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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. - Better Together www.xlequine.co.uk XLVets XLEquine Equine - Better - Better Together. Together. GoGo to www.xlequine.co.uk to www.xlvets.co.uk XLVets Equine - Better Together. Go to www.xlvets.co.uk