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TOPIC: Acute suspensory injury

Acute suspensory injury 03 Aug 2010 03:18 #1

Is there anything I can do to assist with comfort, support and healing in a horse that has acute suspensory injury in both front legs. Said horse is 19 and this happened yesterday. So far i'v got a large egg bar on the bad leg and a straight bar on the not as bad leg because thats what i had in the truck when it happened. I'd like to put something on him as soon as he's standing more. Right now I'm trying to support his legs with bandaging and reduce the swelling(my own horse unfortunatly). Any imput or suggestions would be greatly appreciated! I'll try and get pictures tomorrow.
Put some excitement between your legs... ride a horse!
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RE:Acute suspensory injury 03 Aug 2010 17:58 #2

  • Ray_Knightley
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Not sure if this maybe of use..aswell as support (shoe) and time..



Treating suspensory ligament injury

Damage most often occurs at high speed and when a racehorse is beginning to tire

Suspensory ligament injuries are common in athletic horses. The suspensory apparatus includes the suspensory ligament that extends down from the back of the knee to the fetlock joint, the two sesamoid bones at the back of the fetlock joint, and the various ligaments connecting these bones to each other and to the pastern bone. These structures are crucial for supporting the horse's weight and acting as shock absorbers for the leg.

The suspensory ligament lies between the flexor tendons and cannon bone and is a broad, elastic band that keeps the fetlock joint from dropping to the ground when weight is placed on the leg. The extensor branches of this ligament, which run from fetlock joint to the front of the pastern, keep the pastern joint from buckling forward.

Injuries to this shock-absorbing support system are often debilitating and slow to heal; frequently, they will end a horse's racing career. In the past, treatment consisted of rest and sometimes surgery, depending on the structures that were involved, but new treatment regimens help to return a horse to soundness quicker. Various surgical techniques have been used, but only with moderate success.

Causes

Van Snow, D.V.M., based at Santa Lucia Farm in Santa Ynez, California, sees and treats suspensory injuries in all kinds of horses, including racehorses. "The cause of the problem is variable, depending on the type of horse you are looking at," he said, but the biggest factors are speed and fatigue.

"Suspensory ligament problems can usually be seen-if an ankle is enlarging, or there is swelling down around the back inside or outside corner of the ankles," Snow said. "You usually can't see a high suspensory [injury] because it's tucked up in behind the knee, but it's a very common problem.

"One thing that predisposes a horse toward this type of injury is poor hoof balance, with more stress and strain on certain parts of the leg," he continued. "Horses that are too high on the outside hoof wall will land on the outside wall first, which sets up a torque in the foot. The foot starts twisting around the point it has contact with, then the inside of the foot hits the ground and stops the torque, but the twist comes all the way up the leg and it pulls the soft-tissue structures up the leg. It's important to make sure the hoof is balanced.

"Footing is another big issue. I see less injuries in horses worked in footing that's on the firm side, rather than deep.There needs to be a base they can get down to, so they don't overextend their soft-tissue structures as they will if they get into several inches of soft ground," he said.

"Exhaustion is another thing that causes suspensory ligament problems," Snow added. "Conditioning is really important to prevent suspensory injury. Horses that have not had enough conditioning for work that requires speed and a little more endurance tend to hurt themselves sooner than horses that are well conditioned and prepared for that. Suspensory injuries are common when horses are starting to tire toward the end of a race.

Recuperation

"Suspensory ligament injury is the most common condition we deal with in athletic horses," Snow noted. "I see this more often than any other type of injury. There are several ways to diagnose it. Once diagnosed, however, it needs to be categorized as to whether there are large structural defects or simply a strain. That will help determine how long the horse needs to be rested and how much effort needs to be put into treatment." Snow said this determination is best done with an ultrasound examination.

"Horses with suspensory ligament problems that have holes or lesions that can be seen with the ultrasound typically will become sound and be able to go back to work long before complete healing is evident with ultrasound," Snow said. "The ultrasound doesn't show physical evidence of healing for a long time; most of those horses can be back in training before the ultrasound looks better."

Treatment

"Sometimes we inject the area-not the ligament itself, but tissue around the ligament-with corticosteroids," Snow said. "Sometimes, we put glucosamines or hyaluronic acid into that area, also.

