Hind Suspensory Injury & Chances of Recovery

[heathermhib]

Unfortunately my horse was diagnosed 2 weeks ago with a high suspensory ligament lesion where the ligament attaches to the bone in his hind leg. He has since then been on stall rest, iced, poulticed & wrapped, and will start handwalking just a little next week.

However, my vet feels like he doesn’t have a very good chance of returning to full work without some kind of therapy in addition to rest & rehab. Before his injury he was competing in eventing at Training level, with the eventual goal of FEI levels. My vet tells me that this type of injury only has about a 20% chance of full recovery to previous work. :’(

So, my vet really wants me to do the PRP injection, and I am just wondering if it’s really worth it. Unfortunately I am really broke and I’m not even sure how I’m going to pay the bill for the diagnostic ultrasounds, multiple visits to determine what was wrong with him, etc.

Does anyone have any experience rehabbing a horse with just rest & rehab, vs. rehabbing one after getting PRP? Does it really dramatically increase healing? Has anyone had their horse come back to full work without doing some kind of additional therapy? Has anyone had their horse not come back to full work, even with all the veterinary bells and whistles?

I love my horse so much and he is an amazing guy. I would love to be able to give him every treatment option available, and it breaks my heart but I can’t throw money at this injury on the slim chance that it might maybe help a little. Advice/anecdotes all welcome.

[WW_Queen]

I recently read on a website (I want to say TheHorse.com) about the new non-traditional therapies. The problem is that not all therapies are guaranteed for all types of injuries in all horses. They can be a bit “hit or miss” whether they actually do the job intended.

My older horse tore his hind suspensory and had a year of rehab and recovered in 11-12 months, jumping at 14 months. Another girl at my barn had her horse tear a front and did 3 rounds of shockwave. She was back showing at Training level (her horse was prelim prior to the accident) in about 8-9 months.

Maybe try the traditional methods of rehab for the first 3 months, give yourself time to pay off your existing bills and then if you can swing it, talk to your vet about shockwave or other therapies.

[mg]

Unless the injury is far worse than the description in your post, I don’t understand the 20% recovery stat. My pony incurred hindlimb proximal suspensory desmitis in March 2011. With a combination of immediate shockwave therapy (3 sessions @ 2 wk intervals), appropriate stall rest, hand walking, small turnout, and progressive riding, he was back into full work by November of the same year. This spring he has already completed two novice horse trials and is at his prior level of work…actually performing even better than before!

I bet he would have come back without the shockwave, but I do believe that it helped the process a lot. The cost of doing the therapy and vet appointments was cheaper than the cost to replace him with a horse as nice, already going at the same level he was at. I know that sounds horrible, but that’s how I justified the expense.

Another friend of mine has a horse who tore a huge hole in his suspensory and she treated with PRP. I cannot remember the exact timeline, but he was healed and back in full work in an impressively short amount of time, especially considering the amount of damage he had.

[Twisted_River]

I don’t think it’s so much a question of it he’ll heal. He will. It’s more a question of how well he heals. Tendons and ligaments heal with scar tissue. It’s the scar tissue that can become your worst enemy and cause chronic and/or acute lameness down the road. Tendons move and stretch a lot. Scar tissue irritates the leg structure when it moves around and it doesn’t stretch. I expect that with your current regime your horse will heal fine and likely go back to eventing at training. As the miles pack on he could develop chronic lameness or could re-injure the ligament (notice I said “could” and not “definitely will”)

I think if your goal is for him to be a great low to mid level horse for yourself or someone else, the expense of PRP likely is not justified.

If he oozes with upper level potential, and that is a realistic goal for him, then yes, come up with and spend the money to have PRP done. Research PRP and speak with your vet and other vets about their methods. Not all PRP is equal.

His leg will only heal once. No do overs here. If he is super talented once in a lifetime type horse, don’t take 1/2 measures you may regret later. And if you really truly can’t afford it then that is that. His path may have changed. Your path maybe changed. It’s not the end of the world. Accept the risk, roll the dice, and move forward. He may stay sound and take you to Rolex one day!

I agree with mg’s justification of expenses. Even dropping $5,000 on vet bills is cheaper than: full loss of current horse (his purchase price, all board, training, etc. to date), plus the expense of a new horse, board, training, etc. to get it to current horse’s level. And if current horse doesn’t come back from injury, possible lifelong board of pasture ornament (let’s hope not).

For the time current horse is laid up you won’t be showing him and you could stop taking lessons. Depending on how intensive your showing and training is, that should free up hundreds to thousands of dollars you can spend on vet bills.

I wish you the best of luck and I wish him a speedy, utterly uneventful, and highly successful recovery :yes:

[frisky]

My horse had a bad high hind injury of the suspensory at the insertion point. My horse was old, maybe 19 at the time, and was feeling creeky already, so I did not feel the need to pull out all the therapies. What she did have going for her though was an A+++ temperament. We did the most conservative rehab possible. Again, because of her age, when my horse went back to work, she was not doing anything super competitive, but I do feel comfortable in saying that she healed considerably more than she was expected to heal. I did not ride her very much this past winter and I’ve been riding her lately and she’s still a ton of fun to ride.

