View Full Version : suspensory injury-need input
Jun. 23, 2010, 02:39 PM
My 12 yr old was just diagnosed with a forelimb suspensor injury and is on at least 60 days stall rest with hand walking 10 min/day. I have read all I can find on internet about diagnosis and treatment but was looking for input from those who have dealt with this firsthand. Any info would be much appreciated.
Jun. 23, 2010, 02:57 PM
It all depends. There are numerous types of suspensory injures with different treatments (e.g. shock wave will work while PRP may not and vice versa). I have done things from PRP to shockwave to soft/gel casts to just letting them stand out in a pasture. They all have come back to some extent - depending on the animal's age.
The key is keeping the inflammation down, but not completely restricting movement to get the cells to align the fibers appropriately. My last one had a small paddock in a gel cast for 6 weeks and then 20 weeks of slow rehabilitation. This was his 3rd (he is 18) so there was not rush. On a previous one we did shockwave because the tear was near the bone insertion followed by 16 weeks of rehab and then back to a CIC**.
Jun. 23, 2010, 03:57 PM
Reed has been lucky with time of rehab.
My horse took 2 years and all of my pocket book. I was extra extra slow though with his treatment.
6 months of hand walking 3x a day 10-45 min then to 1 year of walking in hand/ponied by golf cart/ridden 3x daily (what I had time for). Then I threw him out to pasture for 6 months riding him occationally for weekend fun. usually bareback.
I kept him in a run. He was only in a stall for 2 months at the beginning.
honestly I'm not sure just anyone could have stuck with it. I took on a horse in training to keep my mind busy for the past year.
So far he seems to be back 100%.
In the end the 2 years went by quickly and it was well worth it.
My first horse was the normal 6 months off. She had a mid suspensory injury.
I do not believe in keeping them stationary. Unless my horse were to show clear grade 2 + lameness I would keep he/she walking as much as possible.
Really, my rule of thumb is to DOUBLE the time the vet suggests.
Jun. 23, 2010, 04:11 PM
What Reed said.
Where, how, how large and how much damage really dictates both the length of rehab and treatment of choice, as well as what your vet is comfortable with and his or her past experiences with rehabbing.
Jun. 23, 2010, 09:58 PM
Agreed on the doubling of time.
All of mine took longer than vet prescribed.
Jun. 23, 2010, 10:42 PM
I posted this book on the other rehab thread:
Very helpful book!
Jun. 24, 2010, 05:50 AM
There do seem to be a lot of pathways to recovery depending on extent and location of injury.
My horse had bilateral hind suspensory tears (and was quite lame); had a minor surgical procedure called a fasciotomy to relieve pressure, 3x shockwave, several months very restricted movement (stall rest progressing to work under saddle, small paddock turnout, etc).
By 3 months out he was sound, under saddle VERY gently, and on partial day small paddock turnout.
He made a full recovery.
But you must be patient and careful. I also would not wait to begin whatever interventional therapy is recommended; it seems that those folks who waited until the injury was not resolving with rest to do something "more" did not have nearly as good an outcome as those who started out more aggressively...
Jun. 24, 2010, 06:07 AM
Not sure if your horse would qualify, but Ill just throw this out there because I dont think anyone has yet:
My first horse had a pretty bad tear in her left hind suspensory when she was 13. Vet came out, did the usual diagnostics, tried a few things, and then decided to try stem cell therapy with her. The procedure is actually pretty simple: take some cells from the base of her tail bone, ship them off, get them back after the lab work, inject them into the injury site. She needed two injections, lots of stall rest, and the usual hosing.
Obviously Im not a vet and dont know the exact procedure, candidate requirements, ect, but I do know that for such a bad tear she came back pretty well. Within a year and half she was back to little cross rails and eventually did 2"6' for a few years. She is now almost 20 and does cross rail classes and dressage with a little girl. She was put on some joint and tissure supplements as well right after the injury.
Anyway, just a thought. I havent heard of very many horses that have had it done and the vet I used back then was kinda out there. But it worked for her :)
Jun. 24, 2010, 12:30 PM
Thanks everyone for your suggestions. The vet did not want to ultrasound the day he was seen as he felt he would not get a good pix due to the small amts of air under the skin from the blocks, so I won't get a scan till he returns in two weeks. As you all said it does depend on where and how badly it's injured. I am always optimistic. My last horse suffered a coffin bone fracture 2 wks after I bought him; recovered and was my evennt horse for 12 more years!
