Straight sesamoidal ligament injury - any experience?

[Legallygray86]

Horse was recently diagnosed with a tear and enlargement of the SSL in right hind, likely due to conformational issues putting stress on the leg over time. Was off-and-on slightly off for a few weeks until flexion and ultrasound confirmed. Vet isn’t terribly hopeful about anything above pasture puff status as an outcome, and treatment is to just go on full pasture rest for likely a year, but we will re-ultrasound in 3 months to see how things are progressing. The herd is mainly retirees so they are pretty chill and no one plays or is an idiot, which is great because this horse hasn’t seen the inside of a stall in a few years so stall rest would be challenging. At this time, the vet (who sees a lot of sport horse lameness) isn’t even recommending shockwave or any other intervention, except for a bar shoe on that leg. Good news, if there can be, is that the suspensories look fine, and the joints otherwise look great - no real evidence of arthritic inflammation or anything, so the horse is quite comfortable just hanging out - without doing flexions, the lameness isn’t even noticeable. Due to the conformational flaw (the hind leg rotates in a bit at the fetlock), I was always expecting a downgrade from jumper to trail pony, but for an otherwise healthy 14-year-old horse to skip straight over that phase straight to pasture puff is pretty discouraging.

Anyone have a story to tell about this type of injury? Searching pretty much only results in posts and articles about suspensory tears or sesamoidal fractures, so I guess this is an uncommon injury. I’d love to hear the good, bad, and ugly… I’m trying not to get hopes up by seeing only stories about miraculous returns to competition, but I’d like to think we could have a few more years of walking around on trails, at least.

[Equisis]

I’ve seen several rehab to the point of being sound as pleasure horses, as well as one who returned to UL competition. I wonder if the fact that the injury was likely caused by a conformational flaw has something to do with the poor prognosis- if the stress that caused the injury is still acting on the ligament, it seems that it would impair healing.

Sesamoidian ligaments heal slowly and with varied success. Stall rest is standard but every case is different. Did the vet provide any reasoning behind not recommending any interventions? There are a wide variety of treatment options- biological injections, shockwave, laser- each with potential benefits and potential drawbacks. Not a criticism, just curious.

Best wishes to you both for a successful recovery. Pastern injuries are difficult.

[Legallygray86]

@Equisis I think you are right - he’s not hopeful about her ability to heal and not re-injure. I was in a small amount of shock when I was talking to him, since I really thought we were looking at hock and SI injections, not you-can-never-ride-this-horse-again injury - so I’m not entirely sure why he wasn’t urging interventions, but probably bc of the conformation. He wants to see it again in 3 months and see how it’s going, and I’ll have a lot more questions about options then - and I imagine he will have more thoughts. He basically said, you could do XYZ things, but probably none of that will get you a different or better outcome than just time off. I asked about stall rest too, but he seemed to think that a small amount of moving around would be better for the ligament to heal in the right shape. I think if she were younger or in a herd inclined to play that might have been different.

It’s also the first time this vet has seen this horse - not that I think I need a second opinion, I too looked at the ultrasound and can see the tear - but I’m holding out some small hope that because he doesn’t “know” her, he is being ultra-conservative with the prognosis.

What are the downsides to the treatments you mentioned? Of course with injections, there’s always a chance of infection, but besides costs, what are we worried about with shockwave?

Thanks for your reply and well-wishes.

[Legallygray86]

Updating in case this is ever relevant to anyone else - re-ultrasounded 10 months and then 22 months after original diagnosis, and the tear never did fill in. However, the horse was pasture sound the entire time, and we gradually got the green light to start hacking again after the first check, ending up with a trail sound horse, but jumping and even working in deep footing are out of the picture. I’ve retired her now to a friend’s farm but part of me thinks maybe I’ll check on it again in two years, and just see. Something something miracles, right?