Prognosis is dependent on severity and location of injury. It is best for mild cases of branch desmitis and fair to good for mild-moderate body desmitis with prompt and appropriate treatment. Prognosis is guarded for severe injuries, those with avulsion fractures or those who return too quickly to work. There is a risk for reinjury due to scar tissue development. Prevention of suspensory desmitis include regular shoeing/trimming, use of exercise bandages, appropriate training & conditioning of the horse, working in appropriate footing and close observation of a horses’ legs before & after work. Distal Sesamoidean Ligament Desmitis The 3 distal sesamoidean ligaments run between the proximal sesamoids and the back of the phalanges and form part of the suspensory apparatus that supports the fetlock. These ligaments include the: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Repeated hyperextension of the fetlock from strenuous exercise can cause a sprain of 1 or all of the DSLs as the wear and tear compromises the ability of the DSLs to withstand the pressure. Disease, such as , or fracture of the sesamoid bones can also cause sprains of the DSLs as fracture can weaken the integrity of the ligaments. Horses that are predisposed to DSL desmitis such as 3-day eventers and steeplechasers. Other factors described above in suspensory desmitis will all predispose for DSL sprain. Acute signs and symptoms include sudden onset of moderate lameness, possible swelling along the palmar/planter aspect of the fetlock & pastern and pain on palpation. Avulsion fracture of the PSBs is possible. Chronically, we see thickening of the ligaments and enthysiophyte formation.
Diagnosis is through signs and symptoms, ultrasound, MRI, CT scan and x-ray to rule of fracture of the PSBs and to look for bony changes.
Treatment is similar to that of suspensory desmitis. This includes minimum 6 weeks stall rest, cold hydrotherapy, NSAIDs and support bandages. may be necessary if the desmitis is severe. Once the horse is able to return to work, they should be put on a CEP to decrease the risk of re-injury. Surgery is not usually recommended. Prognosis for mild injuries with appropriate treatment is good for athletic return. Moderate to severe or horses that return too soon, prognosis is fair too good, and lameness may persist. Horses that rupture the suspensory apparatus (DSLs, suspensory ligament and branches and fracture proximal sesamoids) are 3-legged lame and their prognosis is often grave and euthanasia is recommended.
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