Hind proximal suspensory injury - nothing I see looks good or hopeful about this. Doing more ultra sounding this week to get a better idea but trying to prepare myself. Have you ever had a horse come back from this? (To 100%? Or a lower level? Or at all?)
I have known several, and have one in my barn right now, who’ve recovered from hind suspensory injuries. There are many many variables, so it’s impossible to say at the outset what exactly will or won’t happen. However, none of those horses were injured initially while part of my program, and I think that solid discretionary ability to find the cause of the injury is a really big step towards ensuring future soundness.
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I helped rehab one in college. I took up the riding when the horse was ready for hacking and hill work. He had done the open jumpers before, which I think at that time was something like 1.40? I got to show him a little bit at 3’6-3’9” once he was back in full work, which I thought was a pretty good outcome.
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Years ago…my gelding had been schooling the GP (I got him as a 4 yo and worked our way up)…we did a show at Int II to prep and something happened. He wasn’t lame, but he wasn’t right. After lots of diagnostics, we found the proximal hind suspensory. We did end up doing a fasciotomy and neurectomy based on the vet recommendation. He also got IRAP done in his hocks…this was when IRAP was brand new.
Fast forward…slow and careful rehab. He came back eventually to solid 4th level/PSG. I tried to do more, and he was mostly game (though at that point he was getting older so it was clear the upper level work was hard). But, I really was afraid I would break him down. So, I just decided I would be grateful for what we could do and that way I could continue to enjoy riding him for many years. Which I did…I also let a para athlete use him and he won the national championships. So clearly he made a pretty good return from the injury!
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I have a suspicion that shoeing, footing and conformation all played a part here…we’re in a better spot now, in every sense. The not quite rightness came on so slowly.
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You’re probably right.
As a part-time trimmer, I was asked by someone who’d seen my work to look at her horse. Same injury. She’d done everything the vets said to the T and he was still not right… about 80% but that was it.
I was kindly blunt: “Pull the shoes, get him on a shorter trim cycle and find someplace with at least 20 or more acres to turn him out and leave him out. Bring him in for dinner and the once over, then turn him back out. Some nights he may come in 3-legged lame as the adhesions let go, but turn him out. Give him a year of Dr’s Time & Movement. You’ll know by then what you’ve got and my money’s on a sound horse.”
That was 6 years ago. He came totally sound and has been happily living on those same 28 acres since then.
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So the ultrasound wasn’t so bad - moderate injury but not “marked” or “severe”. Other leg fine. Going to do a PET scan to see if any bone edema before starting shockwave - the vet isn’t known to be a Pollyanna and she wasn’t acting pessimistic so I’m hopeful the mare can come back 
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I have one that I bought “lame” because my vet is amazing. He was not particularly expensive and his reputation as a good guy preceded him.
She watched him trot in a “ppe”, looked at some xrays, asked if she could block his suspensory and bam that was it. She said “I can fix that” with the surgery and she did.
Is your horse a candidate for the surgery? Many are opposed to it and I understand why – you have to fix the underlying problems, but I did that also (good farrier – he is actually barefoot behind now, less deep footing, and an easier job).
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My first horse had a high hind proximal suspensory injury. He was 13 at the time. He had 5 months of stall rest + a bone marrow transfer at month 4, followed by a year of slow by-the-book rehab. He came back 100% and was my AA hunter. The insurance company even lifted the exclusion on the leg. So yes, it’s possible. Did I spend every waking hour of the year and a half convinced I would never have my horse back? Yes.
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The vets didn’t mention the surgery so I don’t know if it’s warranted - I will ask after the scan.
Yes! So granted, I sold him because I had exhausted my time/money/whatever to rehab him, but he is happily sound and doing the lower-level hunters. I will say that despite a lot of money on shockwave and cold laser, the ultrasound never actually looked great. 
But the horse in front of me was indeed sound after three months of stall rest and turnout.
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And old equine vet at our barn said she had a track vet friend who gave every soft tissue injury ~ a year off. Then, if the horse was sound, he’d bring them slowly back to work, and not worry too much about how the fibers looked. Apparently he had great success with this method, so there’s definitely something to “riding the horse in front of you!”
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She’s already had about two months off while Ive been trying to diagnose this with just hand walking and living in a small paddock next to her buddy (not big enough to run). She’s thankfully been quiet and ok about this, so I’m hoping it bodes well for a not too unhappy rest period.
