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Suspensory tear that doesn’t show up on scan?

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  • Suspensory tear that doesn’t show up on scan?

    I just sold my ottb mare and have been leasing a very game quarab pony. She came back from an eventing clinic head bobbing at the trot. My vet blocked her to the high suspensory. With that block, she trotted sound. He ultrasounded her today and saw nothing that stuck out. We are still moving forward with the protocol for rehabbing a high suspensory for the time being. I’m just wondering if anyone else has had this experience?

  • #2
    A few years back, my horse had a suspensory problem and she was intermittently head bobbing. My vet came out with her portable ultrasound and she could not see anything definitive. I hauled my horse to this super fancy lameness vet about an hour away who had a much nicer ultrasound and I was able to get a definitive picture of what
    was going on. I hauled there 3-4 times through the rehab to make sure the healing was going okay. The injury was small, but a little jagged or something. So, yes.

    Comment


    • #3
      How experienced is your vet? It's definitely a bit of an art.

      Comment


      • #4
        The high suspensory area in particular is a difficult area to ultrasound (hindlimb).

        My vet said if you nerve block and then ultrasound, it can interfere with the ultrasound. I don't know how true that is, but I do tend to trust my vet's opinion. So, possibly you've got a difficult shot to get, with variables working against you.

        Comment


        • #5
          It’s definitely a hard area to image, my own vet actually declined to do it himself and referred us to a clinic to get the ultrasound. That being said my horse was ultimately diagnosed as having a bilateral strain in both hind high suspensories. There were no lesions or thickening visible on the ultrasound.

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          • #6
            It doesn't have to be a tear or lesion for the horse to be head-bobbing lame with a suspensory. I had a young horse with a hind suspensory strain, no tear, no lesion, no measurable thickening. It took blocks, an ultrasound, a bone scan, and an MRI to ultimately find what could only be described as a "suspicious area" at the origin. But as my vet said, diagnostics don't show us pain, and we have to believe them when they are telling us it hurts. He suspected my horse not only tweaked the suspensory but also some of the tiny ligaments/tendons around the hock that we couldn't see, based on the pain level the horse had. We rested and rehabbed him with the protocol for a suspensory, and gave him extra time when we felt he needed to go slow, and he came back fully sound. He wasn't a match for me but is doing well in his new job. The blocks are telling you something is there even if you can't see it.

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            • #7
              You can't ultrasound the suspensory accurately after a nerve block. The block causes swelling that interferes with the ability to get an accurate picture. My vet will come back 2 days later if she needs to ultrasound something that she's already put a direct block in.

              Separately, it can be hard to find bony involvement/detachment at the origin if you don't have a quality machine and a trained eye.

              Comment


              • #8
                Originally posted by tipzythegreat View Post
                The high suspensory area in particular is a difficult area to ultrasound (hindlimb).

                My vet said if you nerve block and then ultrasound, it can interfere with the ultrasound. I don't know how true that is, but I do tend to trust my vet's opinion. So, possibly you've got a difficult shot to get, with variables working against you.
                The block adds a lot of fluid to the area, so an ultrasound right after a nerve block is not likely to be accurate in this area.

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                • Original Poster

                  #9
                  The blocks were not done on the same day as the ultrasound. My vet did his residency at Rood and Riddle, with a tb race farm in CA and then worked at McKinley Peters under Dr.Scneider (arguably best lameness vet in PNW). So for a country vet, he’s had a lot of experience. He did say that his mobile machine might not pick up a small tear or lesion that a higher resolution machine in a hospital might. That said, I trotted her a couple strides tonight on my hand walk and she did seem like she’s improved some already. It’s hard to say totally with just a few strides though obviously.
                  Last edited by Rainier; Jun. 27, 2019, 10:22 PM.

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                  • #10
                    Oh no! I'm so sorry to hear that my pony's doppelganger is lame. I hope it's not in fact a suspensory tear and she feels better very soon.

                    Did your vet x-ray the hock? My understanding is that blocking the hock can block the high suspensory, so I'd think it could work the other way too.
                    Building and Managing the Small Horse Farm: http://thesmallhorsefarm.blogspot.com

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                    • #11
                      Okay Rainier ! Glad to hear it wasn't done on the same day. It is still a difficult place to image.

                      Suspensories can sometimes get better with rest. My horse was totally sound despite significant fiber disruption of his proximal suspensory.

                      I will say if there's any chance it is a suspensory, don't trot her at all. Even to see if she's sound. If you aren't convinced it's the high suspensory, I'd get additional imaging. Prepare yourself for months of rehab if it is a suspensory. Good luck to you and your girl!

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                      • #12
                        Yes, a horse I had was head bobbing lame and was blocked to high suspensory to the front leg. Ultrasound several days later did not show any damage but the vet said the area is notoriously hard to get a clear view of due to the bone. He didn’t think an MRI was necessary and we treated as a high suspensory with a series of 3 shockwaves, stall rest, hand walking then finally under tack walking. I want to say it was about 3-4 months before we were cleared to slowly begin adding trot to the rehab schedule. Hind high suspensory strains/injuries can become chronic so take your time with rehab.

