Inflamed High Suspensory Ligament Injury (Right Hind), should I do the Surgery?

[Myster92]

I know this topic has been discussed on here at length but I was hoping someone could give me new advice maybe on how their horses are doing after having a surgery for high hind end suspensory injury.

In short:

• The vet did Never Blocking and suspected suspensory injury
• We did the ultrasound a few days later after stall rest to discover the right hind suspensory ligament to be inflamed at high end of the ligament (when compared to the Left Hind) - no other damage is apparent.
• Option is to do surgery for best outcome…

Here is my dilemma,

• She is not my horse (leased) and the vet said there is almost 90% chance that this is a chronic issue (so happened before we got her 2 months ago). During this time we’ve had her we haven’t done much but flatting to condition her.
• She is a high strung/hot blooded horse, hates being inside and I worry about how she will do on the rehab stages since this is integral to healing

1. Has anyone had success with the surgery and rehab to the point where your horse could be successfully jumped again?

2. With this type of horse is it worth it to do the surgery? (p.s. I don’t really have the money to do it, but if I could scrap together something maybe it could be an option)

[Buddy0227]

What kind of surgery would be done for inflammation ? I just stall rested then rehabbed my gelding with the same diagnosis.

[TheHunterKid90]

Have you tried anything to actually promote healing or is your vet just jumping right to surgery?
We opt to counter irritate high suspensory injuries and have had great success. Is it strained? Torn?
We will often water blister them and then follow up with routinely counter irritating it with a mixture of iodine, dmso and cedar oil.

[rocky01]

My boy had PRP in both his high hind suspensories for PSD (inflammation in the suspensory) along with a steady rehab protocol and other than a recent unrelated stifle injury he’s come back absolutely amazingly. Personally I would always go that route rather than the surgery.

[gumtree]

Not enough information to give any kind of reasonable advise.

Shouldn’t need to use an Ultrasound to find out the suspensory is “inflamed”. That should be evident to the eye and or trained hand.

Your vet should have told you what the US revealed. Exact location, size of the tear/lesion.

There are several types of procedures. Saying surgery is pretty generic.

A PRP procedure is an injection;

Platelet-rich plasma (Abbreviation: PRP) is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains (and releases through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue.

It does not speed up healing. It can but does not always improve the “quality” of the healing process. Relatively inexpensive at $800-1,200.

Just about all suspensory injuries can be and or will be chronic at some point in time depending on the demands/training/competition the horse is subjected to. There is nothing that will “repair” the injury good as new at this time.

The “call” on what to do and what to possibly expect in the future should be made by a Vet that is highly specialized in this sort of injury. This is not a “call” that should be made by a general practitioner.

Unless your vet using a very dated US machine he/she should have down loaded the file onto a CD or flash drive. Which can be emailed and or sent to a expert for a second opinion. A consultation is not that expensive.

Good luck.

[Simkie]

This isn’t your horse? She’s leased? Don’t do surgery, do not pass go, do not collect $200…give her back! Terminate the lease and let the owner make these decisions. This is one of the HUGE advantages of a lease–take advantage of it!

[gumtree]

[QUOTE=Simkie;8572973]
This isn’t your horse? She’s leased? Don’t do surgery, do not pass go, do not collect $200…give her back! Terminate the lease and let the owner make these decisions. This is one of the HUGE advantages of a lease–take advantage of it![/QUOTE]

That is not always an option. Depends on the terms of the lease. I wouldn’t lease a horse to someone that “breaks” it and then expects to give it back broken and leave me with the bills.

This situation should have/be covered extensively in the lease contract. But it wouldn’t surprise me given what I have read around here from time to time as to people’s idea of a “contract”, sale or lease that it wasn’t included. It there was a lease contract of any sort to begin with.

If someone leases a car they are responsible for any and all damages that are not covered by the warranty if there is one. They blow the motor and it is not covered they have to pay to fix it. Sure they can take it back but they will be billed for damages/repairs.

[LarkspurCO]

[QUOTE=gumtree;8572355]

Shouldn’t need to use an Ultrasound to find out the suspensory is “inflamed”. That should be evident to the eye and or trained hand.[/QUOTE]

Desmitits = inflammation of a ligament. Ultrasound is essential to the diagnosis PSD. There is often no swelling, and the ligament is surrounded by bony structures, so you can’t really palpate it.

