Ruptured Suspensory....keeping him comfortable

[LittleMissBigTime]

My friend, who happens to be the BO where I keep my horse at, has a 16ish year old gelding. A few months ago he came in from turn out one morning with a swollen front left lower leg. After she tried home remedy treatment for something minor, and it hadn’t gotten better, she decided to have the vet out. Without xrays or much else (vet’s decision not hers) the vet concluded that Sarge had ruptured his suspensory ligament.

Sarge had been in super light training, 1 ride a week for 10-15 minutes. I had been the one riding him. We were working on barn sour issues with him.

Does suspensory really fit as a pasture injury? He wasn’t dead dog lame until 2 weeks after the diagnosis. Just swollen. The heat comes and goes, and the swelling travels down into his ankle and back up again.

My main concern is that the vet gave her no direction on keeping him comfortable, or any advice on how to support the recovery process. He just said to give Sarge 8-12 months off and to turn him out as usual.

In the roughly two months since diagnosis he has gone from being stupid in the pasture galloping around, to dog lame, back to stupid, to normal and calm, and lame again. Last week we discovered two abscesses in the lame leg’s hoof & one super hot abscess in his rear right. He also has weird sores on the front of his lame leg’s ankle. Vet says “summer sores” but they almost look reminiscent of an abscess drainage, but through the ankle?!?

Anyways, any suggestions on keeping this sweet guy comfortable? When he goes super lame it breaks our hearts, and to not be given any suggestions on supportive therapy really doesn’t sit well with me.

The whole diagnosis seems fishy. I just can’t fathom a suspensory injury in a horse playing around in a huge open field…but I guess stranger things have happened.

He will most likely not go back to being ridden after this. The vet said “we won’t know until the 8 months are up” but at this rate of heat and swelling travel, and the abscesses and just general misery he seems to be in (he’s so depressed)…we are going to try and find him a long term pasture mate type living situation…

in the mean time…

insight? suggestions on how to help him? Bute helps a little when he goes really lame, but we don’t want to load him up on it and have him create more injury because he “feels good”

[Laurierace]

You can not diagnose tendon or ligament injuries without an ultrasound unless the ankle is on the ground. He should not be outside of the stall except for icing or cold hosing until after the ultrasound when you find out what you are actually dealing with.

[Nickelodian]

Agreed with Laurie, but to add my 2 cents, the two suspensory tears I’ve dealt with happened in the pasture.

[JJARAB]

friend’s horse developed suspensory tears from a pasture injury. it can happen, esp if the pastures are deeply muddy.

[Laurierace]

There is a huge difference between a tear and a rupture. My guess is this horse has neither but that is beside the point.

[LittleMissBigTime]

[QUOTE=Nickelodian;7724285]
Agreed with Laurie, but to add my 2 cents, the two suspensory tears I’ve dealt with happened in the pasture.[/QUOTE]

Okay so it’s not totally out of line for this to have occurred in the pasture.

I keep telling his owner that the vet couldn’t really make this kind of diagnosis without further investigation…

I’ll be passing that along to her and see what she thinks.
He’s a sweet boy, and we feel terrible that he’s so bummed out all the time, and I just got to the point where I’m frustrated that the vet gave us absolutely nothing to go on as far as keeping him comfortable or bringing him back from the injury.

Wish he was mine, so I could make the call and have a different vet reevaluate his situation. Unfortunately, his owner is dealing with having both him and her other guy injured. Other guy has huge nasty gash that has taken a lot of time energy and vet bills to get on the road to recovering. Streak of bad luck. She’s not the type to let him suffer, I think she just took the vet’s word and didn’t question it like me.

[LittleMissBigTime]

no mud-high and dry grass field.

vet had asked if he was raced or jumped previously. Obviously we don’t know his whole past, but for the past 4 years he had been a sound trail horse. I don’t think he was jumped, as he had severe behavioral issues under saddle when taken out on his own to do any kind of work. On the ground, a saint, away or near his buddies.

