The suspensory ligament in horses is a critical component of the equine musculoskeletal system, primarily responsible for supporting the fetlock joint and absorbing shock during movement. This ligament extends from the back of the knee or hock down to the sesamoid bones and continues into the pastern. Injuries to the suspensory ligament, such as strains or tears, are common in performance horses and can significantly affect their mobility and performance. Diagnosis typically involves clinical examination, ultrasonography, or MRI to assess the extent of the injury. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, function, injury mechanisms, and treatment options related to the suspensory ligament in horses.
Dyson SJ, Weekes JS, Murray RC.The aim of the study was to characterize radiopharmaceutical uptake patterns in horses with clinical and ultrasonographic evidence of proximal suspensory desmitis. It was hypothesized that radiopharmaceutical uptake in the proximal palmar (plantar) aspect of the third metacarpal (metatarsal) bone would be greater in lame limbs of horses with proximal suspensory desmitis than in sound limbs and that there would be a positive correlation between the severity of ultrasonographic abnormalities and the degree of radiopharmaceutical uptake. Nuclear scintigraphic evaluation of the proximal metacarpal...
Singer ER, Barnes J, Saxby F, Murray JK.Two related studies on injuries sustained by event horses during competition and during training are reported. During the cross-country phase of competition, the most common injuries were lacerations and abrasions to the carpus and stifle. Superficial digital flexor tendonitis and exertional rhabdomyolysis were significantly more common during Cours Complete Internationale (CCI) competitions compared to one-day event (ODE) competitions. The difference in injury types at ODEs and CCI competitions probably relates to the increased athletic demands of the CCI and the closer veterinary observation...
Bischofberger AS, Konar M, Ohlerth S, Geyer H, Lang J, Ueltschi G, Lischer CJ.The diagnosis of lameness caused by proximal metacarpal and metatarsal pain can be challenging. Magnetic resonance imaging (MRI) offers the possibility for further diagnosis but there have been no studies on the normal MRI appearance of the origin of the suspensory ligament (OSL) in conjunction with ultrasonography and histology. Objective: To describe the MRI appearance of the OSL in fore- and hindlimbs of sound horses and compare it to the ultrasonographic and histological appearance. The findings can be used as reference values to recognise pathology in the OSL. Methods: The OSL in the fore...
Lischer CJ, Ringer SK, Schnewlin M, Imboden I, Fürst A, Stöckli M, Auer J.The objective of the present clinical report was to investigate the short- and long-term outcomes of chronic proximal suspensory desmitis (PSD) treated with Extracorporeal Shockwave Treatment (ESWT). Fifty-two horses with chronic PSD in the forelimb (34 cases) or hindlimb (22 cases) were included in the study. Three horses had lesions in both hindlimbs and one in both forelimbs. The origin of the suspensory ligament was treated every three weeks for a total of three treatments using 2000 impulses applied by a focused ESWT device (Equitron) at an energy flux density of 0.15 mJ/ mm2. This treatm...
Schnabel LV, Bramlage LR, Mohammed HO, Embertson RM, Ruggles AJ, Hopper SA.Studies have shown that surgical removal of apical fracture fragments in Standardbred racehorses carries the best prognosis for return to racing performance, but there are no reports involving mature Thoroughbred (TB) racehorses. Objective: To describe the incidence of apical proximal sesamoid fractures in TB racehorses and determine probability and quality of racing performance after arthroscopic removal of such fractures in TB racehorses age > or = 2 years. Methods: Medical records and pre- and post operative race records of TB racehorses age > or = 2 years that underwent arthroscopic surger...
Hewes CA, White NA.To determine outcome of percutaneous ultrasound-guided desmoplasty with simultaneous fasciotomy for proximal suspensory desmitis (ie, desmitis of the origin of the suspensory ligament) in horses that have not responded to stall rest. Methods: Retrospective case series. Methods: 27 horses. Methods: Medical records of horses with proximal suspensory desmitis treated by means of desmoplasty with fasciotomy were reviewed. Follow-up information was obtained through telephone conversations with owners and trainers of the horses or by examination of horses at the hospital. Results: 23 of the 27 (85%)...
