Bilateral Suspensory Desmitis by Roger Meacock MRCVS

Bilateral Suspensory Desmitis by Roger Meacock MRCVS Overview Bilateral Suspensory Desmitis has been increasingly diagnosed as a cause of hind limb lameness.  It is usually diagnosed based on gait analysis, perineural analgesia (local nerve block) of the deep branch of the lateral plantar nerve, and ultrasound of the proximal suspensory ligaments. The conventional recommended treatment options offer conservative treatment with a "large proportion of horses" having persistent or recurrent lameness, shock wave therapy with approximately 40% of horses returning to full athletic function or surgical treatment by neurectomy (cut the nerve) of the deep branch of the lateral plantar nerve and plantar fasciotomy (cut the soft tissue around the ligament to free it up) with approximately 70% of horses supposedly being able to return to full athletic function. I find it interesting that the non-intervention option that obviously doesn't generate much income compared to treatment is only very vaguely stated as not very successful.  No actual success figure is quoted to enable owners to make a fully informed decision as to how much better shock wave therapy or surgery may or may not be.

I (and others) believe that in the vast majority of cases, proximal suspensory desmitis is not a condition in itself but is symptomatic of one or more other problem(s) that alter the gait and result in inflammation of the proximal suspensory ligaments. From the ultrasound pictures there can be no doubt that there is indeed inflammation present. However the fact that approximately 30% of horses having had the neurectomy (so that they can no longer feel the inflamed suspensory ligaments) still remain lame suggests that not only is the seat of lameness elsewhere, but that the perineural nerve block resulted in a false positive return to soundness during the lameness case work-up.

I have been approached by a number of clients who decided to find another approach to the problem rather than go down the shock wave or surgical routes.  Invariably a primary cause of the secondary high suspensory desmitis has been found and successfully treated.  This successful treatment by myself and others either together as a team or separately by focusing treatment outside the immediate suspensory ligament area would seem to vindicate our position that bilateral proximal sensory desmitis is a secondary condition indicative of other problems.
 
But what of those horses who have gone sound and returned to full athletic performance having undergone surgery?  Well of course not all problems that alter gait are painful once the body compensates for that problem.  In fact the figures suggest that 70% of causes that feed into bilateral suspensory desmitis are not necessarily painful in themselves once the gait has altered.  However, the neurectomy and fasciotomy do not remove the underlying cause which will frequently manifest elsewhere over time and will inevitably lead to an exacerbation of the strain on the proximal suspensory ligaments that the horse can no longer feel.  I have heard it said that there is a very poor prognosis for a subsequent lameness in a horse that has had a neurectomy in the past.
 
It is not the role of a veterinary surgeon to perform a surgical procedure that falsely allows an individual horse to perform at a level that it cannot naturally sustain.  Neurectomies should only ever be performed as a salvage procedure to enable quality of life in a retirement situation when all other avenues have been exhausted.
 
If a significant number of top performance horses are having this problem it either means that

1. the individual horse is incapable of working at that level, or
2. the training/management of that horse is inappropriate or
3. we are asking too much of horses generally to expect them to perform at that level in which case vets should be highlighting this issue so that the FEI can alter tests and standards accordingly to find a different way of separating the stars from the also rans.

If you have a horse that has been diagnosed with this condition I would recommend a more conservative approach to ascertain the reason behind why the suspensory ligaments are inflamed.  By treating/correcting any other issue(s) that are treatable you will have a horse that is sound and far less likely to go lame in the future.  You will also be able to compete at FEI level if you so wish with a clear conscience.  If the reason for the bilateral suspensory desmitis is conformational and/or untreatable it is better to find this out before you breed from them or push the horse harder in work which will inevitably create further health issues that could at worst have repercussions on the rider.

About Roger Meacock Roger Meacock MRCVS is a fully qualified veterinary surgeon who now specialises in treating animals and people throughout the UK using cutting edge medical technology such as the Scenar, e-Lybra 9, orgone energy products, herbs and oxygen therapy amongst other things.

He specialises in taking on cases where more conventional options are offering little hope, are inappropriate or not desired and to speed up the healing process. Most of Roger's work is with horses. He works at the top levels with horses that are competing internationally including the recent Beijing Olympics and with family nags! Roger's techniques can be used to maintain health and optimise performance and even help anti-ageing as much as they can be used for treatment. If you are unsure about how Roger might be able to help with your horse, dog, cat or human health issue  please visit:
Natural Healing Solutions

Reproduced with kind permission of Roger Meacock MRCVS
© Copyright  Roger Meacock  - Natural Healing Solutions

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Added on: 23/12/08.

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