Page 358 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.8 Soft-tissue injuries 333

VetBooks.ir 1.652 1.653

Figs. 1.652, 1.653 Transverse (1.652) and longitudinal (1.653) sonograms of the medial SL branch insertion
in a French trotter with non-painful thickening around the proximal sesamoid bones. A diffuse heterogeneous
lesion is noted over the abaxial portion of the SL at its insertion (yellow arrows). Periligamentous thickening
extends over the abaxial aspect of the bone (red arrows). This lesion affected both lateral and medial branches
in both forelimbs.

racehorses. Extracorporeal shock-wave therapy has COMPLETE BREAKDOWN OF
been used for entheseopathy or sesamoiditis with THE SUSPENSORY LIGAMENT
equivocal results.
Avulsed fragments are dealt with as for desmitis, Clinical presentation
although some authors recommend surgical removal. Complete rupture of the SL is extremely rare.
This may, however, be very invasive and cause marked Breakdown injury of the suspensory apparatus is
damage to the ligament. Splitting and/or injec- most commonly encountered in Thoroughbred
tion of PRP or stem cells may be advocated in these racehorses, particularly those racing over fences.
cases. Distal splint bone fractures may be treated The injury most often involves fracture of both
conservatively with rest and pressure bandages for PSBs and/or breakdown of the distal ligaments
4–6 weeks; most minimally displaced fractures heal of the PSBs. The typical presentation is acute,
satisfactorily. The prognosis is more dependent on the sudden-onset lameness with decreased weight bear-
extent of the associated desmopathy. Surgical removal ing, marked dropping of the fetlock and diffuse
may be advocated if adhesions are identified, if the oedema. Progressive breakdown of the hindlimb SL
fracture is significantly displaced or if desmitis of the is occasionally encountered either as a complication
branch persist or recurs, although the surgery may of chronic proximal SL desmopathy or in old brood-
not always improve the outcome in these cases. mares, presumably as a result of ligament degenera-
tion. This can vary from progressive hyperextension
Prognosis of the fetlock, usually with a straight hock confor-
Prognosis is related to the severity of the SL branch mation, to complete breakdown.
lesion. It is usually fair if one branch is involved,
poor if both branches are involved. Sesamoiditis Diagnosis
does not appear to affect the prognosis, while intra- Radiography
ligamentous mineralisation has been associated with Radiographic examination of the fetlock should
a poorer outcome. Reinjury is very common and fur- always be performed and ideally include radiographs
ther worsens the prognosis. of the digit and metacarpus or metatarsus, up to and