Halper J, Kim B, Khan A, Yoon JH, Mueller PO.Degenerative suspensory ligament desmitis (DSLD) is a debilitating disorder thought to be limited to suspensory ligaments of Peruvian Pasos, Peruvian Paso crosses, Arabians, American Saddlebreds, American Quarter Horses, Thoroughbreds, and some European breeds. It frequently leads to persistent, incurable lameness and need to euthanize affected horses. The pathogenesis remains unclear, though the disease appears to run in families. Treatment and prevention are empirical and supportive, and not effective in halting the progression of the disease. Presently, the presumptive diagnosis of DSLD is ...
Smith JJ, Ross MW, Smith RK.The purpose of this study was to investigate the response of suspensory ligament fibroblasts (SLF) to in vitro stimulation using acellular bone marrow (ABM), platelet rich plasma (in vitro PRP), and serum as potential treatment modalities for suspensory desmitis. Blood, bone marrow, and suspensory ligaments were collected from five horses. SLF were harvested, grown until confluent, and stimulated with various concentrations of ABM, PRP, equine serum, foetal bovine serum, and medium (control). The responses to the treatments were assessed using a combination of radio-labeling for total protein ...
Bischofberger AS, Ringer SK, Geyer H, Imboden I, Ueltschi G, Lischer CJ.To determine via histologic examination and scintigraphy the effect of focused extracorporeal shock wave therapy (ESWT) on normal bone and the bone-ligament interface in horses. Methods: 6 horses without lameness. Methods: Origins of the suspensory ligament at the metacarpus (35-mm probe depth) and fourth metatarsal bone (5-mm probe depth) were treated twice (days 0 and 16) with 2,000 shocks (energy flux density, 0.15 mJ/mm2). One forelimb and 1 hind limb were randomly treated, and the contralateral limbs served as nontreated controls. Bone scans were performed on days -1 (before ESWT), 3, 16,...
Lischer ChJ, Bischofberger AS, Fürst A, Lang J, Ueltschi G.Lameness in horses due to pain originating from the proximal metacarpal/metatarsal region remains a diagnostic challenge. In cases of obvious lameness the pain can be localised to this region by diagnostic anaesthesia. Because a variety of disorders can cause lameness in this region different imaging modalities including radiography, ultrasonography and scintigraphy should be used to arrive at an accurate diagnosis. Even though a precise anatomic-pathologic diagnosis can still be an enigma, because not only bone and joints, but also soft tissue structures including the proximal suspensory liga...
Minshall GJ, Wright IM.Clinical association between the branches of insertion of the suspensory ligament (SL) and metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints has been reported. However, there has been no assessment of the lengths of the SL branches which are subsynovial with respect to the joints or reports of involvement of the MCP/MTP joints in injuries of the SL branches. Objective: To establish proportions of SL branches subsynovial with respect to the MCP/MTP joints and report clinical and arthroscopic findings in horses with desmitis of SL branches identified as having an articular component...
Ringer SK, Lischer CJ, Ueltschi G.To monitor the effect of focused extra-corporeal shock wave therapy (ESWT) on bone and bone-tendon junction of horses without lameness by use of nuclear scintigraphy and thermography. Methods: 6 warmblood horses without lameness. Methods: The origin of the suspensory ligament at the metacarpus (OSL-MC) and the fourth metatarsal bone were treated at 2 time points (days 0 and 16) with 2,000 shocks applied by a focused ESWT device at an energy flux density of 0.15 mJ/mm2. One forelimb and 1 hind limb were treated, and the contralateral limbs served as controls. To document the effect of focused E...
Perkins NR, Reid SW, Morris RS.To investigate risk factors for injury to the superficial digital flexor tendon (SDFT) and suspensory apparatus (SA) of the forelimbs in Thoroughbred racehorses in New Zealand. Methods: Poisson and negative binomial regression, with exposure time represented by cumulative training days for each horse, were used to relate explanatory variables to the incidence rate (IR) of cases of inflammation of the SDFT (n=51), and injuries involving the SA (n=48) in a population of 1,571 commercially- trained racehorses over 554,745 study days. Only the first occurrence of an injury for any one horse was el...
Caminoto EH, Alves AL, Amorim RL, Thomassian A, Hussni CA, Nicoletti JL.To evaluate the effects of extracorporeal shock wave therapy (ESWT) on affected ligaments in the hind limbs of horses with experimentally induced suspensory ligament desmitis by use of ultrasonographic, ultrastructural, and immunocytochemical techniques. Methods: 10 horses. Methods: Suspensory ligament desmitis was induced in both hind limbs of each horse by use of 2 collagenase injections (administered 2 weeks apart) in each suspensory ligament. Two weeks after the second injection, the right hind limb of each horse was treated with ESWT (3 treatments at 3-week intervals); the left hind limb ...
