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  1. #1
    DHEC Guest

    Default Proximal Suspensory Desmitis and Neurectomy-Tell Me About Your Experience

    Help! I'm desperate to make the right choice for my horse!!!I've been a long time lurker but now the welfare of my horse and my ability to still ride are bringing me out of my lurker status. My 7 yr old Friesian has been diagnosed with chronic proximal suspensory desmitis in his rear left leg. We compete in dressage and have been very successful at the lower levels. The vet and I believe it is actually the second time he has injured this area (misdiagnosed the first time). He has already had 3 rounds of shock wave therapy and was on stall rest for 3 months. He showed marked improvement on his 2nd ultrasound and was not lame as he had previously been when hand trotted. He was released by the vet to return to walking under saddle for 5 minutes a day. He didn't even make it 4 days before he was showing up lame. He is normally extremely willing and he let us know when he was first injured and subsequently when he returned to work under saddle by violently bucking that he was in pain. The vet I had at the time insisted that he was just acting up because he had been on stall rest and said continue to ride. He was a gem the whole time he was on stall rest and hand walking and he never acted this way with his earlier injury. She felt what I was describing as lameness was just part of the recovery process and that he would work out of it. Well neither the trainer or I thought that was the way to go so we lightened the load and went for 6 weeks of ground driving with sand bags on him at a walk. Whenever he was asked to trot it appeared to me that he was in pain. I've moved on to a 2nd vet and he agrees that he is lame and that it isn't normal (thank you). After a third ultrasound the new vet says I should seriously consider a fasciotomy combined with a neurectomy. We've looked at other treatment options such as stem cell injections and the vet doesn't think he is a good candidate. Basically he doesn't think it will make a difference.

    I am so worried that the neurectomy in particular will put his long term welfare at risk. All of the studies around this procedure say that the vast majority of horses who have this procedure are sound a year later. They call this long-term, I do not. I want to make sure that I'm not doing anything that will hurt him 5 or 10 years down the road. I realize horses get injured, but I don't want to be responsible for him blowing out his leg becase he can't feel that he is doing damage. On the other hand, I board him and if I decide to just turn him into a pasture horse I would have a hard time paying for a 2nd horse. Building our own barn is in the future as I have two daughters that ride, but won't be happenning for years.

    If you aren't familiar with psd in a rear leg, the prognosis for remaining sound over he long term is very low and the surgery by far has the greatest success rate but there is only info for a year out. I've also seen one recent study that indicated there was signficant muscle atrophy in the leg of a horse with PSD who had the neurectomy. A study of one, but my biggest fear.

    Soooo, has anyone out there had experience with a neurectomy for hind leg PSD? I'd like to hear how the horse is doing years after the surgery if possible. Could he horse still perform at the same level? Did the horse get reinjured, etc. Any help you can give would be much appreciated. I have really struggled over what to do.



  2. #2
    Join Date
    Feb. 17, 2010
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    Purcellville, VA
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    Quote Originally Posted by DHEC View Post
    I am so worried that the neurectomy in particular will put his long term welfare at risk. All of the studies around this procedure say that the vast majority of horses who have this procedure are sound a year later. They call this long-term, I do not. I want to make sure that I'm not doing anything that will hurt him 5 or 10 years down the road. I realize horses get injured, but I don't want to be responsible for him blowing out his leg becase he can't feel that he is doing damage. On the other hand, I board him and if I decide to just turn him into a pasture horse I would have a hard time paying for a 2nd horse. Building our own barn is in the future as I have two daughters that ride, but won't be happenning for years.
    It will cause him long term damage. You are essentially removing the nerve so he can't feel the pain associated with the suspensory injury. Even without the surgery, rear suspensories are very difficult to re-hab. My vet strongly DOES NOT recomment the surgery. I had a client with a horse that had this injury and she just ended up sending him to a retirement facility and then getting another horse. Even with surgery, there is only 0- 50% chance of healing with PSD in a rear limb.

    IMO, It makes them dangerous to both themselves and to their rider(s). And shame on anyone who would do this to any horse and then demand of it this kind of work. Humans at least, generally have the option of saying "NO."

    In Sweden. you are not allowed to compete with a neurectomied horse and I think the operation is very rarely done nowadays over the pond.

    Ask your vet about a suspensory desmoplasty. This is an invasive procedure, but it doesn't cut any nerves!! To date 95% of horses with of rear limb proximal suspensory desmitis, which did not heal with rest or rest and shock wave therapy healed and returned to work after suspensory desmoplasty. Eighty percent of lesions at the insertion of the suspensory ligament on the sesamoid bone have healed with horses return to their original level of work.

    Unfortunatly, as you know, these are the risks you take when buying a horse. If no other job can be found for the animal, if the human connection is unwilling to undertake the higher level of maintence required, then the concept of humane euthanesa and potentially rendering seems a good and viable alternative. Regardless of the age of the animal.

