears. I’ve elected the shockwave and he received his first treatment yesterday. Wait and see!

Mine had a tear in a left hind extensor tendon with edema that settled in the fetlock. It didn’t respond to Adequan, steroid injections in the joint, sweating with DMSO/Furazone/Dex/Surpass, or shockwave. Minor improvement from consistent PMEF treatments on a weekly basis for 5-6 weeks in a row.

I did end up getting amazing results from PRP in that fetlock joint and the horse went back to regular work and showing up to 1.30-1.35m by the end of the next season. I don’t think anyone knew the results would come out so great and I’m sure if it were a suspensory prognosis would have been even more guarded.

If you’ve got the money, it’s worth a shot.

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My now 18 year old OTTB was diagnosed with huge tears in both hind suspensories near the origin (IIRC the lesions were 1/3 the circumference of the ligament). We suspected they were old racing injuries as they were cold and not reactive to touch (confirmed via US and block). He had the surgery- fasciotomy with plantar neurectomy and PRP while in surgery. That got him back to up 3’ jumping and he also did 3rd level dressage years after the surgery. He did have a relapse in one hind a few years back after playing hard in the mud- he came in acutely severely lame- and that was treated with shockwave and icing/poulticing.

I think it really depends on how old the injury is. I would definitely recommend PRP though - and it is cheaper than stem cell, so you might be able to do shockwave + PRP. I work in equine insurance claims and I find the preference of using PRP vs. stem cells is totally vet dependent. Some vets just prefer one or the other.

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