Download Suspensory Ligament Injury

Sheet
Fact Sheet
hoke
Suspensory Ligament
Injury
a relatively common condition seen in horses
es and is typically caused by obstruction of the
gus (food pipe) with food; occasionally a foreign
ligament
(SL) runs down the back of the
be involvedThe
e.g. suspensory
wood or plastic.
Fortunately
cannon
bone
from
just
below
the hock/knee, between the
ses of choke resolve quickly and spontaneously
splint
bones
and beneath
thelonger
two flexor tendons, before
cases in which
the
obstruction
lasts for
twoveterinary
branches that
insert on two small bones
minutes are dividing
likely to into
require
assistance.
(sesamoid
bones)
immediately
ortant to note that this is not the same as thebehind the fetlock joint.
atening condition
in humans,
The main
functionwhere
of thethe
SLterm
is to prevent excessive extension
refers to blockage
of the windpipe
rather
than thealso contributing to joint
of the fetlock
joint; the two
branches
agus. This difference
means
that
unlike
humans,
stability. There
are
three
regions
of the SL that can be injured;
with choke can
still breathe.
proximal
(top end), mid-body and the two branches. SL injury
can follow a single traumatic event, be due to a repetitive
strain or age related longer term degeneration.
Clinical signs
•
Lameness – variable in severity and speed of
onset. Often worse on soft going or with the
affected limb on the outside of a circle on the
lunge.
•
May be poor performance rather than obvious
lameness if both fore or hindlimbs are affected.
•
•
•
May be positive to flexion test.
THE SUSPENSORY LIGAMENT
CAN EASILY BE SEEN AND
FELT IN THE MID CANNON
AREA (ARROWS)
Diagnosis
Diagnosis is based on clinical signs and ultrasound
examination. Nerve blocks and x-rays may also be
used and less commonly MRI or nuclear scintigraphy
(bone scan).
Localised heat, pain and/or swelling.
Fetlock joint or digital flexor tendon sheath filling
(windgalls) with SL branch injuries.
REGULAR
DENTAL EXAMINATIONS
AND hocks, and
Some conformation
faults e.g. straight
TREATMENT
CAN
REDUCE
THE
RISK
OF
foot imbalance may predispose to CHOKE
injury.
KEY POINTS
KEY POINTS
•
•
•
•
ULTRASOUND IMAGE SHOWING ENLARGEMENT
OF PROXIMAL SL OF RIGHT FORE
Don’t panic! Choke is rarely life-threatening and
• The
SL is to prevent overextension of
many cases
willfunction
resolve of
spontaneously.
the fetlock joint.
Seek veterinary advice if the choke lasts more than
• and
Injurywhile
can occur
tofor
thethe
topvet
end,
mid-body
30 minutes
waiting
remove
all or SL
branches.
food to prevent your horse eating and worsening
the obstruction
• Lameness can be variable.
Following
episode ofexamination
choke it is is
worth
monitoring
• anUltrasound
required
to diagnose
your horse’sand
respiratory
rate
(normal <16 breaths/
monitor an
injury.
min) and rectal temperature for several days.
• Treatment includes rest, shockwave therapy,
Arrange regular
dental
check-ups
your horse
injections
into
the injuredfor
ligament,
controlled
to reduce the
risk of and
choke
as a result
of aimbalance.
painful
exercise
correction
of foot
mouth.
• Prognosis is affected by limb and location as
well as severity.
XLEquine - Better Together
ULTRASOUND IMAGE SHOWING ENLARGEMENT
WITH CORE LESION IN LATERAL BRANCH OF
RIGHT HIND
XLEquine Suspensory Ligament Injury
Fact Sheet
TREATMENT
Choke
Treatment will include a combination of the following
depending upon the site and nature of the injury:
Lameness
L
Platelet Rich Plasma (PRP) - Some
acute tears of the SL can be treated with PRP
therapy.