    If you have to give him away as a pasture buddy, you risk the chance of him getting passed around and eventually ending up at New Holland or something. Not saying this is his fate....but there is a chance of this happening. If you do go this route, I would call local rescues in your area to see if you can home him through them. That way your sure he will be safe

    Anyway, good luck and I am sure you will do whats best for your horse



  3. #3
    Join Date
    Aug. 28, 2006
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    My horse had the surgery at NCSU. He didn't have a tear, just swelling, and his back feet were probably a major contributor (which is why I trim his feet now). We had tried shockwave and he improved dramatically, but kept getting sore. That chronic inflammation is hard to shake.

    We went ahead with the surgery because we knew it'd be a long time before his feet were better. In fact, he didn't stay sound until his underrun heels were corrrected. (Sigh. There was a major hiccup after the surgery working with the NCSU podiatrist and a farrier who worked with the podiatrist but didn't correctly apply NB shoes.) Now 3 years later he's still sound, and this spring I had the ligament ultrasounded. It looks great and hasn't atrophied at all.



  4. #4
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    Quote Originally Posted by grayarabpony View Post
    My horse had the surgery at NCSU. He didn't have a tear, just swelling, and his back feet were probably a major contributor (which is why I trim his feet now). We had tried shockwave and he improved dramatically, but kept getting sore. That chronic inflammation is hard to shake.

    We went ahead with the surgery because we knew it'd be a long time before his feet were better. In fact, he didn't stay sound until his underrun heels were corrrected. (Sigh. There was a major hiccup after the surgery working with the NCSU podiatrist and a farrier who worked with the podiatrist but didn't correctly apply NB shoes.) Now 3 years later he's still sound, and this spring I had the ligament ultrasounded. It looks great and hasn't atrophied at all.
    You de-nerved his front feet though correct? The OP is talking about a rear suspensory injury.



  5. #5
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    No. Just the nerve supplying the upper hind suspensory. Why did you think I was talking about his front feet?



  6. #6
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    Quote Originally Posted by grayarabpony View Post
    No. Just the nerve supplying the upper hind suspensory. Why did you think I was talking about his front feet?
    Mis-read your original post!! Sorry, thats what I get for working and posting at the same time



  7. #7
    Join Date
    Jun. 10, 2001
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    nj
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    Default hind suspensory issues

    i unfortunately have had an opportunity to learn about hind suspensory injuries quite a bit in the last two years. my mare's first injury took place in spring of 2008. her second injury (the other leg) happened last december.

    first, it really doesn't sound like he underwent a lot of treatment. am i reading correctly that all you did to date was shockwave and stall rest?

    my mare's more recent injury was slow healing. we went back under saddle after a couple of months (just walking) but then things weren't progressing and the u/s images didn't look well enough for my vet. so in june she underwent a fasciotomy with PRP injection. that was a relatively cheap treatment which my vet has had good results with. on her 6 week re-exam the u/s image look better already, and clinically she was much improved as well.

    after this experience i'm a big fan of fasciotomy with PRP as treatment for hind suspensory injuries. i don't have any experience with use of neurectomy on hind suspensory injuries nor has it ever been mentioned by my vet as an option.

    lots of luck to you and your horse!
    http://www.eponashoe.com/
    TQ(Trail Queen) \"Learn How to Ride or Move Over!!\" Clique



  8. #8
    DHEC Guest

    Default Thanks for your willingness to share your insights

    Thanks to everyone who has shared their comments and experiences so far. Just hearing them has already brought me some comfort. I realize this is considered a controversial surgery and I need to talk to those who have some real life experiences both good and bad.


    sar2008-thank you for sharing your thoughts and doing it with sensitivity to the struggle I am having. Receiving different recommendations from a number of vets at odds with each other and me and my horse squarely caught in the middle is quite frustrating. You have expressed many of the fears that I have for my horse including the fate he might suffer if I gave him away as a pasture pet. The good news is that I won't have to face this even if my horse remains unsound. My husband is a prince and has discovered a local option where I could be involved in his care, but reduce some of our expenses so that we could afford another horse. Hopefully it won't come to that, but my lay awake at night fear that I would have to make the decision to give up owning another horse or give him away has been eliminated.

    grayarabpony-I am so very glad to hear your horse is doing well and has shown no muscle atrophy 3 years out. NCSU has one of the consulting vets that has reviewed my horse's case and recommended a fasiotomy and neurectomy. Sounds like our horses have very similar injuries although so far none of the vets have seen any significant contributing factors such as the low heels you have described with your horse. Again, I know that there will be differing opinions expressed in this thread and I appreciate your willingness to step forward and share to help me with my decision. I hope your horse has a lifetime of comfort and continued success.

    marta-so happy to hear that your horse is doing well. I was not familiar with the desmoplasty (knew about the PRP) but I'm not sure if my horse would be a good candidate as there is no evidence of a core lesion. When I did a search on a desmoplasty it indicated that this was used specifically for core lesions. However, it is an option beyond the fasciotomy and neurectomy that has not been discussed with me so I will pursue further.


    Has anyone else done a fasciotomy with PRP or a desmoplasty without a core lesion on a chronic hind PSD case and had long-term success? Anyone else willing to share about a neurectomy? Other options that you've found success with?



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