Firth EC, Rogers CW, Anderson BH.To determine the weight, volume, density and cross-sectional area (CSA) of the digital flexor tendons, common digital extensor tendon (CDET) and suspensory ligament (SL) of the forelimb of young Thoroughbred horses in early training, and to assess the response to a training programme of known parameters of superficial digital flexor tendon (SDFT) tissue at mid-metacarpal level. Methods: The tendons of seven 2-year-old Thoroughbred horses in training were inspected, transected into segments of known length, and compared with those from seven untrained horses matched for age, sex and breed. The ...
Kicker CJ, Peham C, Girtler D, Licka T.Support boots are thought to reduce tension on the superficial digital flexor tendon (SDTF) of the horse and are frequently recommended for horses convalescing after tendonitis, but evidence of their effectiveness is conflicting. Objective: To document the effects of 4 different types of support boots on fetlock joint angle in comparison to the unprotected fetlock. Methods: In 26 horses, the kinematics of the forelimb fetlock joint angle was measured at walk and trot on a treadmill when wearing 3 different types of support boots and 1 protective boot, as well as without boots. As outcome param...
Hill AE, Gardner IA, Carpenter TE, Stover SM.To assess concurrently the effects of moderate ligamentous suspensory apparatus injury (MLSAI), racing-speed exercise, and horseshoe characteristics on risk of catastrophic suspensory apparatus failure (SAF) or metacarpal condylar fracture (CDY) in forelimbs of racehorses. Methods: Cadavers of 301 Thoroughbred racehorses (108 with SAF, 33 with CDY and 160 control horses). Methods: A cross-sectional epidemiologic study was used to describe distributions and relationships between MLSAI, exercise, and horseshoe variables. Logistic regression was used to assess potential risk factors for developin...
Zubrod CJ, Schneider RK, Tucker RL.Four horses were examined because of chronic forelimb lameness. In all horses, the cause of the lameness was localized to the metacarpus by means of physical examination and diagnostic anesthesia, and radiography of the affected limb revealed a small exostosis of the second metacarpal bone. Magnetic resonance imaging revealed suspensory desmitis in the region of this exostosis in all 4 horses. In addition, an abnormal area of low signal intensity, suggestive of an adhesion, was seen between the exostosis and the suspensory ligament. In all horses, an adhesion between the suspensory ligament an...
Crowe OM, Dyson SJ, Wright IM, Schramme MC, Smith RK.Proximal suspensory desmitis (PSD) is diagnosed with increasing frequency in horses and radial pressure wave therapy (RPWT) is a widely used therapy for painful orthopaedic conditions in man and dogs. There are, however, few published data as to the outcome of its use in PSD. Objective: To evaluate the use of RPWT in the treatment of chronic or recurrent PSD in the horse, an injury which carries a poor prognosis for return to athletic function with conservative management alone. Objective: RPWT and controlled exercise improves the prognosis of chronic or recurrent PSD in the horse when compare...
Kasashima Y, Takahashi T, Smith RK, Goodship AE, Kuwano A, Ueno T, Hirano S.Overstrain injuries to the superficial digital flexor tendon (SDFT) and suspensory ligament (SI) are among the most common musculoskeletal injuries which contribute to the considerable wastage of racing Thoroughbreds. Many epidemiological studies have demonstrated the prevalence of and risk factors for tendon injury when racing but have not included those injuries sustained during training. However, since tendon injury during training is seen commonly in clinical practice, it is appropriate to determine the overall prevalence of tendon injury sustained during both training and racing. Objectiv...
McClure SR, VanSickle D, Evans R, Reinertson EL, Moran L.Extracorporeal shock-wave therapy (ESWT) may stimulate healing of desmitis in multiple species. The objective of this study was to evaluate the ultrasonographic and histologic appearance of collagenase-induced suspensory ligament (SUL) desmitis in untreated ligaments and ligaments treated with ESWT in horses. Four mature horses had SUL desmitis induced in both forelimbs. Beginning 3 weeks after induction of the lesions, one ligament per horse was treated 3 times at 3-week intervals with ESWT. The percent lesion, echogenicity and fiber alignment scores of the SULs were evaluated at 3-week inter...