                        Comment

                        • Original Poster

                          #13
                          I’m into my second month of stall rest/rehab. According to the protocol i’m Using (Dr. Schbeider’s here in WA), in a month I start gradually adding trot in-hand. I’m not sure how to do that as I literally can’t run because of a knee injury? Use bike? Gator? Also, i can’t remember if I asked, but do most do their hand walking and trotting on a harder surface or in an arena?

                          Comment


                          • #14
                            Dr. Gillis told me that you want to avoid uneven footing most of all. Sand or dirt is OK as long as it's not half way up the hoof wall. That being said, I do try and stick to hard flat surfaces as much as I can.

                            As far as trotting in hand... that is a conundrum. As someone who is fit and not injured, I had trouble jogging with my horse for 4 minutes in hand (I simply didn't have time to ride that day). Can you trot US? Or have someone else trot US?

                            I once took my dog on a bike ride. She pulled me off and dragged me down my dirt road. She wasn't a big dog. I'll never forget it though. I would really not think either option is safe. Can you walk longer while you heal? Walking longer won't hurt!

                            Comment


                            • #15
                              Originally posted by Rainier View Post
                              I’m into my second month of stall rest/rehab. According to the protocol i’m Using (Dr. Schbeider’s here in WA), in a month I start gradually adding trot in-hand. I’m not sure how to do that as I literally can’t run because of a knee injury? Use bike? Gator? Also, i can’t remember if I asked, but do most do their hand walking and trotting on a harder surface or in an arena?
                              It would not hurt at this point to email or contact your vet, for clarification on what kind of footing.

                              For most, it seems to be in the arena, straight lines only -- and arena footing must not be deep. For that reason we usually did rehab work in the outdoor, which was bigger, and harder footing due to exposure and type of footing.

                              I would not use a bike -- or even a gator -- unless the horse is already used to trotting in hand on a gator. Rehab is not the time to teach a horse something new like that. Any way you can pay a teen to jog in hand under supervision? Or possibly pony off of a seasoned very excellent pony-horse?
                              AETERNUM VALE, INVICTUS - 7/10/2012

                              Comment


                              • #16
                                I'd ask your vet about modifying your plan to see if you can introduce rider weight before you get to trotting. Might mean spending more time at the walk, but I've done a little bit of in hand straight line trotting with long lines but this is not fun (I'm only moderately sound myself). Mostly, if a large circle is not allowed (20m+/-), I don't do much in the way of in-hand trotting. Walking is very good for them, so I really don't see any hurry in getting to the trot.

                                You might be able to use a gator if the horse is already dead broke to doing that, but even so, I don't think I'd necessarily put a rehab horse in that situation, since they can be nuttier than usual. Definitely not a bike--too unstable for you.

                                Comment


                                • #17
                                  I've never had a vet recommend trotting a rehab horse before putting a rider up.

                                  Comment


                                  • #18
                                    If you don’t think that trotting in hand is viable, ask vet for alternatives. If vet insists, pay a professional. Not a teen. The horse may get a bit over stimulated and you don’t need to get a kid hurt.

                                    Add me to the the camp of walking under saddle before trotting. Current vet (and the BN referral vet) gave me the option of tack walking a horse with a bone bruise and slight collateral ligament irritation. Vet says he’s almost always in favor or tack walking, if it can be managed safely.
                                    The Evil Chem Prof

                                    Comment


                                    • #19
                                      After going through tons of ultrasounds for my own high risk pregnancy, the quality of the ultrasound images you get are going to vary significantly based on the machine used and the person performing the ultrasound. I've seen ultrasound machines that looked like they were 20+ years old to state of the art machines where just the replacement wand costs $30k.

                                      I would either treat as a suspensory injury and do the rehab protocol or take the horse to a hospital for a better ultrasound. When my horse had a suspensory injury, the vets wanted to do an MRI as it is more definitive than an ultrasound. But the cost of the MRI was basically as much as the surgery itself and it also required the risk of full anasethia. There were significant enough findings on the ultrasound and we were able to rule out hock issues with comparison radiographs. This was all done after nerve blocking had shown the general area of concern.

                                      I had my horse on stall rest for 3 months. Then had the surgery performed after she had clean ultrasounds. She's been better than ever since restarting under saddle work in January 2018.

                                      Comment

                                      • Original Poster

                                        #20
                                        I wonder what people think about this article? https://thehorse.com/19778/tips-for-...tissue-injury/


                                        I’ve been going off of a fairly old rehab protocol, and this one was from 2016 I think? The pony is getting hard to handle walking in-hand and is sound at the trot (just trotting her for a bit in-hand). I’m thinking that walking her under saddle is better than her frequently getting away at trotting or cantering. She’s six weeks into rehab.

                                        Comment

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