Suspensory Desmitis Suspensory desmitis is defined as a sprain of the suspensory ligament and or the branches. Suspensory desmitis is commonly called “dropped fetlock” or “dropped suspensory”.
Suspensory desmitis can be caused by acute trauma or chronic overuse leading to hyperextension of the joint during strenuous activity.
When the fetlock joint hyperextends this causes overstretching of the suspensory ligament which causes a disruption of the suspensory fibres leading to haemorrhage and inflammation.
It is more common for horses to injury the suspensory branches of the forelimb but suspensory desmitis is commonly seen in the forelimb of Thoroughbred racehorses, the hind limb of Standardbred racehorses and . Imbalanced hoofs, toe grabs and caulks, deep or slippery footing, tight turns, steep slopes and work at speed also predispose horses of any breed to suspensory desmitis. Fatigue of the flexor muscles can predispose to suspensory damage as this overloads the other supporting structures of the fetlock. Suspensory desmitis is named depending on the location of the lesion in the suspensory ligament. If the injury is in the proximal third of the cannon it is called a proximal suspensory desmitis or Suspensory origin desmitis, if the lesion is located in the middle third of the cannon it is called a desmitis of the body of the suspensory and if the injury is located distal to the fetlock it is considered a desmitis of the extensor branches. with work, pain and heat on palpation of the suspensory ligament and pain on both passive and active stretch of the suspensory. Swelling of the palmar/plantar aspect of the cannon/fetlock can vary and is often hidden due to the surrounding structures. fracture of the proximo-caudal Clinically suspensory desmitis is seen as lameness that cannon or proximal sesamoids can occur, or a splint bone fracture may also occur. Hyperextension and approximation of the fetlock to the ground is seen if the suspensory ligament as well as the deep & superficial digital flexor tendons are damaged. If the tear is in the extensor branches of the suspensory, the branches thicken, and the lesion may be palpable. Chronic suspensory desmitis may result in of the PSB. Diagnosis of suspensory desmitis is made through clinical signs and symptoms as well as a positive fetlock flexion test, nerve blocks, ultrasonography, MRI, nuclear scintigraphy and x-rays. Avulsion & splint bone fractures must be ruled out as well as distal sesamoidean ligament desmitis before a definitive diagnosis can be made. Treatment of suspensory desmitis will be similar to that of a bowed tendon. It involves rest, hand- walking, NSAIDs, support bandages, laser, ultrasound, shockwave, cryotherapy, IRAP, PRP, stem cell therapy, massage therapy, hydrotherapy, corrective trimming & shoeing and a CEP to return to work. Surgery is indicated in severe cases or where avulsion fractures has occurred. Some vets may prescribe turn-out for prior to resuming training after acute inflammation has subsided.
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