Le Jeune SS, Macdonald MH, Stover SM, Taylor KT, Gerdes M.Objective-To determine whether partial transection of the medial branch of the suspensory ligament (MBSL) alters equine third metacarpal bone (MC3) condylar surface strains and forelimb, distal joint angles in a manner consistent with promotion of lateral condylar fracture. Study Design-In vitro biomechanical experiment. Sample Population-Right forelimbs from 7 Thoroughbred horse cadavers. Methods-Lateral and medial MC3 condylar, dorsal and abaxial, bone surface strains and distal joint angles were measured both before and after partial transection of the MBSL during in vitro axial limb compre...
Brown NA, Pandy MG, Kawcak CE, McIlwraith CW.A detailed musculoskeletal model of the distal equine forelimb was developed to study the influence of musculoskeletal geometry (i.e. muscle paths) and muscle physiology (i.e. force-length properties) on the force- and moment-generating capacities of muscles crossing the carpal and metacarpophalangeal joints. The distal forelimb skeleton was represented as a five degree-of-freedom kinematic linkage comprised of eight bones (humerus, radius and ulna combined, proximal carpus, distal carpus, metacarpus, proximal phalanx, intermediate phalanx and distal phalanx) and seven joints (elbow, radiocarp...
Hill AE, Carpenter TE, Gardner IA, Stover SM.To evaluate a Markov-chain model for the development of forelimb injuries in Thoroughbreds and to use the model to determine effects of reducing sprint distance on incidence of metacarpal condylar fracture (CDY) and severe suspensory apparatus injury (SSAI). Methods: Weekly exercise and injury data for 122 Thoroughbreds during racing or training. Methods: Weekly data were used to construct a Markov-chain model with 5 states (uninjured [UNINJ], palpable suspensory apparatus injury [PSAII, SSAI, CDY, and lost to follow-up [LOST]). Transition probabilities between UNINJ and PSAI were estimated as...
Zekas LJ, Forrest LJ.The purpose of this study was to describe ultrasonographic changes of the equine palmar metacarpal area attributed to the infiltration of local anesthetic solution and to determine whether these changes were noted immediately or at 24 h. The palmar metacarpal region of one forelimb in each of six horses was examined ultrasonographically with a 10-MHz linear array transducer and a 7.5-MHz curvilinear transducer. Transverse and longitudinal images were recorded at 5-cm intervals distal to the accessory carpal bone. High and low palmar and palmar metacarpal nerve blocks were performed with a 2% m...
Tnibar MA.To describe a surgical technique for splitting the proximal third of the medial patellar ligament (MPL) in horses and ponies with upward fixation of the patella (UFP), and to report outcome. Methods: Prospective clinical study. Methods: Four horses and 3 Shetland ponies. Methods: With ultrasound guidance, the proximal third of the MPL was split by percutaneous use of a no. 15 scalpel blade. The rationale for this surgical procedure was to induce a localized desmitis with subsequent ligament thickening. No anti-inflammatory drugs were administered, and horses and ponies were exercised the day a...
Meershoek LS, Lanovaz JL, Schamhardt HC, Clayton HM.To calculate forces in the flexor tendons and the influence of heel wedges in affected and contralateral (compensating) forelimbs of horses with experimentally induced unilateral tendinitis of the superficial digital flexor (SDF) tendon. Methods: 5 Warmblood horses. Procedure-Ground reaction force and kinematic data were obtained during a previous study while horses were trotting before and after induction of tendinitis in 1 forelimb SDF and after application of 6 degrees heel wedges to both forehooves. Forces in the SDF, deep digital flexor (DDF), and the suspensory ligament (SL) and strain i...
Alexander GR, Gibson KT, Day RE, Robertson ID.To measure the effects of transection of the accessory ligament of the superficial digital flexor (SDF) muscle (superior check desmotomy) on flexor tendon and suspensory ligament (SL) strain in vitro. Methods: In vitro experimental biomechanical investigation. ANIMALS USED: Ten equine cadaver forelimbs. Methods: The effects of superior check desmotomy were determined using equine cadaver forelimbs secured in a servocontrolled hydraulic testing machine. Strain sensors were used to measure strain on the superficial and deep digital flexor tendons and SL, and a goniometer was used to measure join...