This is how bad she was: My horse got a month off on total stall rest and light grazing. Then we started hand walking twice a day for 3 minutes adding 3 minutes every week (I think). At around 15 minutes of hand walking, she went totally lame. It was sad to watch. I waited and restarted again. When my horse was up to 45 minutes 2x/day, I got in the saddle and walked her for 10 minutes. She went TOTALLY LAME. You could see it in her stall, particularly when she got up from lying down. I gave her time, started her back slowly and she was fine.

I have used prp/shockwave on another horse. Honestly, I could not tell you if it made any difference at all. My guess is that doing the therapies was mostly for my benefit.

Consistency and patience are the key.

[frisky]

[QUOTE=Twisted River;6434676]

His leg will only heal once. No do overs here. If he is super talented once in a lifetime type horse, don’t take 1/2 measures you may regret later. [/QUOTE]

This! I have seen several horses with suspensory injuries not go sound because the rehab, even with prp and all, wasn’t done consistently the first time. Do it right the first time.

[Carolinadreamin]

Horse retore his suspensory while undergoing his first rehab, after undergoing rounds of shockwave, Etc. He retore it while I was still just walking him u/s. Ugh. So, this time we just turned him out for over one year, making sure nothing was done with him until well past the year anniversary of his retearing it. Then we brought him back very, very slowly. Today he is back to his pre-injury level and doing well.

He was not at the level that your horse was, but I think (purely unscientific) that the year of turnout was the best thing for him.

Good luck, it’s a tough road.

[Herbie19]

I’ve had good luck with stall rest/tack walking and shockwave. Hind limbs are tough though and like another poster said scar tissue in your biggest enemy with this type of injury.

Since money is tight I’d be inclined to tell you to turn the horse out in a safe FLAT field for a year and left nature take it’s course. Either that or if you think you can manage it, stall rest with 30 minutes walking (hand or under tack preferably) twice a day for six months and then reultrasound.

You’re lucky because it’s a new lesion that hasn’t had a chance to heal incorrectly. I had a horse brought to me for rehab with this exact injury. He was simply stall rested and then brought back into work WAY to quickly. He came to me after a second thought fasciotomy. At that point PRP was not indicated as the ligament had “healed”. This horse is now happy mowing my grass.

Whatever you decide NOT NO RUSH the initial rehab. If/when the horse is ready to return to work it should take months (as in increasing trotwork by 30 seconds a week) to return to full flat work. All the ones that I have done (which range from only stall rest to pulling out all the stops with therapies) have taken over a year (some 18 months) to return to full flatwork. Just remember you only have one shot. Fingers crossed for you and please keep us posted!

[joiedevie99]

I wonder if the vets 20% statistic is because the lesion is at the attachment to the bone?

[merrygoround]

There is a very long thread on this subject in the Eventing Forum

I believe the recovery rates vary with the amount of damage and scar tissue at the site. Some horses seem to go on performing without showing clinical signs until they have done extensive damage. These are the tough one.

I have read a 35% success rate.

Most on that thread had surgery , many had stem cell ( now falling out of favor according to my vet).

To save a hunt:http://chronofhorse.com/forum/showthread.php?t=271451&highlight=Suspensory+Surgery

[dwblover]

Of course this is only my personal opinion, but I think the reason there is such a poor rate of success with healing soft tissue injuries is due to the amount of time it really takes to heal them. I think anything can heal naturally if given ENOUGH time. If you really don’t have the money to do the newest techniques, then I would personally try to double the timeframe given to you by the vets. Take it very, very slow and bring the horse back into work VERY slow and I think you will be alright.

[merrygoround]

The amount of scar tissue laid down by the injury, no matter how careful the initial handling, or subsequent rehabilitation will have a big effect on the actual return to usefulness. Few return to their initial potential. Yes, there are some out there that were competing at the lower level of their competitive fields, that were rehabbed and went back to that level of competition. But that wasn’t necessarily the level of their potential in that field.

Don’t give those who had a horse seriously misbehave and undo months of work, or those who spent a year at rehab only to have it inexplicably fail, a guilt trip… saying that they just didn’t take long enough or enough care.

If it were that simple there wouldn’t be so many retired top horses.

[dbolte]

So sorry to hear this… Can completely sympathize! I am currently rehabbing a high hind suspensory strain on my 5yo. She’s in a bit of an odd situation, as her ultrasound has been completely clean all along, so nothing specific to do shockwave or anything else on- she had a little over two months of stall rest, with limited space turnout (about the size of four stalls) if she would stay quiet (which was about the first two weeks) and handgrazing pretty much as long as I wanted to keep her out, the only stipulation being to limit the amount of walking she did while grazing.