Blood
is taken from the patient and passed
Choke is a relatively common condition
seen
in horses
Box/small paddock
rest
- at least three
through
a
special
and ponies and is typically caused by obstruction offilter
thebefore being injected under
months is required to allow inflammation to subside,
ultrasound guidance into the tear. Natural growth
oesophagus
(food
pipe)
with food; occasionally
a foreign
repair to start and to reduce
the risk of
further
injury.
factors contained
within the PRP promote tissue
body can be involved e.g. wood or plastic.
Fortunately
repair and
healing.
many cases
of choke
resolve quickly and spontaneously
Controlled exercise
- a gradually
increasing
Surgery
- (forlonger
certain hindlimb suspensory
programme over three and
to nine
months
to strengthen
the obstruction
only
cases
in which the
lasts for
injuries) involves removing the nerve branch
SL and help align fibresthan
during
repair.
30 minutes are likely to require veterinary assistance.
supplying the injured tissue and cutting through
It is important to note that this is not
same as
the
the the
surrounding
constricting
tissues to relieve pain
Foot balance assessment/correction
wherewith
theincreased
term pressure in a restricted
associated
- poor foot balance can life-threatening
increase strain oncondition
the SL andin humans,
space.
“choke” refers to blockage of the windpipe
rather than the
predispose to injury.
oesophagus. This difference means that unlike humans,
Monitoring response to treatment
Egg bar shoes - may
be used
reducecan
fetlock
horses
withtochoke
still breathe.
extension and strain on SL.
Extracorporeal Shockwave Therapy
Shock waves targeted at the injury are thought to
provide pain relief, increased blood flow and directly
affect cells to improve healing. A course involves up to
four treatments at weekly intervals.
ical signs:
culty/repeated attempts at
lowing
Check ups will be scheduled to monitor clinical
signs and healing using physical exams and
ultrasound scans. A graduated exercise program
will be tailored to each individual patient and injury.
PROGNOSIS
For recovery to pre-injury level of use (guidelines only).
Upper SL
Forelimb
Good > 80%
Upper SL
(Proximal)
Hindlimb
Without surgery:
Poor <30%
ching/arching of the neck
With surgery:
Good 75%
ghing
Mid SL
& saliva discharging from the nose
Branch
oling
nterest in food
asionally a lump may be seen or felt
he left side of the neck.
uspect your horse is suffering from
is important to prevent your horse
s this will make the blockage worse
e difficult to clear.
Poor < 25%
1 branch
2 branches
Good > 80%
Guarded 40-60%
REGULAR DENTAL EXAMINATIONS AND
TREATMENT CAN REDUCE THE RISK OF CHOKE
KEY POINTS
• Don’t panic! Choke is rarely life-threatening and
many cases will resolve spontaneously.
Anti-inflammatory
medications
-A
struction doesn’t clear quickly of its
• Seek
veterinary
range of anti-inflammatory medications
may be
used inadvice if the choke lasts more than
ord then veterinary assistance must
the early management of these injuries.30 minutes and while waiting for the vet remove all
ht. There are a number of steps
food to prevent your horse eating and worsening
can take to help to confirm and treat
the obstruction
lem.
further information contact your local XLEquine practice:
• Following an episodeFor
of choke it is worth monitoring
and ponies with dental problems
your horse’s respiratory rate (normal <16 breaths/
vent them grinding their food
min) and rectal temperature for several days.
), individuals that bolt their food too
• Arrange regular dental check-ups for your horse
and those fed XLEquine
dry pelleted
or cubed
is a novel and exciting initiative conceived from within
to reduce the risk of choke as a result of a painful
e all at increased
risk. profession made up of independently owned,
the veterinary
progressive veterinary practices located throughout themouth.
United
Kingdom, members of XLEquine are committed to working
together for the benefit of all their clients.
© XLVet UK Ltd.
No part of this publication may be reproduced without
prior permission of the publisher.
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