[drawstraws]

One of my geldings was leased out in 2013 when I was laid up with a broken leg and I got a text message from them just before Thanksgiving that he was off. Took him to the vet and after nerve block and ultrasound, he was diagnosed with a strained RH suspensory, just below the hock. Did shockwave and he was sent home with instructions to use Surpass and lay him up for a while, but turnout was OK. Brought him back in February for a recheck with another ultrasound and shockwave and gave him a bit more time off. After a third recheck, we ended up doing Stem Cell and a fasciotomy in June 2014 as the vet said that the hinds don’t heal as well with just rest as the fronts do. It was a fairly minor procedure - was done in a couple of hours and I took him home the same day. I had him on stall rest for approximately 45 days but my set up at home made it really difficult, so he ended up just getting turned out after that. I let him have all of 2015 off as I had my younger horse at a trainer all year so he’s just now going to be going back to work now that spring is coming. He’s looked sound since treatment but will have to see how it holds up once in work and I’m hoping to get him back up for another ultrasound to see how it looks before we go too far.

Even though he was on a lease, I didn’t expect my lessee to pay for something like that. As far as I know, it was something he most likely did himself while on turnout (he was on pasture board) so they were not negligent in any way. I did have him insured, so I paid for his bills but the reimbursement came to me. I probably paid $1,500 out of pocket but he’s my horse and my responsibility. If they had done something to cause the injury, I would have asked for some payment from them, but that wasn’t the case so I didn’t expect them to pay. Depending on your contract, I would sit down and have a talk with the owner. This isn’t a quick fix, so it could be several months before the horse is rideable again, if not longer.

[gumtree]

[QUOTE=LarkspurCO;8573120]
Desmitits = inflammation of a ligament. Ultrasound is essential to the diagnosis PSD. There is often no swelling, and the ligament is surrounded by bony structures, so you can’t really palpate it.[/QUOTE]

While I don’t entirely disagree. IMO and experience that is a broad statement. It really depends on the injury and the expertise of the “trained hand and eye”.

[Simkie]

I certainly hope that this was covered in the lease contract. But since the OP says they haven’t done much with the horse and have been legging it back up, it’s entirely possible that this is a long standing chronic issue already. Why was the horse out of work to begin with?

Regardless, the leaser certainly should not be responsible for this decision alone. What do the owners say?

[Gumby80]

My understanding is that chronic high suspensory strains generally don’t heal well just with stall rest and PRP/shockwave. Or, they improve, but recur once the horse is back in work. I suspect this is why the vet is recommending surgery, and it’s probably a good idea to listen to them over a bunch of strangers on the internet.

The fact that this is a lease horse makes it tricky. Is there any clause in your contract that deals with this situation? At any rate, it’s time to have a conversation with the owner. If the injury is chronic, and many high suspensory strains are, then you did not cause it, but may have exacerbated it. Even so, it’s not usual or appropriate for you to pay for surgery on someone else’s horse. Added to that, the rehab process is pretty hellish, and it already sounds like this horse is going to be a handful. I’ve done the rehab, stall rest, hand walking progression, and it is very stressful. Do a search on this board, and you’ll find many other stories. It is not easy.

Unfortunately it sounds like she needs to go back to her owners. The decision on treatment is up to them. You could put them in touch with the vet to explain the situation, amd hopefully this will convince them that it was a pre-existing condition that you were not responsible for (I’m assuming you’re not, since you say you’ve only been flatting her). You have my sympathies, it sounds lik a very disappointing situation for all concerned.

[gumtree]

[QUOTE=Simkie;8573434]
I certainly hope that this was covered in the lease contract. But since the OP says they haven’t done much with the horse and have been legging it back up, it’s entirely possible that this is a long standing chronic issue already. Why was the horse out of work to begin with?

Regardless, the leaser certainly should not be responsible for this decision alone. What do the owners say?[/QUOTE]

Fair enough. The OP didn’t go into specifics of their lease arrangements. My comment was based on a lease that I have agreed to. Which is pretty much the norm in my neck of the woods.

If a horse had a known pre-existing “old” injury is one thing. If not known and was not pick up on a PLE as far as most lessors would be concerned that is the chances one takes. The same as if they bought the horse.

I would like to think I am very fair about these things. I leased a really nice horse for an extremely fair price because I like the people and they didn’t have a lot of money. A few months later it was discovered the horse had an issue that went diagnosed by the “experts”. I could have held them to the letter of the contract but didn’t.

Drawstrings IMO was very magnanimous. Yes that could have happened in her back yard. But that doesn’t let the lessee off the hook for the expenses needed to get the horse sound. Leasing a horse is the same as owning it during the period of the lease. A long with all of the expenses associated. Good or bad, that IS the chances one takes when they sign on the dotted line.

The SAME chances any of us take when we buy and or breed a horse. Why do buyers, lessees feel we should take, accept 100% of ALL risks?

When I sell a horse I really hope the new owner knows what they are doing. Care taking and training. But if they screw up directly and or the horse gets hurt in a padded stall at no fault of anyone’s, sh*t happens. They pay the price.