Jun. 24, 2010, 12:37 PM
Indeed 60 days isn't too bad, so it must be a mild strain vs. a severe tear.... that is the GOOD news! The other good news is that many many horses recover from these injuries and go on to full careers.
Follow the rehab instructions from your vet closely. If your vet doesn't specialize in this type of horse/injury, find a specialist. If treated correctly you can have a very good outcome...but if you rush recovery you can do permanant damage.
Jun. 24, 2010, 01:04 PM
Curious, you didn't mention if it is a high suspensory injury, or lower near the fetlock? I worked at tracks, mostly the Meadowlands, for years doing work on injuries with what then was called a soft laser, or infra red light. I had a very good success rate...
I don't know where you are located, however there is a center in Virginia, and I believe outcroppings of folks who do this kind of work. It really and truly can encourage the body to heal itself 3 times faster than on its own. Like Reed mentioned too- movement at a particular time is important for the ligament to heal and maintain stretch.
If you have an interest, PM me and I will help you find someone close to you.
Jun. 24, 2010, 01:09 PM
I too would double the time the vet suggests. Soft tissue just really needs to heal, and there is no rushing it or pushing it or second guessing it. The horse needs not to twist himself, so hand walking needs to be sedate and slow and straight with very few turns, and those slow and brief, with few non-straight steps.
Jun. 24, 2010, 04:40 PM
My experience was a good one - injury to the lower branch in front- but he was LAME - and the leg was the size of a telephone pole when I found him at breakfast. Did it in the pasture and he was prelim fit- so an accident, not one of the long-term injuries.
Reduce inflammation ASAP. Icing, cold hosing, DMSO, bute and wrapping. Stall rest until all swelling was gone, then handwalking, then because he was a better patient out than in, turnout. He was wrapped all the time for the first month then not wrapped when inside but whenever he was moving around, he was wrapped. He did it mid-June and was back in full work in Sept. And never had another problem.
His return to work was as follows: Hard ground on straight lines at the walk. Then add a little trot. Then straight lines on grass OR wide turns on hard footing, first at the walk, then trot. Finally canter/ He didn't see a sand ring for a long time.
Jun. 24, 2010, 05:35 PM
Is the nature of the injury chronic or acute?
Chronic-type injuries (might look like 'cottage' cheese' on the ultrasound) are often aligned with an organic soft-tissue weakness. Acute injuries (stepped in a hole, sudden onset) are often more dramatic in terms of lameness but because the underlying tissue -- when not injured -- is basically healthy, the prognosis is better.
In other words, horses either heal or they don't. This is why we've all seen these warriors with blown tendons and wonky legs who just keep going, and it's also why you see perfectly-conformed specimens who don't stay sound.
Jun. 24, 2010, 08:12 PM
One of our horses had bilateral high core lesions in his suspensories. We did several months of paddock rest (he kept kicking out the stall walls, so no stall rest), followed by several months of a rehab program. 6 months after the initial ultrasound, he was healed.
It is worth getting an opinion from a good lameness specialist, preferably not one who has a vested interest in one particular treatment. We went to a well known vet school faculty member/surgeon, who said we could do shock wave, high tech treatments or surgery, but this type of injury would heal well if we did nothing but paddock rest and a gradual rehab program. He was right. When we sold the horse a few years later, I disclosed that he had suspensory lesions. The purchaser's vet tried to tell me that his ultrasounds were normal and that he must have never had anything wrong.
Jun. 25, 2010, 09:56 PM
On September 11, 2009 horse tore inside and outside branch (inside worse with wee tiny bit of bone coming off of the sesimoid). Found fat RF leg when went to get horse out of stall, so injury from previous evening's turnout. Very Lame grade 4. Stall rest, Shockwave 3x, wraps at night (just stopped night wraps this week when he went on night time t/o) Next u/s in Thursday. Fingers crossed. The RF has been healing well but the left hind falling apart. Hocks. Horse is 15.
Started handgrazing immediatly, then handwalking. was out every day for 2 hours walking him around. Then got the ok for walking under tack for 30 min, then got the ok to trot, then ok to canter. Did u/s (ultrasound) every 5 weeks. Take it slow, keep them moving, ACE was my friend.
Fingers crossed for you, and me!
Jun. 26, 2010, 07:25 AM
one more thing - learn to palpate the leg -it takes a little practice, but you can do it easily, and won't need to rely on ultrasounds to know if you are making progress or having a setback. Yes, US gives you a nice picture to read but there is an art to knowing what your horse's legs feel like and it comes in very handy. And it's free.