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Suspensory. Tell me everything.

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    Suspensory. Tell me everything.

    Yesterday the vet came out to dx a slight lameness in my gelding, and it's a left hind suspensory, about 6" below the point of hock and an 8mm tear according to her, that happened sometime around July 4th (fireworks anyone?)

    She's out of town now, and the gelding is very unhappy in his stall...

    She left me with instructions to ice, equioxx and voltaren it daily for a week. 30 days in the stall, then start handwalking.

    First of all, allow me to scream for a minute. he injured himself late last year and we did 8 months of rehab, and he came up lame at a show - his debut at first level. So FML.

    Now, questions. Because vet is away.

    1. We're looking at about 9 months, right? maybe longer?
    2. Is an 8mm tear very bad, or just bad bad?
    3. Can he be hand walked a bit before the 30 days is up? People are saying a 5m walk is OK.
    4. Shockwave? Yay or nay?
    5. Stem cell? Other treatments? Do they actually help?
    6. What else do I need to know?

    #2
    You have my sympathy. I am in the middle of my third summer in a row of horse rehab. This time it's bc he stepped on a rock and somehow sustained a bone bruise and slight collateral ligament damage. This was at a fancy show, complete with VIP area and jumbotron but with lousy rock abatement. I think we might be due to start cantering about the time I go back to school and jumping should commence right in alignment with our rainy season.

    Beyond that, I won't be much help. Once you have sound horse, you're probably looking at a month each of walk, trot, and canter, and then a month of normal flat work.

    The only times I've had someone tell me to leave a horse in a stall were 1-a horse that may or may not have been a strangles carrier and 2-a horse that is clearly lame at the walk. This was us for about a week last summer, when the creature from the black lagoon appeared in my horse's foot. I do have friends who have kept horses on strict stall rest following some sort of surgery.

    We did ACS ($$$$$) for my horse's current injury and several people in my barn have been using it for both acute and chronic things. It's been described as IRAP 2.0. They pull blood and process it; the resulting material can be used as an IV injection (like Legend) or in specific areas. For my horse it was IV every other day for a month and three intra-articular, two weeks apart, into the coffin joint of the foot that stepped on the rock. Now that the month is over, the IV interval goes to one month. I got a lot--sixty syringes-- for my $2600 processing fee.

    Good luck and hang in there. We have now done two days of trotting in straight lines. Everyone else is complaining about the heat, but I am embracing it as a behavior modification tool.
    The Evil Chem Prof

    Comment


      #3
      Peggy: Just curious as to how your horse was diagnosed, US or MRI?

      Xanthoria: You might also check out ProStride. I think it might be a little different than ACS, but similar to IRAP.

      FWIW, I agree with hand walking on hard ground unless horse is lame at walk, or unless horse is a handful at a walk. Safe movement is good. I have no experience with suspensory, but yeah, 9 months for any soft tissue injury seems the norm. :-(

      Comment


        #4
        BlueDrifter MRI preceded by nuclear scintigraphy. The ambulatory vet tried ultrasound but, even with a lot of dampening the coronet band area with alcohol, really couldn't see much.

        Scintigraphy + MRI + ACS = my major medical limit for the year in less than a week.
        The Evil Chem Prof

        Comment

          Original Poster

          #5
          Thanks all for the sympathy send advice. I’m feeling pretty down. Can anyone tell me if there is a reason to keep this horse shod while he’s in a stall? He is very expensive and difficult to shoe because he has shivers and PS SM and I’d be pretty happy to just have him barefoot during this time...

          Comment


            #6
            No advice on the suspensory, but I've been watching a friend rehab and slow is the name of the game.

            However, definitely ask the vet before pulling those shoes (as I'm sure you will). I would think the support of shoes may be important to his rehab. That's pure speculation and with his issues, maybe the benefits of barefoot outweigh the benefits of shod.

            Comment


              #7
              A fellow boarder did a long and slow rehab for a similar injury and her horse came back really well. She doesn't like a lot of turnout though, but does like to work. She was barefoot in the front and had aluminum bar shoes in the back for support. After awhile and after rehab she transitioned back to plain steel shoes. She has kept her shod like this since. So you could do something like that.

              Comment


                #8
                Dealing with a suspensory rehab right now. We're 8 months in and I just got on for the first time yesterday. Still a very long road ahead.