After seven or eight weeks, she started longing every other day, gradually building from five minutes up to ten or fifteen, all trot work out on the hard ground, not in the sand in the arena, and then was ridden every other day, first at a walk and then adding trotwork, again, all done out in the pasture not in the sand and on straight lines and large turns. At that point she was allowed to be turned back out, and she had been doing fine- she was back up to fifteen minutes of more or less normal walk-trot dressage work every other day, plus twenty minutes or so of hacking- but she bruised her front leg playing two weeks or so ago, so she’s been back out of work for the past couple weeks…but thankfully not because of the suspensory! Although I would like it if she would stop hurting herself this year…

[Samantha37]

My horse had proximal suspensory holes in BH legs. We did surgery and PRP and he has come back 110%. He is back to 1st level dressage, Novice level eventing and schooling 3’3 jumps.

I’d say the PRP is definitely worth it. My guy had a 60% chance of coming back with surgery and rehab and I’d do it all over again if I had the chance. The PRP worked wonders on my guy, combined with the necessary surgery.

[dwblover]

Vicarious you made up a guilt trip in your own mind. I have found that many vets give what I feel is a short timeline for recovery in the cases of soft tissue injuries. I would expect a horse to be totally out of work for close to 18 months for a soft tissue injury, many vets have the horse back in full work at the end of the year. So how in the world you turned that into me giving owners that have had rotten luck with their horses a guilt trip is beyond me. :o

I have personal experience with my own WB who went through years of lameness for a deep digital flexor injury who DID need more time off then the vets told me. I had my own rotten luck where he reinjured it several times. Finally after being out of work for over two years he is now sound. Of course I’m not stupid, I realize every soft tissue injury is not going to heal with time, and of course the horse may not end up at the same level of work, but I really freaking hate it when people want to get snippy and imply things from a post.

[kiwifruit]

I agree with Samantha 37. If you have any funds, do the PRP and rest for a good year. I did PRP with surgery and the PRP was an afterthought after 1.5 months post surgery the vet was not happy with the healing on ultrasound. I really do think that made a huge difference in my guys recovery. We are now 10 months post surgery and he is in full flat work and large turnout. I hope to have the final ultrasound next month to clear us for jumping. (knocking furiously on wood) I hope to return him to training level eventing late fall.the cost of the PRP was about 1.2k which was covered by my insurance (which they are dropping me at the end of the policy but that’s another thread) I would sure do it again in a heart beat. Good luck! I feel your pain!

[merrygoround]

[QUOTE=dwblover;6435768]

I have personal experience with my own WB who went through years of lameness for a deep digital flexor injury who DID need more time off then the vets told me. I had my own rotten luck where he reinjured it several times. Finally after being out of work for over two years he is now sound. Of course I’m not stupid, I realize every soft tissue injury is not going to heal with time, and of course the horse may not end up at the same level of work, but I really freaking hate it when people want to get snippy and imply things from a post.[/QUOTE]

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[Quote=dwblober]So what exactly are you wanting people to say on this thread then? You seem a bit snippy with my post. I was simply trying to tell you that A-fib is not awful, obviously there may be something more going on with your horse as evidenced by the super high heart rate, but what exactly do you want people to say??

:lol: Seems to be an epidemic of snippiness. :lol: :lol:

[heathermhib]

Thank you for all your replies everyone! Let’s see - I think the poor chance of recovery was due to the face that it separated right where it attaches to the bone - you can almost see a faint line on the X-ray where it pulled off the bone. It seems to be a large lesion - I know nothing about reading ultrasounds and I could see the hole on the ultrasound.

It’s good to hear everyone’s stories. At this point I am leaning towards doing the PRP, since as I do more research and talk to more people, they really do seem to have less chances of re-injury after some kind of therapy. I am in no hurry and plan on giving him LOTS of time to heal, and it does make sense that I have this one chance to really give him all the help I can to heal without scar tissue that could screw him up for life.

Twisted River, you made a lot of good points. I’ve had my horse since he was born and even if he only ever ends up as a pasture ornament, he’s family and he’s not going anywhere. If I do the PRP, he stays sound and ends up at Rolex, I’m sure I will be extremely happy I did it, and the cost of the PRP is nowhere near the cost of a new horse as sane and brave as him. If he doesn’t stay sound, he will still be my trail riding buddy and I won’t have any regrets.

I had more thoughts but I will have to post them tomorrow as my brain is tired out for the night. Thanks again everyone!

[horsefaerie]

Runners Relief can be your friend. If your horse will stand with his leg in a bucket, pick up a homedics home spa for the tub thing and do your own hydrotherapy. When you are done use the water to make a clay poultice.

Per a vet 300mg of COQ10 for 10 days.

THese are both fairly inexpensive and I have used them with great success.

Good luck to you!

[Twisted_River]

Strains heal in a matter of months. Tears take 1-2 years to heal. I’m not a veterinarian, but I would never ever ever recommend allowing a tear to heal with long term turnout. Ever. What will happen is the hole will start to heal. For arguments sake, let’s say 20% healed. Something will spook the horse, causing him to go galloping full steam to an eventual sliding stop at the gate (or something along those line). Causing the 20% healed to tear back down to 15%. Then heals another 20% (35% now), and tears back down to 30. Back and forth, back and forth. By the time the hole has closed completely it will be the biggest, gnarliest bundle of scar tissue EVER! Strains can heal in a pasture as you are simply waiting for inflammation and aggravation to go away. Tears need stall rest with controlled hand walking.