Equis ISSN 2398-2977
Suspensory ligament: desmitis - proximal
Synonym(s): PSD, high suspensory disease
Contributor(s): Ron Genovese, Graham Munroe, Vetstream Ltd
Introduction
- Cause: repetitive strain or single overloading injury, and/or body = most important cause of lameness in the metatarsal region; a common compensatory injury.
- Signs: generally acute onset lameness in the forelimb but usually a chronic progressive problem in the hindlimb Musculoskeletal: gait evaluation , often no heat or swelling Musculoskeletal: physical examination - adult , unilateral > bilateral forelimbs, but bilateral cases more common in the hindlimbs.
- Diagnosis: regional anesthesia Forelimb: perineural analgesia , ultrasonography Ultrasonography: musculoskeletal , radiography Forelimb: radiography Hindlimb: radiography , scintigraphy Bone: scintigraphy .
- Treatment: strict box rest, anti-inflammatories Therapeutics: anti-inflammatory drugs +/- physiotherapy, controlled exercise for minimum 3 months, intra- or periligamentous injections of various therapeutic agents, various surgical techniques.
- Prognosis: potentially much more serious a condition in the hindlimb than the forelimb; guarded for forelimb and hindlimb acute PSD, poor for chronic hindlimb PSD.
- See also:
Pathogenesis
Pathophysiology
- Probably result of cyclical fatigue and repair processes.
- Ligament strain +/- avulsion fracture of third metacarpal/metatarsal bone MC / MT 3: fracture .
- Chronicity → hyperextension of the metatarsophalangeal joint (dropped fetlocks)
.
- Persistent lameness in hindlimbs may be caused by a compartment-like syndrome and pressure on the adjacent plantar metatarsal nerves.
- See SDFT: tendinitis SDFT: tendinitis .
Diagnosis
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Treatment
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Miller K D & Juzwiak J S (2010) Bilateral degenerative suspensory desmitis with acute rupture in a Standardbred colt. Equine Vet Educ 22 (6), 267-270 VetMedResource.
- Dyson S (2009) Bilateral hindlimb proximal suspensory desmitis as a cause of poor performance in the horse. UK Vet 14 (8), 5-10 VetMedResource.
- Schnabel L V, Mohammed H O, Jacobson M S & Fortier L A (2008) Effects of platelet rich plasma and acellular bone marrow on gene expression patterns and DNA content of equine suspensory ligament explant cultures. Equine Vet J 40 (3), 260-265 PubMed.
- Hewes C A & White N A (2006) Outcome of desmoplasty and fasciotomy for desmitis involving the origin of the suspensory ligament in horses: 27 cases (1995-2004). JAVMA 229 (3), 407-412 PubMed.
- Smith J J, Ross M W & Smith R K (2006) Anabolic effects of acellular bone marrow, platelet rich plasma, and serum on equine suspensory ligament fibroblasts in vitro. Vet Comp Orthop Traumatol 19 (1), 43-47 PubMed.
- Crowe O M, Dyson S J, Wright I M, Schramme M C & Smith R K (2004) Treatment of chronic or recurrent proximal suspensory desmitis using radial pressure wave therapy in the horse. Equine Vet J 36 (4), 313-316 PubMed.
- Kasashima Y et al (2004) Prevalence of superficial digital flexor tendonitis and suspensory desmitis in Japanese Thoroughbred flat racehorses in 1999. Equine Vet J 36 (4), 346-350 PubMed.
- Gibson K T & Steel C M (2002) Conditions of the suspensory ligament causing lameness in horses. Equine Vet Educ 14 (1), 39-50 VetMedResource.
- Dyson S J et al (1995) Suspensory ligament desmitis. Vet Clin North Am Equine Pract 11 (2), 177-215 (Review) PubMed.
- Dyson S J (1994) Proximal suspensory desmitis in the hindlimb - 42 cases. Br Vet J 150 (3), 279-291 PubMed.
- Dyson S J (1991) Proximal suspensory desmitis: clinical, ultrasonographic and radiographic features. Equine Vet J 23 (1), 25-31 PubMed.