                Here's what I can tell you about mine:
                1. My horse's injury was a little different than yours: he had a severe tear to his lateral suspensory branch on the left hind. Not sure how big in terms of mm but vet said it was almost completely sliced through. There were additional complications to his injury because he also had a joint infection in the fetlock joint.

                2. He was hospitalized for around 2 weeks at the beginning for the infection. Early on he was getting sweat wraps and I think those can help with inflammation for the suspensory as well. Then just regular daily wrapping and 5 min walks.

                3. From there he went to a rehab barn and was on complete stall rest for 3 months with 5 min handwalking twice a day. He was only wrapped as needed. We did 2 PRP injections in this time.

                4. After 3 months he was increased to 10 min walking twice a day and was allowed to go in a small pen for 30 minutes (about double the size of a stall), then an hour, working up to about 2-3 hours a day if he was calm.

                5. At 5 months he was rechecked and we increased his walking to 15 min twice a day for a few weeks, then 20 min twice a day. His outside time in the pen was increased as well and he was going out for most the day (5 hours). The instruction from the vet was to build his turnout time up slowly over the next 3 months so by month 7 he was going out in a larger paddock for a few hours each day, while continuing 20 min handwalking twice a day.

                6. We just had the next recheck this week. Now we're getting him undersaddle, starting with 25 min walking for 1 week, then add 1 min of trot for two weeks (straight lines only), and building up from there. He'll get checked again in about 2 months and by the point he will be trotting one full circle around an arena in both directions. He's also going out in a larger turnout field and is allowed to stay out for longer (this is weather dependent with the heat of summer so he's still just doing 4-5 hours).

                The vet has been amazed at his progress, but the expectations are not that he will ever return to doing what he was doing before. Part of this is due to the joint damage from the infection, but even if we were just dealing with a suspensory, we would not be looking at doing eventing ever again. I'm hoping that he comes back sound enough to do very low level dressage, trail riding, and just fun stuff.

                The prp is the only additional therapy we tried. He is not on any supplements for his issues (he is on an Omega supp). He has been an outstanding patient so far and I think that has contributed greatly to his progress. He has also always had hay in front of him and a buddy for when he's in, so he's never bored or lonely. I've been working with a lameness specialist at a major clinic and I think that was a good choice as well.

                Sorry for the novel. I hope you have an easy rehab, and good luck!

                ETA: We had a bar shoe put on the affected hind right away and immediately noticed a difference in his comfort level. I would not recommend pulling shoes on the hinds. His other 3 are shod with normal steel shoes.

                Comment


                  #9
                  I am so sorry to hear.

                  1. We're looking at about 9 months, right? maybe longer? Yes. I'm rolling into my 8th month with my hind suspensory

                  2. Is an 8mm tear very bad, or just bad bad? I think unfortunately it's pretty bad. My horse had fiber damage but no tear. He wasn't lame and it's been a huge long rehab still. The good thing it's ACUTE and you caught it.

                  3. Can he be hand walked a bit before the 30 days is up? People are saying a 5m walk is OK. Everyone's opinion varies. If he's a saint to hand walk, I'd say 5 minutes and grazing is OK. But if he explodes.. you're looking at him reaggravating that tear and potentially making it worse. I would personally keep him on stall rest for 30 days.

                  4. Shockwave? Yay or nay? Shockwave worked well for my chronic proximal injury! After 90 days we had 'moderate' healing on 'considerable' fiber damage. It's expensive but it's easy and non invasive. Also had a horse with a suspensory tear at my barn... took over a year to rehab... but with shockwave he's competing at shows again!

                  5. Stem cell? Other treatments? Do they actually help? I would say yes they would help for you. IRAP or PRP but... $$$$ when you look at all these things. I've heard good stories, especially for an acute injury

                  6. What else do I need to know? It's ugly. It's boring. It makes you want to let your horse into the wild. My horse is getting 2 walks a day right now and it's been so much orchestrating. Make sure you cut the grain, so your horse doesn't get fat or have too much energy.

                  I would personally evaluate his feet and make sure he has good balanced feet. As far as pulling his shoes... mine got shod UP with the suspensory. He has to wear the denoix suspensory hinds right now. They seem to make him more comfortable TBH but $$$$$. I personally wouldn't pull them, and would unfortunately instead ask about the suspensory hinds.

                  I was also overly eager to work my horse and I found him sore when I started him back i about month 5 when we got to 2 5 minute sets of trotting. I trusted my gut and backed off and my horse is back to walking.