"There are some electromagnetic machines like the Therascope that we've used with great success in treating soft-tissue injuries in the suspensory area. The Therascope has really helped a lot of these horses. It can be used all the way through the training period because the injuries continue to heal during training."

With a suspensory ligament injury, the horse is taken out of hard training but is not kept immobile; Snow recommends exercise by daily walking. "I have them back off the training schedule quite a bit, optimize the foot, do some therapy, and reevaluate in two to three weeks," he said.

"If things are looking much better, I'll let the training gradually increase and keep monitoring the horse," Snow continued. "Often, I don't ultrasound it again for quite awhile, because it's quite a long time before you see much evidence of change with that, anyway. The physical exam, for me, is more important and helpful."

For horses that do not respond to conservative treatments, Snow said shock wave therapy is quite useful in high suspensory as well as branch suspensory disease. "I have used that quite a lot; more and more people are doing shock wave therapy now, also," he said.

First used in humans for breaking up kidney and gall-bladder stones, this procedure requires that the horse be anesthetized. Snow said he has had a 75% success rate with shock wave therapy.

"There's another technique that I don't use at all, but has been used occasionally for suspensory injuries, and that's injection of bone marrow into the high suspensory area," Snow said. "Some people find that useful."

Flexion tests

Snow also utilizes flexion tests for horses that may be in danger of suspensory damage. "I encourage my clients to monitor their horses by doing flexion tests," he said. "It's not a hard thing to do-to flex the ankle-and can often tell you whether the horse is sore. If you put pressure on a horse's ankle in a flexion test for 30 seconds or a minute, and on one side he goes off lame and the other side is not lame, this gives a clue.

"Or you flex the knee, which can be a generic test for high suspensory disease. You can do a 60-second flexion of the knee-holding it up tightly with the fetlock just out to the side of the forearm or even up above the forearm, so you are really flexing the knee. Then you jog the horse off to see if it nods the head or not.

"A horse tends to have a similar flexion test month after month," Snow continued. "It should stay the same. For instance, a horse might never be lame but doesn't flex well in the right knee. You get to know the horse and what is normal or not normal for him.

"The same with hind-leg flexions-though they must be held up longer, probably for 90 seconds. You hold those hocks and stifles, flexing the whole hind leg. It's not very specific, but gives you an idea about the soundness of that leg. If a person flexes all the horse's legs once a month, it gives a clue on any changes. You can often catch a problem before it gets to be a really big problem," Snow said.

"Another way to check for lameness is to put the horse in a 30-foot round pen or longe it in a 30-foot circle on hard ground to see if the horse is off," he said.

Nonsurgical treatment

Gregory A. Beroza, D.V.M., of Long Island Equine Medical Center, has developed a nonsurgical method for rehabilitating suspensory ligament damage. Initial treatment consists of a brief rest period with aggressive anti-inflammatory medication, as well as cold hosing and icing for the first week or two, corrective shoeing to raise the heel and decrease tension on the damaged suspensory, and application of local anti-inflammatory cold-laser treatment.

Early in the treatment regimen, intensive massage and therapeutic ultrasound are used, and later an individually tailored exercise program is begun. Stall rest is brief and is followed by increased periods of hand walking. Within 30 to 60 days of the injury, the horse is exercised with a rider or weights.

Throughout the recovery period, the horse is given nutritional supplements containing chondro-protective agents (Adequan, Cosequin, Legend, GLC 5500) to maximize fibroblastic production of collagen, but no local injections.

With this program, most lesions were resolved within the first 90 days, and they were virtually gone by 120 days, Beroza said in a 2000 presentation. Racehorses usually resumed full training after eight months and were able to race again competitively one year after the injury. Successful recovery, Beroza said, depended on the initial degree of damage, how soon treatment began, appropriateness of subsequent therapy, and continued trainer compliance after the horse was discharged as a patient.
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RE:Acute suspensory injury 03 Aug 2010 21:33 #3

  • Gabino
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Ray_Knightley wrote:
Nonsurgical treatment

Gregory A. Beroza, D.V.M., of Long Island Equine Medical Center, has developed a nonsurgical method for rehabilitating suspensory ligament damage. Initial treatment consists of a brief rest period with aggressive anti-inflammatory medication, as well as cold hosing and icing for the first week or two, corrective shoeing to raise the heel and decrease tension on the damaged suspensory, and application of local anti-inflammatory cold-laser treatment.