Meershoek LS, van den Bogert AJ, Schamhardt HC.To describe a method to calculate flexor tendon forces on the basis of inverse dynamic analysis and an in vitro model of the equine forelimb and to quantify parameters for the model. Methods: 38 forelimbs of 23 horses that each had an estimated body mass of > or = 500 kg. Methods: Longitudinal limb sections were used to determine the lines of action of the tendons. Additionally, limb and tendon loading experiments were performed to determine mechanical properties of the flexor tendons. Results: The study quantified the parameters for a pulley model to describe the lines of action. Furthermo...
Meershoek LS, Lanovaz JL.To test the sensitivity to measurement and modeling errors of a method for noninvasive calculation of flexor tendon forces in the equine forelimb and to calculate tendon forces for Dutch Warmblood horses during trotting. Methods: A normative set of kinematic and ground-reaction force (GRF) data obtained from horses during trotting in another study. Methods: Forces in the flexor tendons were calculated from the data set before and after addition of fixed relative and absolute errors. Amount of error was based on normal accuracy of the variables. A similar analysis was performed for a measure of...
Lyons ET, Tolliver SC, Drudge JH, Swerczek TW, Crowe MW.Examination of the ligamentum nuchae for Onchocerca spp was completed in 523 Thoroughbreds (1 to 29 years old) at necropsy in Kentucky during a 13-month period (1984 to 1985). Onchocerca spp were found in 306 (59%) of the horses. Frequencies of this parasite were 3%, 17%, 40%, 43%, and 42% in 1-, 2-, 3-, 4-, and 5-year-old horses, respectively. For 6- to 29-year-old horses, frequency varied from 71% to 100%, except for 26-year-old horses (50%); 87% of the 304 horses examined in the 6- to 29-year-old age groups was infected. The suspensory ligaments and flexor tendons from fetlocks (thoracic li...
Grabner A, Kraft W, Essich G, Hänichen T.Cases of enzootic calcinosis in breeding mares in a Southwest German highland area are reported. The symptoms increased in the latter part of summer and existed in disturbances of movement, moderate kyphosis, sensitivity to palpation in the flexor tendons and, especially, the suspensory ligament, weight loss in spite of good food intake during summer-time and painful costal percussion; less clinical signs of renal and cardiac disorders were established. The sickness was caused by a high percentage of Trisetum flavescens in the feeding plants.
Williams J, Miyabayashi T, Ruggles A, Yamamoto J, Takiguchi M.A 2.5-year-old female Thoroughbred horse was referred to the veterinary teaching hospital for right front limb lameness of 1 year duration. Physical examination and diagnostic nerve blocks failed to localize the origin of the lameness. Scintigraphy with 99mTc-MDP suggested increased radionuclide uptake in the palmar metacarpal soft tissues of the right front limb. Ultrasonographic examination revealed hypoechoic lesions in the superficial digital flexor tendon and the suspensory ligament, suggesting tendinitis and desmitis. Combined imaging modalities improved detection and characterization of...
Verschooten F, Gasthuys F, De Moor A.An experimental and clinical study to investigate the aetiology of distal splint bone fractures is described. In vitro, extension of the fetlock did not appear to alter the position of the distal ends of the splint bones, although tension in the interosseous tendons increased. Flexion of the fetlock resulted in slight outward displacement of the distal ends of the splint bones. It is suggested that concurrent desmitis of the suspensory ligament can cause movement of the ends of the splint bones thus predisposing to a fatigue fracture. In a clinical study of 87 horses, 114 splint bone fractures...
Morrison S.Laminitis is a disease of the suspensory apparatus of the distal phalanx, which can advance to the chronic stage with varying degrees of structural failure. Because the disease may ultimately lead to mechanical failure of the digit, a foot management plan is required to effectively and mechanically treat these cases. Many laminitis cases can be successfully rehabilitated back to athletic soundness, light use, breeding, or pasture soundness, whereas others suffer from permanent instability and never enjoy an acceptable level of comfort. To understand how to minimize damage in the acute laminiti...
Knudsen O.The paper briefly describes the percutaneous tendon splitting operation as performed in general practice and evaluates its effectiveness on the basis of races run during a 2 year follow-up period. The results are compared with similar figures for normal Standardbred trotters. A higher percentage of horses subjected to splitting of the suspensory ligament failed to remain sound long enough to run more than 10 races during the follow-up period. The percentage of horses returning to racing whose superficial flexor was operated upon was somewhat lower than the control group.