                  Get a second opinion from dr. carol gillis. She's available for an online consult, reasonably priced, an expert.. and you can compare what she offers for you to do vs your vet. In my experience the local vets tend to want the horses back to work too quickly.

                  Good luck!!!!!!

                  Comment


                    #10
                    So sorry. You have my sympathy. I have heard good things about using ProStride and IRAP for this.

                    1. We're looking at about 9 months, right? maybe longer?
                    I'd say longer.. Depends on how it looks on US during check-ups. Hind suspensories are really hard to rehab.

                    2. Is an 8mm tear very bad, or just bad bad?
                    Caveat, not a vet.. but it's not small.. depends on where it is too... high suspensories seem to have poorer prognosis to return to previous level of sport.

                    3. Can he be hand walked a bit before the 30 days is up? People are saying a 5m walk is OK.
                    Is he sound? If so, yes for small intervals in straight lines on firm footing.

                    4. Shockwave? Yay or nay?
                    If you can afford it - otherwise, put that $$ towards other treatments like ProStride/Stem Cell/PRP.

                    5. Stem cell? Other treatments?
                    I think they help more than Shockwave. YMMV.

                    6. What else do I need to know?

                    Do not look at time or make a schedule. Take it at your own pace..

                    Hind suspensories have a poorer prognosis to return to work than front suspensories. I am not sure why. My layman's opinion is that maybe front suspensories can be "one offs" or a matter of horses stepping the wrong way, when hind suspensories usually seem to go along with other issues: chronically bad trims/shoeing, hock issues, stifle issues, and kissing spine seem to commonly prop up when there's a hind suspensory involved. Chicken or egg issue, I think.

                    Really take your time. They also have a very small window of tolerating inflammation, which can make them flare and seem more painful even when healing, so it is good to stay on top of the inflammation... but of course, stalling makes horses prone to stocking up... I would supplement with some anti-inflammatories if you can. I personally use Platinum Performance any time I have a horse on soft-tissue injury layup. YMMV but I think it makes a big difference in the overall comfort of the horse while they are healing and I think it speeds up their healing time, personally. I've had vets be really surprised with the progress during re-evaluations; maybe it is not speeding up the healing, so much as it is preventing inflammation which also causes secondary issues.

                    I would not pull his shoes -- unless you think his trim is what caused the issue. IME they get very back-sore while on stall rest, particularly hind suspensory horses. Any sort of medication or supplement you can give to help.. even putting So No More on their back once every other day..

                    Horses used to shoes or horses needing shoes that have them pulled, I've found, tend to stand more protectively while they adjust (which in turn makes them even more sore) -- that's something you don't want, given he has an injury on that hind.

                    Regarding the rehab and taking it slow.. in general, (and I think you know this but repeating for those that don't) however much time he spent in a stall on complete stall rest, multiply that time by two to get the amount of time it should take you to get back to W/T/C work. So if he was on stall rest for 3 months, he should have 6 months of gradually increased work-load and should not be cantering until he is towards the end of the six months.

                    Suspensories abhor circling. No lunging. No deep footing. Hand-walks and walking under saddle should be performed on firm footing, no deeper than 2 inches above the hoof wall. If you have stone-dust or grass arena, great.

                    No circles during tack walk. Avoid things that might make the horse prone to twist his hind.

                    Sometimes more turnout is better. Check with your vet, but if he is quiet in turnout a standing paddock/medical paddock can usually make them better behaved, make them feel less "burning at both ends", and gives them some gentle conditioning outside of hand-walks that is beneficial.

                    Avoid hill work for the first few months back into saddle.

                    Dr Green is your best friend. Once cleared for turnout, see if you can do as much as possible (24/7). They tend to do really well, with that extra conditioning gotten from being outside and moving around.

                    Good luck and lots of jingles..