.

What??? If you raises the heels,the pastern descends and it increases the tension on the suspensory ligament. How can be that?
Gabino Fernández Baquero

www.farriergabino.com
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RE:Acute suspensory injury 03 Aug 2010 21:58 #4

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Gabino wrote:
What??? If you raises the heels,the pastern descends and it increases the tension on the suspensory ligament. How can be that?

Thats what i would say to,but i remember a Test Done in Wien where they have proven to this method does bring Relief for healing SLI
Somewhere here was a thread where the method could only really make sence under Stall arrest ,because of the logical danger .
Not sure if it makes a difference that the above Info is for TB horses ?
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RE:Acute suspensory injury 04 Aug 2010 13:56 #5

  • chris bunting
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done a lot of racehorses , suspensory injuries ,as gabino says do not raise the heels it will not help . one ****** question though ,how does a 19 year old get put in a position for an injury of this nature , it takes some doing . first thing is to correctly trim and balance the feet
chris
common sense is not needed when you have rules
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RE:Acute suspensory injury 04 Aug 2010 14:44 #6

Gabino wrote:
What??? If you raises the heels,the pastern descends and it increases the tension on the suspensory ligament. How can be that?

well the vet is wrong!

you lower the heels on a suspensory and raise the heels on a tendon injury

and that my dears is on the trainer's and plater's test questions; before we all became politically correct and couldn't give written tests any more to the plater's and that question might be asked anymore on a trainer's test.
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RE:Acute suspensory injury 04 Aug 2010 18:58 #7

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ladyblacksmith wrote:
well the vet is wrong!

you lower the heels on a suspensory and raise the heels on a tendon injury

and that my dears is on the trainer's and plater's test questions; before we all became politically correct and couldn't give written tests any more to the plater's and that question might be asked anymore on a trainer's test.

I raised the heels on a Suspensory a few years back Hind leg and was told that it was a 60% damage .....The Vet at the time also said its the wrong thing to do ,but strange enough it worked ...and the horse was back in work in 3 months...

But this is going to confuse everything ...and after reading more in internet .
It would interest me why One guy goes for raising heels ....why one test in wien states that wedges have no effect on the fetlock (which i think has been cleared up to a mistake in the readings)
And also that by tendon damage raising of heels will also not help....

With the Suspensory ligement is it not to do with which area of the ligement is damaged to which method is used and when ,and does this not sometimes include a wedge If needed ,and how long does the wedge stay in....which sadly is not stated...:(
Also a reduction of heel lenght in other cases...

I have also used shoes on suspensory ligement damage supporting the Toe and thining the heels down ,even in one case wedged the toe all of which have worked on each individual case in question ...Both time with the vet .

Please help to clear this up for me or is each case so different???
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RE:Acute suspensory injury 04 Aug 2010 19:32 #8

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I don't know Mr Barozo,either their work or number of cases succesfully.I know Jean Marie Denoix. I know their work: Denoix ever say than in injury suspensor,put a shoe toe wide and heel slender.I work in this way and the horses are fine and sound. Why must I changing my succesfull methode?

When a guy say "The old knowledge that works good is wrong.You must eat my new sciencie", I think "Bah...another barefootist".
Gabino Fernández Baquero

www.farriergabino.com
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RE:Acute suspensory injury 05 Aug 2010 03:33 #9

chris bunting wrote:
one ****** question though ,how does a 19 year old get put in a position for an injury of this nature , it takes some doing .

Great question actually! My vet is thinking along the lines of cushings and how it can weaken the body's systems. Will be testing for it as soon as possible. Other than that, he's fit, well balanced and appropriatly faced. I think some of the extent of the damage was caused by him just continuing to run, too much heart. Three fractures and not a lame step.

Just an observation, when he does stand up, he wants to raise his heel on something. If he cant find anything by his foot then he steps the worse leg on the better leg, resting his heel up on the other foots wall.
Put some excitement between your legs... ride a horse!
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RE:Acute suspensory injury 05 Aug 2010 12:33 #10

Ray_Knightley wrote:
I raised the heels on a Suspensory a few years back Hind leg and was told that it was a 60% damage .....The Vet at the time also said its the wrong thing to do ,but strange enough it worked ...and the horse was back in work in 3 months...

