Suspensory ligament desmitis in the horse can take many forms and have a variety of presentations. In all, if not most, there is a lameness noted by a head-nod or reluctance to stretch out in front. This can be evident on different levels, dependent upon the degree of damage to ligament and which area is affected. Recovery can be challenging for some horse owners and result in long-term stall confinement and sometimes incomplete recovery. This then impacts the horse’s ability to work and compete. Through addressing the problem on a different level, suspensory ligament injuries in the horse can be managed more completely with a swifter recovery.
A 15-year-old Hanoverian gelding was presented for evaluation of a chronic suspensory injury impacting both rear limbs. He was used initially as a jumper but due to his injuries, he has been on stall confinement for the past twelve months in an attempt to foster ligament healing at the recommendation of his veterinarian. The gelding was being hand walked daily for 30 minutes, but the owner was finding it increasingly difficult to perform this task as he was often out of control and she was concerned about further injury. He was on a daily dose of 2 grams of phenylbutazone daily to help manage inflammation and pain, along with ulcer medications.
His current diet consisted of an alfalfa-mix hay forage at about 2% bodyweight per day in addition to around 3 pounds of a fortified grain ration. He was also on a trace vitamin-mineral supplement, glucosamine, and a few other generalized supplements promoted for tendon health.
On examination, the gelding was very alert and responsive with no evident lameness at the walk. His overall physical examination was normal. Flexion tests were performed on a straight line, hard surface with no response. He was visibly off on his left rear with a slight head drop and shortened anterior or forward stride. This was worse when lunged counter-clockwise. A slight and very similar type of lameness was noted on the right rear as well.
Prior ultrasound examinations had indicated damage to both medial suspensory ligaments with core defects and fiber damage, with some fluid accumulation. A repeat ultrasound was not performed at this time. The gelding was moderately sensitive to palpation of the suspensory ligaments, both rear limbs, just above the fetlock region. There was only slight fluid accumulation or edema present on examination.
Further evaluation was performed to assess his conformation and hoof balance on all four feet. In the forelimbs, he was noted to be slightly toed out and in the rears, also slightly cow-hocked in his conformation. Additionally, upon assessing hoof balance, the heels were slightly under-run with a cut-off toe to match the shoe. The medial-lateral balance was also off in all four feet, generally with a higher wall or heel in the lateral aspect and shorter medially. He was currently shod in aluminum based competition shoes.
Recommendations and approach to his recovery were as follows:
- All grains were removed from his diet. He was a big horse and was carrying excess weight from lack of use and being stalled. The grains were adding to this temperament issues and likely contributing to inflammatory events. He was placed on 1 pound of alfalfa pellets twice daily for supplement administration.
- It was recommended that he be turned out in a small paddock, starting at 1 hour per day for the first week, then increasing incrementally to 2 hours and then up to 6 hours if he allowed based on degree of soundness.
- All supplements were discontinued.
- He was started on Cur-OST EQ Plus twice daily for 14 days based on label dosing in addition to the Cur-OST EQ Topline for tissue repair and support, being administered at label doses twice daily.
- His shoes were removed. Sole thickness was assessed and adequate, being estimated at 9 mm, so boots were not utilized. The sole was mapped and the heels pulled back closer to an ideal position. The toe was rolled at the break-over point and walls were rolled. Medial-lateral balance was applied in all four feet.
The gelding was reassessed in one week and noted to have a 80% improvement in his lameness in both rear limbs. There was still a mild evident favoring of the left rear over the right, but overall, there was a marked improvement. The owner had been steadily increasing his turnout and currently was at 3 hours per day. This was going faster than desired, but given there was no worsening to his lameness, the owner decided to increase the time out. The first few days he did seem to be excited, but soon settled down to where most of the time he was just grazing and quiet.
The owner continued with the supplement and diet regimen, revisiting in 3 weeks for a hoof trim and balance. The feet were trimmed accordingly and balanced. At this time, he was 90% sound at the trot and was allowed to resume normal training and work.
In telephone contact with the owner in 6 months, he was in full work and doing very well with hopes to resume his normal jumping career. The owner continued forward on his supplement, diet, and lifestyle changes.
Suspensory Ligament Injuries in the Horse Discussion
Tendon and ligament injuries are very common in the horse, especially those involved with competing in various disciplines. The twisting and torqueing motions generated, along with increased loads, are often to blame and while these forces do create more stress upon the structures, there are often underlying problems which create susceptibility to injury. As in the case of various infections, just because a bacteria or virus is around does not mean every horse will become sick. In order for that infection to set up, the host or horse must be susceptible. The same applies to tendon and ligament injuries.
Sadly, many owners are left with long-term stall confinement and often very expensive rehabilitation to get their horses recovered. Even then, many do not respond and fail to return to full work. Typical therapies employed are stall confinement, non-steroidal medications, and topical remedies to manage inflammation. In this particular case, these therapies had been utilized along with long-term stall confinement, but the horse failed to recover.
It is in my experience that increased susceptibility to suspensory injuries in the horse stem from ongoing internal inflammation, which disrupts cellular health, and improper foot balance. So, you have a heightened level of inflammation which weakens the ligaments and tendons, which is then made worse by improper loading of the structures. In the case of internal inflammation, the usual causal link is digestive health or lack there of, which is directly related to stress, diet, and medications being utilized. In the case of the foot, more times than not, there is an imbalance, usually medial-lateral, which is shifting distribution of weight improperly. In this particular case, the inside wall was shorter than the outside, which was forcing the horse to improperly load medially, stressing the medial suspensory ligament branch.
In the case of this gelding, the two contributing culprits were modified, being the diet and foot balance. They were both addressed to return the body back to a state of balance and proper loading in the foot. These were the two contributors and if modified properly, the strain on the suspensory ligament would almost instantly be relieved, now opening the door for tissue repair and healing.
To further accelerate the healing process, two herbal based formulas were used. The Cur-OST EQ Plus was utilized to address ongoing inflammation in the body which was contributing to ligament healing failure. The Cur-OST EQ Topline was utilized to provide additional plant-based protein along with vital amino acids and mitochondrial function enhancers to stimulate cellular function and repair.
This gelding responded quite rapidly with improvements noted in one week. While this may seem very quick, it is not unusual in our experience. One of the biggest factors not addressed in these cases is proper foot balance. More so, special shoes are applied in attempts to wedge heels, when in truth, they do not need to be elevated but instead moved back. In addition, many of these horses are stall bound, which increases the stress response and cortisol release. Cortisol is a catabolic steroid hormone and known for tissue degradation, not repair support. In addition, anxiety tends to build which is made worse by grain diets. These then fuel digestive imbalance and dysfunction, which then contribute to further systemic inflammation. In truth, given these typical scenarios, it is a wonder that some horses actually heal and recover.
Sometimes, a very simple and logical approach can provide better results for all parties involved.
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Author: Tom Schell, D.V.M, CVCH, CHN