Mizobe F, Okada J, Shinzaki Y, Nomura M, Kato T, Yamada K, Spriet M.Desmitis of the oblique distal sesamoidean ligaments (ODSL) is caused by hyperextension of the metacarpophalangeal/metatarsophalangeal joint and has been described as a significant cause of lameness in racehorses. In this study, three Thoroughbred racehorses (age range: 3-6 years) were diagnosed with desmitis of the forelimb ODSL using standing low-field magnetic resonance imaging (sMRI). Radiography and ultrasonography were inconclusive with regard to a definitive diagnosis. For all horses, the sMRI characteristics included increased signal intensity within the medial ODSL on T1-weighted grad...
Samol MA, Uzal FA, Blanchard PC, Arthur RM, Stover SM.The most prevalent causes of death in racehorses are musculoskeletal injuries, causing ~83% of deaths within the racing industry in California and elsewhere. The vast majority of these injuries have preexisting lesions that predispose to fatal injury. A 4-y-old Thoroughbred colt suffered an acute suspensory apparatus failure, including biaxial proximal sesamoid bone fractures of the right front fetlock, causing loss of support of the fetlock joint and consequent fall with fractures of the cervical and sacral spine. Cervical fracture caused spinal cord damage that resulted in sudden death. A pr...
Noble P, Lejeune JP, Caudron I, Lejeune P, Collin B, Denoix JM, Serteyn D.Whereas the effect of heel configuration on the tension of the suspensory apparatus is well documented in the literature, there are few reports of joint contact force components in the equine distal forelimb. Objective: To improve understanding of the effect of heel configuration on equine digit joint loading, a sensitivity analysis was performed to compare the effect of a raised heel on joint contact force components in the coffin and fetlock joints during the stance phase of the trot. Methods: Four Warmblood horses were used. An inverse dynamic analysis was carried out using kinematic and ki...
Hill AE, Blea JA, Arthur RM, McIlwraith CW.Private-practice racetrack veterinarians in southern California recorded non-fatal injuries meeting defined criteria in Thoroughbreds for 1 year. Injury incidence was 2.29 injury events per 100 horse-months, which was lower than other studies where trainer reported injury data were collected. Of 477 injuries recorded, 344 (72.1%) were acute and 133 (27.9%) were chronic. Fractures were common (47.6% of injuries), with stress fractures accounting for 14% of injuries. Superficial digital flexor tendonitis and suspensory ligament desmitis accounted for 15.3 and 11.5% of injuries, respectively. Agr...
Takahashi T, Mukai K, Ohmura H, Aida H, Hiraga A.The purpose of this study was to create a lower forelimb model of the Thoroughbred horse for measuring the force in the superficial and deep digital flexor tendons (SDFT and DDFT), and the suspensory ligament (SL) during a trot. The mass, centers of gravity, and inertial moments in the metacarpus, pastern, and hoof segments were measured in 4 Thoroughbred horses. The moment arms of the SDFT, DDFT, and SL in the metacarpophalangeal (fetlock) and distal interphalangeal (coffin) joints were measured in 7 Thoroughbred horses. The relationship between the fetlock joint angle and the force in the SL...
Kamineni S, Ruggles A, Ashfaq H.Ultrasonic debridement as a treatment for tendinopathy and desmitis is a relatively new approach in orthopedic surgery. Previously only used in limited cases, this procedure shows promise for treating ligament-bone and tendon-bone interface injuries. We present a case study of a 2-yr-old thoroughbred male horse, unable to train due to recalcitrant symptoms after extensive conservative management of suspensory branch desmitis. It was then treated with ultrasonic debridement and concurrent manubrial stem cell autograft injection, to treat the ultrasound visualized lesion. Post-surgically, the pa...
Lavagnino M, Madison J, Williams MR, Arnoczky SP.To determine if regional variations in strain patterns occur within the suspensory ligament under tensile load. Local increases in strain may put certain regions of the suspensory ligament at risk and may explain the poor healing and high recurrence rates associated with suspensory branch injuries. Methods: The suspensory ligament and its bone attachments were isolated from each of 10 adult equine cadaveric forelimbs and radiodense reference beads were inserted throughout the length of the ligament. Specimens were attached to a custom fixture secured to a materials testing system. Radiographs ...