                    And now for the positive:

                    My first horse blew his (front) suspensory, full rupture, we think caused by not so great trimming.. This was on top of double bows he had from the track. This was decades ago, before PRP was as common. We could barely keep him in a stall, so he went back outside within 2 weeks. He had about a year off on Dr Green with no fancy treatment.. then I took a year to bring him back. I was conservative because it was a complete rupture and very ugly.. anyway... He then went back to his previous level (H/J 2'6") and surpassed it -- he even had a discipline switch from HJ to Eventing, and competed at pony club rallies, events, and all around shows.. then went on to be a packer for my younger sister, even training Training level jumps in his late teens He did not have much scope for more than Training but was a very reliable BN/Novice mount for my younger sister and was sound as the day was long other than that one suspensory. Never bothered him again... of course, we worried about it EVERY day

                    I've been involved in lay-up of various horses with hind end suspensories now as a BM. One had a high suspensory tear and took 2 years to get back, but is now competing Novice with her young rider. Another was a 2* horse that had a really ugly rupture and was not expected to even be pasture sound. They put her on Dr Green, bred her, bred her again because her first baby was so stunning, and now she is back in work and competing Training with a new rider.

                    So there is light at the end of the tunnel... just don't rush. Lots of jingles!




                    AETERNUM VALE, INVICTUS - 7/10/2012

                    Comment


                      #11
                      Ugh... sorry OP. I've been there. My hind suspensory horse had his sprain at the point of attachment inside the hock, and there was bony involvement, so slightly different, but also very similar. Another horse of mine sprained a front suspensory branch about 6 years ago. I've also seen a few others in the barn.

                      My vet allows hand walking from day 1 - provided you are willing to tranq the horse as needed to avoid any jumping around/antics and have a decent hard surface to do it on. Her maximum is 10 minutes two times per day for the first month. Then you start adding 5 minutes per week. She's also ok with the horse hand grazing so long as he's mostly stationary (with drugs if needed).

                      Her standard rec is injectable of choice (stem cell or IRAP) along with three shockwave treatments. She also recommends suspensory shoes on both hinds.

                      My proximal suspensory sprain didn't respond as we hoped to the first 3 months of rehab, so we sent him in for surgery given the location of his injury and the risk for compartment syndrome. I opted to keep him barefoot after surgery, and am rehabbing him barefoot now. Vet was fine with that choice. He showed no difference between suspensory hinds and barefoot, so it was clear to us they weren't making a difference for him.

                      The biggest thing is that rehab takes time. My vet gave me a very conservative schedule, and we didn't even keep up with that. Listen to the horse. Some of them just aren't quite ready to start trotting when the schedule says to. It's better to wait than push it.

                      Comment


                        #12
                        Really sorry to hear about the situation, OP. The second opinion is not a bad idea. Also discuss drug options if some hand-walking/grazing is acceptable.

                        Comment

                          Original Poster

                          #13
                          So grateful for all the stories and opinions!

                          So, I guess I am still wondering how much al the therapies help? he's insured so a lot of that is covered, and it's likely I'll do everything my vet offers. But if it's a year in pasture vs a year with lots of therapies in a stall...

                          Can anyone point me to studies that prove these therapies work? I'll make an effort to Google more too of course. Last year he had a lot of shockwave and a shot of osphos for a front cartilage avulsion injury and it made no difference...

                          Comment


                            #14
                            Originally posted by Xanthoria View Post
                            So grateful for all the stories and opinions!

                            So, I guess I am still wondering how much al the therapies help? he's insured so a lot of that is covered, and it's likely I'll do everything my vet offers. But if it's a year in pasture vs a year with lots of therapies in a stall...

                            Can anyone point me to studies that prove these therapies work? I'll make an effort to Google more too of course. Last year he had a lot of shockwave and a shot of osphos for a front cartilage avulsion injury and it made no difference...
                            The Osphos at the very least, should have helped him comfort-wise..

                            Do you need horse-specific, or just in general?

                            In general, there's lots of evidence in humans that shockwave can help with discomfort in soft-tissue injuries. It certainly can improve circulation.

                            KER, which of course does many studies for the JC, believes shockwave therapy can help. The key word seems to be "can", and is situational on injury and severity:
                            https://ker.com/equinews/extracorpor...-wave-therapy/
                            https://onlinelibrary.wiley.com/doi/...1111/eve.12780

                            I remember reading a study about KS and long-term soundness, and there was no difference in the wastage % between horses treated with injections, and horses treated with injections & shockwave. They both had the same success rate down the road; so maybe for some things it is not as beneficial.

                            In MY experience, it doesn't make as much a difference as other therapies available can: like PRP/stem cell, etc, but it helps in the way a "cocktail mix" of various therapies can help address multiple things at once.

                            Big caveat: I have never used shockwave for a suspensory. So others who have used SWT should chime in on if they saw a difference.