[Nickelodian]

[QUOTE=LittleMissBigTime;7724330]
no mud-high and dry grass field.

vet had asked if he was raced or jumped previously. Obviously we don’t know his whole past, but for the past 4 years he had been a sound trail horse. I don’t think he was jumped, as he had severe behavioral issues under saddle when taken out on his own to do any kind of work. On the ground, a saint, away or near his buddies.[/QUOTE]

Both of mine were in a dry field. I’ve also seen a horse who stepped on himself and tripped and tore his suspensory.

Further diagnostics are needed.

[rcloisonne]

Owner needs a new vet, like yesterday. Turning a horse out to yahoo around with a suspected suspensory rupture/tear/injury is ridiculous! Has the owner done any research on suspensory injuries? Surprised anyone but a rank newbie would follow advice like this. Maybe she doesn’t really care or want to spend the money?

Ditto what the others have said, your friend needs a vet who will provide a proper diagnosis and has the equipment to do so. Some ambulatory vets don’t have an ultrasound machine. Mine doesn’t but has provided the names of other vets in the area who do.

I don’t buy the excuse the vet didn’t want to do further testing. Your friend should have insisted this be done. A very important part of responsible animal ownership is to advocate for them when they are sick or injured.

[Promise_No_More]

Just popping in to say I know a horse who tore a suspensory standing in a 12x24 box stall overnight - in the middle of his rehab for a torn suspensory on the opposite leg! They are so clever, these horses!

[kcmel]

My guy was misdiagnosed with a suspensory injury. And that was WITH both nerve blocking and an ultrasound. So there is no way I would trust a vet to just look at a horse and claim it was a suspensory injury. Really, an ultrasound isn’t that expensive (although I would block first–not that the block can’t lie!)

[RC1]

There really needs to be more diagnostics in this case. First off a vet with xrays and an ultrasound would be ideal. Is the horse sore to palpation on the suspensory? If so then the vet can always block the suspensory. If the horse goes sound after the block than you either have a suspensory issue or a hock issue (as the suspensory and the hock can sometimes block each other out). I would then recommend taking xrays of the hock just to be sure and then after the fluid from the block is gone from the suspensory (which can be accomplished the next day with a tight standing wrap and possibly some dex), ultrasounding the suspensory would be my next step.

This way the vet can get a better idea of how serious of a suspensory injury the owner is looking at. Depending on the extent of the injury will determine the treatment, such as amount of stall rest, wrapping, cold therapy, NSAIDs, steroids, possible injections, etc. If it truly is a suspensory injury the last thing the horse should be doing is running around the pasture. The suspensory is a weight bearing tendon and the more concussion and stress is receives the higher the chance of making the injury worse.

[steelerino]

[QUOTE=kcmel;7727249]
My guy was misdiagnosed with a suspensory injury. And that was WITH both nerve blocking and an ultrasound. So there is no way I would trust a vet to just look at a horse and claim it was a suspensory injury. Really, an ultrasound isn’t that expensive (although I would block first–not that the block can’t lie!)[/QUOTE]

What did the injury end up being if you don’t mind me asking??

[gumtree]

[QUOTE=RC;7727501]
There really needs to be more diagnostics in this case. First off a vet with xrays and an ultrasound would be ideal. Is the horse sore to palpation on the suspensory? If so then the vet can always block the suspensory. If the horse goes sound after the block than you either have a suspensory issue or a hock issue (as the suspensory and the hock can sometimes block each other out). I would then recommend taking xrays of the hock just to be sure and then after the fluid from the block is gone from the suspensory (which can be accomplished the next day with a tight standing wrap and possibly some dex), ultrasounding the suspensory would be my next step.