Mizobe F, Nomura M, Kato T, Nambo Y, Yamada K.Problems associated with the proximal metacarpal region, such as an osseous injury associated with tearing of Sharpey's fibers or an avulsion fracture of the origin of the suspensory ligament (OISL), are important causes of lameness in racehorses. In the present study, four Thoroughbred racehorses (age range, 2-4 years) were diagnosed as having forelimb OISL and assessed over time by using standing magnetic resonance imaging (sMRI). At the first sMRI examination, all horses had 3 characteristic findings, including low signal intensity within the trabecular bone of the third metacarpus on T1-we...
Keg PR, van den Belt AJ, Merkens HW, Barneveld A, Dik KJ.The influence of regional nerve blocks on lameness resulting from tendon injury was studied in six horses. Tendonitis was induced in the midmetacarpal region of the Superficial Digital Flexor Tendon (SDF), Deep Digital Flexor Tendon (DDF) and the Suspensory Ligament (SL) through collagenase injections. The results were evaluated through sequential clinical examinations, ultrasonographic imaging and kinetic gait analysis (force plate) during a period of 144 days post injury and subsequently compared with gross and microscopic findings. The lameness corresponding to the SDF and DDF tendon lesion...
de Souza AF, Pascual CJ, Maia BT, do Valle De Zoppa AL.This study aimed to evaluate the distribution of dye at two perineural injection sites of the palmar/plantar nerves and describe their anatomical variations of positioning at the level of the distal metacarpus/metatarsus in horses. Two ml of 1% methylene blue solution was injected in 24 limbs (12 forelimbs and 12 hindlimbs) of horse cadavers at two different points: Group 1: between the branch of the suspensory ligament and deep digital flexor tendon, and Group 2: between the deep and superficial digital flexor tendons. This was followed by dissection and evaluation of the solution diffusion. ...
Bowker RM, Rockershouser SJ, Linder K, Vex KB, Sonea IM, Caron JP.The innervation of the navicular bone (os sesamoideum distale) and its suspensory ligaments (ligamenta sesamoidea collateralia) (CSL) or proximal suspensory ligament and the ligamentum sesamoideum distale impar or the distal sesamoidean impar ligament (DS-impar ligament) was examined using combined anatomical techniques of silver impregnation and immunocytochemistry. Silver impregnation studies revealed an abundance of nerve fibres present in both the CSL and DS-impar ligament with the latter having relatively more nerve fibres. These silver-impregnated nerves coursed parallel to and were asso...
Brown KA, Johnson AL, Bender SJ, Nolan TJ, Pfisterer B, Slack J, Willis E, Rule EK.A 5-year-old imported Zangersheide gelding was evaluated for SC swellings over both forelimbs and lameness localized to the distal metacarpus. Ultrasound examination of the SC masses was compatible with verminous granulomas. Linear hyperechoic foci were present within the suspensory ligament branches of both forelimbs, suggestive of ligamentous parasitic infiltrates. A diagnosis of onchocerciasis was confirmed on biopsy of a SC mass. The gelding was treated with ivermectin and a tapering course of PO dexamethasone but was eventually euthanized. Necropsy confirmed the presence of SC eosinophili...
Khairoun A, Hawkins JF, Moore GE, Lescun TB, Adams SB.Superficial digital flexor tendinitis (SDFT) and proximal suspensory desmitis (PSD) are common causes of lameness in horses. Current treatment options include rest, controlled exercise, administration of anti-inflammatories, intralesional injections, surgery, and electrohydraulic shock wave therapy (ESWT). ESWT is safe, noninvasive, and is used to treat a variety of musculoskeletal abnormalities. Medical records between 2010 and 2021 were reviewed. Horses were separated into two categories: (group 1: ≥ 3 ESWT treatments; group 2: < 3 ESWT treatments). Our objective was to examine the effe...
Hill AE, Carpenter TE, Gardner IA, Stover SM.To evaluate a Markov-chain model for the development of forelimb injuries in Thoroughbreds and to use the model to determine effects of reducing sprint distance on incidence of metacarpal condylar fracture (CDY) and severe suspensory apparatus injury (SSAI). Methods: Weekly exercise and injury data for 122 Thoroughbreds during racing or training. Methods: Weekly data were used to construct a Markov-chain model with 5 states (uninjured [UNINJ], palpable suspensory apparatus injury [PSAII, SSAI, CDY, and lost to follow-up [LOST]). Transition probabilities between UNINJ and PSAI were estimated as...