                            Just while I am discussing this particular issue -- I feel the reason there is a pretty high failure rate in coming back to work with these injuries in my own social circle, is because I see that the riders or owners don't quite understand how conservative they need to be, and usually are going right back to their level of work without much ramping up or limb loading.. which.. of course.. can lead to reaggravation of the injury. Seems those that take it slow, get there sooner than those that don't.


                            AETERNUM VALE, INVICTUS - 7/10/2012

                            Comment


                              #15
                              Originally posted by Xanthoria View Post
                              Can anyone point me to studies that prove these therapies work? I'll make an effort to Google more too of course. Last year he had a lot of shockwave and a shot of osphos for a front cartilage avulsion injury and it made no difference...
                              I hear you, I am all about evidence-based medicine too and can get frustrated when vets just say that XYZ expensive fancy treatment "seems to help" in their experience.

                              Here's a study on shockwave for suspensories: https://www.ncbi.nlm.nih.gov/pubmed/17076464

                              PubMed is a great resource. I did a lot of my own research on there while dealing with my hind suspensory horse (who ended up having DSLD).
                              Building and Managing the Small Horse Farm: http://thesmallhorsefarm.blogspot.com

                              Comment


                                #16
                                I'll tell you I've seen shockwave work first hand.

                                My horse has bilateral proximal suspensory "strains" -- but the right had come attached from the bone so we focused on that one and the left suspensory was left alone.

                                I did clear leg paint. I poulticed. I sweated. I cold hosed. I iced BOTH legs. Pretty religiously. My back still aches thinking about all the crouching.

                                Three months later we did a new ultrasound. The right one had moderate healing. The left was exactly the same as before.

                                So -- I'm a shockwave believer! But -- mine also wasn't a tear.

                                Comment


                                  #17
                                  I am so sorry to hear this. Hugs and strength to you. I have no experience (knock on wood) but have friends who do. Agree with everyone re: take time and slow. Don't rush it towards the end when you have been rehabbing for it-seems-forever......

                                  Comment


                                    #18
                                    Let me commiserate....significantly damaged check ligament. Just starting rehab after rehabbing a SDFT in the same leg last summer. Prognosis is not good for full return to work (third level dressage). The SDFT healed up great and I used shockwave so I will use it again for this injury. Prp was also recommended but not covered on insurance so likely will skip that.
                                    As for stall rest, my vet recommended a small paddock instead for both injuries, imo many of them are quieter in small turnout than stalls. Agreed with the other poster I’d only stall rest if quite lame at the walk.

                                    Comment


                                      #19
                                      Originally posted by Xanthoria View Post
                                      So grateful for all the stories and opinions!

                                      So, I guess I am still wondering how much al the therapies help? he's insured so a lot of that is covered, and it's likely I'll do everything my vet offers. But if it's a year in pasture vs a year with lots of therapies in a stall...

                                      Can anyone point me to studies that prove these therapies work? I'll make an effort to Google more too of course. Last year he had a lot of shockwave and a shot of osphos for a front cartilage avulsion injury and it made no difference...
                                      I've used shockwave for suspensory injuries (they didn't have tears, but were enlarged. one had some disturbed fibers) and an Artemis laser. I can't say enough good things about the artemis. The artemis got my one horse over the hump after a couple sets of shockwave and a set back from playing to hard over the fence with his friend. Sadly i had that horse jumping and going great, and he just chipped his fetlock in his stall- i think he was startled from fireworks. So I feel your pain.

                                      For one stubborn suspensory that wouldn't heal after the above, i also did stem cell. AND LOTS OF TIME. She became sound but had a legitimate year of just turnout. I think time is the key and a very slow deliberate rehab. PRP also an option with tears, but I've not personally had to do that.

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                                        #20
                                        No advice, just sympathy. I am in a similar boat. My gelding did a real number on himself in turnout only a week after I did ProStride on the significant arthritis in his left front fetlock. Ultrasound showed "1/4 of the suspensory distal medial branch enlarged with abnormal fibers, and DDFT anechoic area 0.87cm by .5cm long at point of fetlock" in his left hind. Next week is the follow up ultrasound so I hope that there is some good news. While my horse needs the strict stall rest I constructed an outdoor stall with electric tape so he can have a few hours "turnout" each day, it seems to help his mental state quite a bit, especially since he is always able to see the other horses at the barn.

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