People who lease a horse take a BIG chance and risk. Maybe the lessee did everything right and sh*t happened. Maybe they did too much to soon and the horse suffered a soft tissue injury or any number of things. I don’t think it is fair to expect the owner to shoulder all of the expenses because the lessee doesn’t “own” the horse.

Generally the only reason people lease a horse is because they can’t afford to buy it. The same with people who lease expensive cars by and large. But not always in either case.

IMO people who lease a horse are taking a huge risk. Even if the lessee pays all of the expenses when the horse is injured. Good chance the horse will be worth far less when it is returned. If it was sold that’s not the case. There are good reasons to lease a horse and it can be a win, win for both. But if things go wrong the owner is screwed far more than the person who leased it.

Just my way of looking at the big picture.

To each their own.

[mishmash]

My horse has the same injury. Was told by vet (at well known veterinary school) to do surgery, and given pretty grim prognosis. Did some research on who has had success treating these types of injuries, and ended up sending all US, xrays, and nuclear scan to Rood and Riddle for a second opinion. Recommendation was shockwave, turnout, ultrasound every 60 days. When swelling down, slow rehab under saddle. Was told surgery should be very last resort. I would get a second opinion-and would not do surgery unless you and owner ok with pasture pet.

[LarkspurCO]

[QUOTE=gumtree;8573425]
While I don’t entirely disagree. IMO and experience that is a broad statement. It really depends on the injury and the expertise of the “trained hand and eye”.[/QUOTE]

What I said isn’t just a “broad statement,” and you’re free to agree or disagree, but that doesn’t change the anatomical features that make this part of the ligament unreachable to a “trained hand,” and a “trained eye” does not possess x-ray vision.

Nerve blocks, ultrasound as well as radiographs (or MRI) are widely accepted as the gold standard in diagnosing PSD.

What sets apart an expert diagnostician from the others is that, even though their visual and manual examination may lead them to strongly suspect a particular diagnosis, that diagnosis is useless until it is confirmed by diagnostic imaging. That’s not to say there aren’t many ailments that CAN be accurately diagnosed in this manner, but PSD is not one of them.

I’ve wasted a lot of time and money on the “trained eyes” whose experience told them one thing while the real problem went undiagnosed. No thank you.

[Gumby80]

[QUOTE=LarkspurCO;8573906]
What I said isn’t just a “broad statement,” and you’re free to agree or disagree, but that doesn’t change the anatomical features that make this part of the ligament unreachable to a “trained hand,” and a “trained eye” does not possess x-ray vision.

Nerve blocks, ultrasound as well as radiographs (or MRI) are widely accepted as the gold standard in diagnosing PSD.

What sets apart an expert diagnostician from the others is that, even though their visual and manual examination may lead them to strongly suspect a particular diagnosis, that diagnosis is useless until it is confirmed by diagnostic imaging. That’s not to say there aren’t many ailments that CAN be accurately diagnosed in this manner, but PSD is not one of them.

I’ve wasted a lot of time and money on the “trained eyes” whose experience told them one thing while the real problem went undiagnosed. No thank you. :)[/QUOTE]

Yep. My vet said that the high hind suspensory origin is very difficult to palpate by hand, and that ultrasound is the best way to diagnose. Have seen more than one horse with high hind suspensory lesions mis-diagnosed as having hock arthritis for months to years.

There’s nothing like experience when it comes to horses, but you do start to get the “old vet” syndrome. You know, the ones who barely lay a hand on the horse, and say “we’ll inject his hocks”. They’re saying this because from their vast experience, it’s about 80% likely that that’s what the problem is. But if you’re in the 20%, it really sucks.

[Laurierace]

What exactly is surgery for suspensory inflammation?

[mishmash]

[QUOTE=Laurierace;8574199]
What exactly is surgery for suspensory inflammation?[/QUOTE]

Fasciotomy to remove pressure on ligament and neurectomy to cut nerve.

[Samantha37]

My horse (not leased- that is a different circumstance) - had bilateral hind proximal suspensory desmitis with core lesions that were 1/3 the circumference of the suspensory. We think they were old racing injuries from several years prior that he was just being extremely tough and going around on. He had the fasciotomy with neurectomy and PRP intra-operatively. That was in 2011 and since then he has done the 3’ hunter/jumpers, Novice level eventing, and I just entered my first show doing 2nd level dressage. A re-ultrasound done in December 2015 showed the ligaments look normal for a horse his age and size.

I am SO glad I did the surgery. I talked to another well respected vet other than the one I was using at the time and she said that the fasciotomy/neurectomy with PRP is the “gold standard” for hind suspensory injuries.