Page 353 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

328 CHAPTER 1

VetBooks.ir be increased if the ligament CSA and lesion size have oedema may extend proximally and distally in acute
cases. Biaxial lesions are more common in the fore-
decreased or remained stable, or if the echogenicity
of the lesion has increased and the fibre alignment
has improved. limb and lateral lesions in the hindlimb. However,
in the acute stage there may be diffuse oedema and
Healing seems to be faster than for the SDFT distension of the fetlock and digital sheath synovial
and most horses can resume work after 4 months, pouches, making diagnosis somewhat confusing.
although this is variable and individually adaptable. Severe, chronic branch injuries are extremely com-
A typical controlled exercise programme involves mon in Standardbreds and may affect either or both
4–8 weeks of rest with in-hand exercise, followed by branches in several limbs.
slowly increasing amounts of jogging depending on
ultrasonographic evaluation. Differential diagnosis
Longitudinal tenotomy (‘splitting’) is not usu- Lesions within the other ligaments and tendons
ally recommended. Cautery and blistering are in that region; other causes of inflammation in the
often used, but there is no evidence of any benefit. metacarpal or metatarsal area; synovitis of the fet-
Biological treatments are commonly used and there lock joint or digital sheath; fractures and sesamoid-
are circumstantial claims that they significantly itis of the proximal sesamoid bones (PSBs). Chronic
improve the outcome. Intralesional PRP was found entheseopathy of the SL insertions on the PSB may
to be effective in a small number of Standardbred or may not be a related condition.
racehorses in one study, although this was not evi-
dence based. When SL body injuries are associated Diagnosis
with splints, local corticosteroid injection coupled Clinical examination
with rest and physiotherapy may be useful early on. There may be painful and positive fetlock flexion.
In chronic cases, fibrous adhesions may be dif- Observation of local swelling and palpation often
ficult to deal with and chronic interference may provide a strong suspicion (Fig. 1.637). Diagnostic
aggravate the ligament lesion. In these cases, surgi- analgesia is rarely necessary. Concurrent injuries of
cal treatment (adhesiolysis [resection of the adhe- overextension may involve sesamoid fractures, distal
sions] and/or segmental amputation of the affected sesamoid ligament injuries, fetlock joint disease or
bone) may be recommended. digital sheath inflammation. In severe bilateral cases

Prognosis
The lesions often persist despite clinical improve- 1.637
ment and there is often severe intra- and periliga-
mentous fibrosis. Recurrence is extremely common.
SL body injury associated with splints carry a good
prognosis if small; poorer if extensive or recurrent.
Fig. 1.637 Swelling
SUSPENSORY BRANCH DESMOPATHY over the medial aspect
(right-hand side) of
Clinical presentation the distal metacarpus
This is probably the most common injury of the providing a strong
suspensory ligament, especially in non-racehorses. suspicion of a medial
It affects all types of horses from sports to pleasure suspensory ligament
riding animals. Lameness is variable and depends branch injury (arrow).
on the severity of the lesion(s), and is worse if the Ultrasonography is
lesion affects both branches and in acute cases. Local paramount to confirm
signs are usually obvious, with marked thickening the diagnosis and
+/– palpable pain of the affected branch(es). Marked establish a prognosis.