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Suspensory Injury, Cause and Rehab Questions
 Moderated by: DrDeb  
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Bryy
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Joined: Sun Jun 21st, 2015
Location: Guilford, Connecticut USA
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 Posted: Sun Nov 24th, 2019 05:31 pm
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Hi Dr. Deb and fellows,
My 12 year old Andalusian gelding has been diagnosed with a strain to his right hind medial branch of his suspensory. The injury was blocked and imaged with an ultrasound, there is no core lesion. The tendon sheath in the area has been enlarged since I purchased him about a year ago. I looked through "The Lame Horse" by James Rooney to try and understand how this happened and how to hopefully prevent re-injury in the future once we've gone through the long process of rehab. A Google search of the forum suggests and supports that uneven landing on the foot or uneven push off medial-laterally could be a risk factor. Though he has been barefoot for years I had hind shoes put on to intentionally limit his "grip" and prevent torque. I have films of his feet available, taken this summer before there was an issue.

My specific questions are:
What more can I do to prevent this occurring again?
During the months of walking ahead is it more helpful to not generate heat during the walks or is it not detrimental to have a heat reaction to the exercise of the area? Are there other questions I don't know to ask about his rehab? The program given to me was "20 minutes 2x/day until re-imaging in a few months to look for decreased size and filament alignment."

Best,Julie

DrDeb
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 Posted: Tue Nov 26th, 2019 07:47 am
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Bryy, it was a good idea to look through Rooney. You will also want to look at Adams/Stashak's "Lameness in Horses", making sure to get the latest edition.

As to generating heat during the walks: "heat" appears when whatever the horse has been doing provokes the proliferation of small blood vessels. The body does this as a way of bringing materials in to the injured area for repair and healing, so to a degree it is good. You'll have to gauge carefully, though; too much of a good thing is bad, in other words, you don't want to let the horse re-injure himself. As a rule of thumb, some heat after a walk is OK if it subsides in an hour or so. In fact it is not only OK, but actually good as promoting healing. Little stretches on the injured area, which may promote some heat, also help the fibroblast cells which have to lay down new tendon fibers to know not to lay them crosswise, but rather align them with the direction of the pull.

You'll want to adhere to the prescription given, because the situation will almost certainly be requiring you to put the horse in a stall, with his 2X daily walks the only times he's let out. Depending on how much of a clown your horse is, he may very much want to play and gambol and generally have a good bit of a run when let out, and you absolutely must not let him do this because he will almost certainly re-injure himself. One thing that is completely justified to do during this period, therefore, is to cut his ration to zero of anything with a lot of TDN's in it. Let him eat clean straw plus just the minimum of grass hay of some benign variety such as orchard grass or timothy -- just enough to keep him between condition score 4 and 5. He will look horribly thin to your neighbors but do remember that their standards of reality are probably far biased toward the fat end of the spectrum, and if they want to gossip about your negligent horsekeeping you can just tell them to go mind their own business.

In putting him on a low-carb diet, you cut his energy down and you also almost compel him to be much more interested in hand-grazing once he's on the lead line than he is in going off for a good breather. Build this into your nursing strategy, and pre-select areas that are scattered along your walk where you can pause and let him graze. So long as whatever he's grazing isn't too too rich, the limited amounts he will get on these relatively brief excursions won't hurt him. Add the grazing time to his walk time, i.e., he should still be hiking along with you for a total of twenty minutes; if he spends an additional thirty minutes scattered in there where he's eating, really, so much the better as to buddy-up time.

The amount of feed he ingests on these walks is trivial as to amount but very delicious to him, so you can use it as a reward; in fact, you may as well teach him to urinate on request while you're at it.

Many Andies have rather crooked hind legs, and that in both side and rear view (i.e. both "sickle hocked" and "cow hocked"), so it doesn't surprise me to hear if his hind hoofs were more or less out of mediolateral balance. Shoeing him or not shoeing him will make little difference, UNLESS the shoes you put on are designed to force his toes to orient in one certain direction which is not the direction they're meant to orient in, i.e., particularly, straight forward. In that case, the shoes will make re-injury more likely, not less.

Good luck with this. It's a tedious pain in the butt, but as he heals and the vet gives you permission to let him loose in a small pen and/or trot some, then you can go back to free schooling; just avoid sharp turns or rollbacks. Also as he heals then you can use this as a huge opportunity for buddy-up time and trick training, especially drum work, which is doubly helpful as it can be very calming to the animal. Let us know how it goes -- Dr. Deb

Bryy
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Joined: Sun Jun 21st, 2015
Location: Guilford, Connecticut USA
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 Posted: Tue Nov 26th, 2019 05:11 pm
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Hi Dr Deb

Thank you for the prompt reply. Understanding how the body heals is very helpful for me to know if the somewhat generic rehab prescription is suitable for where his injury is in terms of healing.

This particular horse came with pre-installed tricks, Spanish walk, plie a bow, drum mounting and others that he delights and showing. Are any of these things that I can use now or do they stretch the back of the leg too much at the moment? I have started teaching him to fetch which I don't anticipate taking very long at all!

DrDeb
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 Posted: Thu Nov 28th, 2019 10:16 am
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I think I would pause a couple of weeks before doing plie bow; the other learned responses (a.k.a. "tricks") don't represent anything that would stretch the hind tendons. Some horses are so delighted to be obedient that they will perform even though it hurts them, but most are at least a little more sensible. So after a couple of weeks I'd monitor what is safe to do by observing what the horse tells me is comfortable. If plie bow hurts his hind tendons, if he's a normal horse he'll compensate by angling the hindlimbs backwards to minimize the stretch. If he does that I would take that as a sign that you should wait again a couple of weeks before asking for that particular thing again. -- Dr. Deb


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