But this is going to confuse everything ...and after reading more in internet .
It would interest me why One guy goes for raising heels ....why one test in wien states that wedges have no effect on the fetlock (which i think has been cleared up to a mistake in the readings)
And also that by tendon damage raising of heels will also not help....

With the Suspensory ligement is it not to do with which area of the ligement is damaged to which method is used and when ,and does this not sometimes include a wedge If needed ,and how long does the wedge stay in....which sadly is not stated...:(
Also a reduction of heel lenght in other cases...

I have also used shoes on suspensory ligement damage supporting the Toe and thining the heels down ,even in one case wedged the toe all of which have worked on each individual case in question ...Both time with the vet .

Please help to clear this up for me or is each case so different???

Because sometimes what's wrong is right; and what is right is wrong:confused:

This is not an exact science and what the horse needs is what we wind up doing for the sake of the horse's soundness.

Linda Muggleworth
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RE:Acute suspensory injury 06 Aug 2010 01:19 #11

  • Rick Burten
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ladyblacksmith wrote:
you lower the heels on a suspensory and raise the heels on a tendon injury.
Ummmm, it depends. It depends on which tendon is injured and what type of injury has been sustained. IIRC, there were some studies done several years ago that showed the best course of action was to keep the hoof and pastern aligned, ie: neither rasing nor lowering the hoof capsule other than to align the pastern bones.
Rick Burten PF

In the immortal words of Ron White: "But let me tell you something, folks: You can't fix S-tupid. There's not a pill you can take; there's not a class you can go to. S-tupid is forever."
."


Je pense donc je suis
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RE:Acute suspensory injury 06 Aug 2010 23:24 #12

Ultrasound shows tears in deep digital flexor, superficial flexor and suspensory. No complete tears and still attached to sesamoides. Vet suggested putting deep sand in his stall so he can rest his feet how ever he feels fit, right now he's pulling the bedding up under his heels or stepping on the front of his other foot.
He's not going down without a fight, took three of us to hold him so i could give him a naquasone(sp?) shot, so I think Briggs is going to live in a giant kitty litter box :)
Put some excitement between your legs... ride a horse!
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RE:Acute suspensory injury 08 Aug 2010 18:41 #13

  • mwmyersdvm
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Allowing the horse to choose what makes him feel good is an excellent plan. Reduction of pain and controlled exercise are the hallmarks of initiating recovery for any horse. Due to the landing pattern of egg bars when the horse moves into a trot and faster, I would not recommend this for suspensory injuries. The rapid unloading of the deep flexor can momentarily overload the suspensory and cause further injury. If he wants his heels raised, raise them. A tape on boot can work quite well to adjust him until it seems to be just right then you can move to a shoeing package. You will likely have to shoe more frequently as he will change his preferences as he heals, so the old "six week schedule" will not apply.
I have had the best response from Ric Burten's observations - align the pastern axis. Lowering the heels of already low heels in a suspensory injury would be a really bad idea, so be cautious of pat answers in these cases. As Ric generally points out, "it depends".

M. W. Myers, D.V.M.
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RE:Acute suspensory injury 09 Aug 2010 00:33 #14

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Rick Burten wrote:
IIRC, there were some studies done several years ago that showed the best course of action was to keep the hoof and pastern aligned, ie: neither rasing nor lowering the hoof capsule other than to align the pastern bones.

reference, please?
P
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RE:Acute suspensory injury 09 Aug 2010 00:52 #15

mwmyersdvm wrote:
Allowing the horse to choose what makes him feel good is an excellent plan. Reduction of pain and controlled exercise are the hallmarks of initiating recovery for any horse. Due to the landing pattern of egg bars when the horse moves into a trot and faster, I would not recommend this for suspensory injuries. The rapid unloading of the deep flexor can momentarily overload the suspensory and cause further injury. If he wants his heels raised, raise them. A tape on boot can work quite well to adjust him until it seems to be just right then you can move to a shoeing package. You will likely have to shoe more frequently as he will change his preferences as he heals, so the old "six week schedule" will not apply.
I have had the best response from Ric Burten's observations - align the pastern axis. Lowering the heels of already low heels in a suspensory injury would be a really bad idea, so be cautious of pat answers in these cases. As Ric generally points out, "it depends".

M. W. Myers, D.V.M.

so dear but to say it depends on any racetrack test would get you failed and not licience.
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