WWYD: Suspensory issue that maybe isn't really a suspensory issue after all

[Tha_Ridge]

Long story:

I imported a nice sale horse back in April, a big, leggy 5-year-old WB gelding. Very nice horse, who vetted well. Shortly after he came, he dropped a bit of weight due to my previous barn’s feeding program (assistant trainer addressed quickly, a long separate story there!), lost some topline, and seemed a little weak behind. Nothing crazy, just chalked it up to import adjustments. The then-assistant and I worked really hard to get him in a good flatwork program and saw lots of improvement. Meanwhile, the horse was showing with me in the 3’ AA hunters, with no noticeable issues.

In early July, the horse gets tried. They love him. At the vetting, he shocked us all and flexed off on the LH. The buyer still loved him, and we agreed to try again a week later, proceeding with the PPE if he flexed fine and moving forward with a lameness exam if there was still an issue. Reader, there was still an issue. The lameness exam, performed by arguably the top lameness practice in the country, was… less than conclusive. No changes to any X-rays; he finally blocked to the LH suspensory, so we ultrasound and got some wishy-washy answer about there maybe being a minor strain (described as a “slight separation of fibers”) to the proximal LH suspensory. Since there was no hole or tear, PRP or stem cells weren’t an option. The diagnosis was to pull his shoes, give him some time off, do shockwave, turnout, and hand walk for three months. He was jogging maybe 2/5 lame at this point.

Now we’re three months later, and there’s been no noticeable change on the ultrasound, but the more I read about ultrasounds on proximal hind suspensories, the more skeptical I am in the diagnosis in the first place. It sounds like muscle and fat can sometimes be misleading on those images, making an MRI a better option. I’ve also not been pleased with the vet’s approach and advice—he didn’t even care to watch the horse jog a few weeks ago and halfheartedly said we could start tack-walking, “I guess.” (Even though the vet didn’t watch, the horse is jogging sound.)

We started laser shortly after that visit with a different practitioner and have seen tremendous improvement—she felt he was having issues higher up in his SI. In just a few laser sessions, he went from being somewhat sensitive to palpation to letting me curry his back quite vigorously and even enjoying it! I’ve been long-lining him at the walk—he’s now a pro!—and is tracking up well and traveling evenly behind. He even trotted off on a tiny circle the other day (still a little fresh, LOL! ) and was moving as well and as sound as he ever has.

I’m not a vet, but I know what I can see with my own eyes, and this horse is feeling and looking great compared to July—my assistant trainer moved out on her own, and he is no longer too thin, has pretty good muscle tone for being out of work, and his bare feet look fantastic. So, what would you do if he were yours? Continue with rehabbing slowly and carefully? Get a second opinion with an MRI?

[beowulf]

It almost never hurts to get a second opinion if you’re second guessing the diagnosis.

The suspensory flexed and blocked, which means there is something there - that’s much more concrete than just seeing evidence on an ultrasound with no corresponding clinical symptoms. I’d be curious for videos of the horse and photos of the feet.

Usually the suspensories have a shoeing component. SI is quick to get irritated and sore from them too. Next comes the hocks.

So if it was my horse, I’d continue as you were doing and really put an eagle eye on the angles of the trim. Suspensories benefit from 24.7 turnout, if that is an option for you.

[Tha_Ridge]

@beowulf

Usually the suspensories have a shoeing component. SI is quick to get irritated and sore from them too. Next comes the hocks.

You made me think of something… The last show a week before the trial was on grass. He was tapped behind and wore studs, which, in retrospect, certainly could’ve caused or exacerbated an issue that may have been brewing.

I’ll take some photos tomorrow! He’s not out 24/7, but at our new farm (compared to where he was last summer), he’s out from around 7am-3pm every day. We’ve been able to wean him off of ace for turnout as well.

[Railbird]

Over the years I have been in many situations where the horse is not quite right and the diagnosis isn’t really clear. Every time, looking back, I wished I had just gone for the heavy duty diagnostics earlier or just committed to throwing them out for a year and revisiting it. Playing the game of trying to read signs and tea leaves for months and paying all the farm call fees and treatments for a problem we aren’t even sure if they have makes me crazy and adds up to just as much as if I got the MRI or CT or whatever up front. For an imported sale horse, where future xrays are going to matter, I would just ship them to a clinic and have it diagnosed definitively, if for no other reason than to cover your butt when you try to sell him.

[No1]

If the horse is sound 3 months later, I’m not sure I’d spend my money MRIing at this point. You have to lay them down to MRI the high suspensory, too. I would not jump to that for a sound horse.

Nothing you’ve said has convinced me the horse didn’t have a suspensory strain. Those horses are often also sore over the SI and glutes. Add to that, you are correct, high suspensories can be difficult to ultrasound, especially if the horse had a proper origin.

I’d do the slow rehab.

[Tha_Ridge]

@No1

Nothing you’ve said has convinced me the horse didn’t have a suspensory strain. Those horses are often also sore over the SI and glutes. Add to that, you are correct, high suspensories can be difficult to ultrasound, especially if the horse had a proper origin.

Thanks, that makes me feel better! I guess I was just discouraged to hear that the most recent ultrasound wasn’t miraculously better, despite the horse appearing sound, but now I’m realizing that doesn’t paint the entire picture. So, a slow and steady rehab it will be, unless the horse tells us otherwise.

@Railbird

For an imported sale horse, where future Xrays are going to matter, I would just ship them to a clinic and have it diagnosed definitively, if for no other reason than to cover your butt when you try to sell him.

The initial diagnostic was done in-house at Furlong’s Soundness Center, so yeah, no expense was spared there. It was another vet at the practice who did the most recent ultrasound and was less than helpful, in the opinion of my trainer and myself.

[J-Lu]

Yea, no expense spared if you brought your horse there.

I don’t have much to add except to comment on the idea of “pulling shoes and turning a horse out” to see if things get better down the road. I think that is often a terrible thing to do. If the horse has shoes, he has shoes for a reason. Pulling all shoes on a sore horse makes them more sore in the short term. All of my youngsters started barefoot and got shoes as the need arose. No one WANTS to pay for shoes! Making sure the horse has balanced feet even if not ridden and turned out for several months makes sure the foot is balanced. My bigger pet peeve is the idea that you can pull shoes and turn that horse out in a herd situation for several months. Obviously that’s not in the cards for your import, but strangely some think that is a good idea for a NQR horse.

A slow and steady rehab will likely save his prospect as a sales horse in the future. It’s better to go slow on a healed horse and take too much time than to go fast on an injury prone to reinjuring and getting worse. Perhaps have a good vet flex your horse here and there while you bring him back and opening those records up to potential future buyers. This will help you gauge subsequent sales. Good luck!!