SARAH: "Can you do a video on suspensory ligament injuries
please?"
DR LYDIA GRAY: OK so I think-- did
we do bowed tendons last time?
SARAH: I don't know if it was last time,
but we've definitely talked about them.
DR LYDIA GRAY: So they're related,
because they're both soft tissue, connective tissue.
The tendons are the structures that connect muscles to bones.
And the ligaments connect bones to bones.
So they're related.
When we're talking about the suspensory ligament--
easy for me to say--
in particular, we'll talk about the location first.
So it's on the leg between the knee and the ankle
or the hock and the ankles--
so lower limbs of all four legs.
And it's the tissue that butts right up against the cannon
bone.
So if the horse is facing this way.
So it's from the outside you have
your skin, your superficial digital flexor
tendon, your deep digital flexor tendon, and then
the suspensory.
What that means is it's not as easy, especially
on the hindlimb, to image.
So our imaging choices are X-rays,
ultrasound is pretty good.
But not as good as with tendons.
They're looking now at maybe MRI is the best way
to categorize the original injury
and then follow the progression.
And you can now do standing MRIs with just sedation
and not need general anesthesia.
So that's why they're thinking maybe
this imaging tool is now becoming appropriate for this.
I was going to say, I've got good news and bad news.
Well, the good news is that if you catch this early
and get right on it with some modern medical management
treatment, the forelimb suspensories,
they take longer than tendons.
Because last time remember we did the--
SARAH: --the number of letters in the word.
DR LYDIA GRAY: So bone was four, tendon was six,
and ligaments, what, eight?
SARAH: Yep.
DR LYDIA GRAY: So they can take nine months to a year to heal.
But if it's an acute front limb suspensory you've got a chance.
I want to read something.
Acute hindlimb proximal suspensory desmitis
is much worse.
13% were sound and in full work at six months.
And the prognosis for their chronic hindlimb cases
approaches 0%.
Now, don't give up all hope.
But do involve your vet right away.
They're challenging-- the cardinal signs of inflammation
or the signs of this kind of lameness
are heat swelling and pain, except that with the suspensory
being so deep you always don't get that swelling.
So you can't depend on the limb being
big and swollen as like, oh, got to call the vet.
Sometimes the only clinical sign is the horse isn't performing
as well as he used to.
One of the risk factors for a pulled suspensory
is advanced dressage training.
So if you have a horse that does a lengthen
or medium or extended trot, and then they can't or they
don't want to, that should make you think that maybe I
should have the vet out.
So it can be as subtle as that.
And you have to get on it to give your horse the best
chance of recovering from it.
I will say Newman had a pulled suspensory back
when he was five.
SARAH: Wow.
DR LYDIA GRAY: Yeah.
And that was what I saw.
SARAH: That was so long ago.
DR LYDIA GRAY: Yeah.
And he's 17 now.
And he has not only returned to full work the same level,
but went up.
So I got right on it and managed it appropriately
and did everything my vet said.
And he's back to working.
So there is hope.
And it was his front limb so I had a better chance.
The hindlimbs are-- boy, they're tough.
They're really tough.
I hope this person does not have one on their horse.
SARAH: Yeah.
I mean it was just a request for a video.
So we don't know.
DR LYDIA GRAY: True, true.
We don't know.
SARAH: So hopefully we addressed all the questions
that you have.