This way the vet can get a better idea of how serious of a suspensory injury the owner is looking at. Depending on the extent of the injury will determine the treatment, such as amount of stall rest, wrapping, cold therapy, NSAIDs, steroids, possible injections, etc. If it truly is a suspensory injury the last thing the horse should be doing is running around the pasture. The suspensory is a weight bearing tendon and the more concussion and stress is receives the higher the chance of making the injury worse.[/QUOTE]

The “suspensory” is a ligament not a tendon. Big difference

[gumtree]

I and others have covered this extensively. Identifying, treatment and re-hab. One of these days I will go back and find some of my posts and create a file so as to copy and past.

In short, NO competent vet would diagnose a suspensory injury without at least an Ultrasound. I would never use a general practitioner To perform the US who did not have EXTENSIVE US experience and a state of the art US. A lot of people can speak basic “Chinese” very few are fluent. But I would only use a person fluent to interpret/translate an important document that has a lot is riding on. (pun intended)

A suspensory ligament injury can be detected by palpation of an experienced hand. Especially the front legs, IME hind suspensory injuries are a lot more tricky. I have had several horses that had hind suspensory issues that were completely overlooked and or misdiagnosed because they attending vet was not an US specialist. Paid a lot of money for that T-Shirt and lessons.

Detecting a problem/issue/injury by palping is one thing. The most important thing to find out is the extent of the injury, tear, rupture, pull and exact location etc. A US specialist will locate and determine the size, usually in centimeters. But they will usually translate to us laymen in percentage, 50%, 25% tear etc. They should be happy to down load the data, “pictures” to a CD so a person can give and or send to another Vet for a second opinion and or to give to the attending Vet.

With this information a course of action, treatment and rehab plan can be put together. Just guessing without. Especially when it comes to long term expectation of what the future holds for the horse. Non performance horses once sound most likely will stay that was by and large. Depending on the extent and location of the injury. High performance horses are a different story. With proper management, picking one’s “spots” carefully and constant vigilance, like in periodic ultrasounds a high performance horse can maintain a certain level of training and competition. Buy IMO and experience it will become chronic at some point. IMO and experience ligament issues are a lot more problematic then tendon.

Basic treatment after knowing the above. I have a PRP done, around $800-$1,200. A mild blister, 3 months stall rest, hand walking, ride walking, multiple US to monitor the healing process. Once an OK for turn out is given, we start in a small pen, and then kick out into a field and start back with the horse months later. We rarely start back with a horse before 12 months have gone by. The above is not a “home treatment” I have worked with some of the best in the business. I have also tried several “treatments, rehabs” pretty much all had the same results.

Long term comes down to the extent of damage and the quality of the healing. Every horse responds/heals differently. It comes down to how much “scaring” takes place while healing. A suspensory will never be as good as new with the treatments that are available to us at present.

A rubber band will stretch quite long before breaking. Take a rubber band and tie a knot in it, the knot representing scare tissue, and stretch. It will stretch out far less and always break at the knot.

IMO horses that injure a suspensory turned out and or in a stall may have had a preexisting condition and or an old injury that the owner was unaware of.

The above is based on my work and experience with TB racehorses, flat and steeplechase only.

[gumtree]

Left out this link to my post. Gives a pretty good explanation of things.

http://www.vetmed.ucdavis.edu/ceh/docs/special/Pubs-SuspBrochure-bkm-sec.pdf

[kcmel]

[QUOTE=steelerino;7727526]
What did the injury end up being if you don’t mind me asking??[/QUOTE]

We were never able to get a clear diagnosis. It was a hind leg lameness. We blocked everything at least twice (except the SI which we did once), and did a bone scan. The best anyone could come up with (between my vet and Dr. Richardson and Dr. Davidson at New Bolton) was some sort of high soft tissue injury. After several setbacks he came sound about 9 months out and was just starting back to work when he trashed his stifle running and bucking in the paddock. So now he is a pasture ornament. Sigh.

[Sansena]

Just want to say Thank You to Gumtree for the informative post. Really appreciate you sharing your knowledge. Accurate knowledge