Caldwell FJ, Waguespack RW.To develop a tenoscopic approach for desmotomy of the accessory ligament of the deep digital flexor tendon (AL-DDFT) in horses. Methods: Experimental. Methods: Cadaveric forelimbs (n=10) and 4 forelimbs from 2 horses anesthetized for terminal teaching procedures, and 12 forelimbs of 6 experimental horses. Methods: Saline distention of the carpal flexor sheath facilitated insertion of an arthroscope into the distal medial aspect of the sheath between the AL-DDFT and deep digital flexor tendon (DDFT). Location of an instrument portal on the lateral aspect of the metacarpus was identified with a ...
Carpenter RS, Galuppo LD, Simpson EL, Dowd JP.To report use of a locking compression plate (LCP) for fetlock arthrodesis in Thoroughbred racehorses after catastrophic disruption of the suspensory apparatus. Methods: Retrospective case study. Methods: Racing Thoroughbreds (n=6) with a catastrophic breakdown injury of the suspensory apparatus. Methods: Medical records (2004-2006) of horses that had fetlock arthrodesis using an LCP were reviewed. Preoperative recorded variables were: age, gender, affected limb, injury type and occurrence, limb support used and time to surgery. Recorded surgical variables were: implants used and cost, surgery...
Alexander GR, Gibson KT, Day RE, Robertson ID.To measure the effects of transection of the accessory ligament of the superficial digital flexor (SDF) muscle (superior check desmotomy) on flexor tendon and suspensory ligament (SL) strain in vitro. Methods: In vitro experimental biomechanical investigation. ANIMALS USED: Ten equine cadaver forelimbs. Methods: The effects of superior check desmotomy were determined using equine cadaver forelimbs secured in a servocontrolled hydraulic testing machine. Strain sensors were used to measure strain on the superficial and deep digital flexor tendons and SL, and a goniometer was used to measure join...
Ford TS, Ross MW, Orsini PG.Three techniques for inducing analgesia of the proximal metacarpal region were evaluated for the frequency of inadvertent injection into the middle carpal and carpometacarpal joints. Using methylene blue solution as a marker dye and 30 fresh cadaver specimens each, three clinicians performed either 30 infiltrations at the origin of the suspensory ligament (method A), 30 palmar and palmar metacarpal nerve blocks at the proximal end of the metacarpus (method B), or 30 palmar and palmar metacarpal nerve blocks at the distal aspect of the accessory carpal bone (method C). The frequency of inadvert...
Gerdes C, Morgan R, Terry R, Foote A, Smith R.This descriptive anatomical study investigates the relationship between the third interosseous muscle, also known as the suspensory ligament, and the carpometacarpal joint in forelimbs of horses, with the hypothesis that there was a direct synovial communication between these structures as shown by computed tomographic arthrography, histology, and gross anatomy sections. Computed tomography of the carpus and metacarpal region was performed on two groups. Group 1 consisted of eight cadaver limbs undergoing computed tomographic arthrography following injection of a mixture of positive contrast m...
Ross MW, Ford TS, Orsini PG.Seven horses, 2 to 4 years of age, were examined because of moderate-to-severe forelimb lameness, mild effusion of the middle carpal joint (3 horses), and pain on palpation of the origin of the suspensory ligament (4 horses). The lameness was abolished by anesthetic infiltration of the middle carpal joint in six horses. In four of them, a high palmar nerve block also abolished the lameness. A linear radiolucency in the proximal end of the third metacarpal bone (McIII) was interpreted as an incomplete longitudinal fracture. In one horse, distinct intramedullary sclerosis limited to the palmar c...
Brokken MT, Schneider RK, Roberts GD, Holmes SP, Gavin PR, Sampson SN, Farnsworth KD, Dahlgren LA.To evaluate the effects of a new microfracture and ligament splitting procedure on ligament healing and to examine the usefulness of magnetic resonance (MR) imaging for monitoring ligament healing over time using a collagenase model of hind limb proximal suspensory desmitis. Methods: Experimental in vivo study. Methods: Healthy adult horses (n=6). Methods: Horses were free of lameness with normal hind limb proximal suspensory ligaments (PSL). The origin of both hind limb PSL was injected with collagenase and underwent MR imaging 2 weeks later, followed by the microfracture and ligament splitti...
Minshall GJ, Wright IM.Clinical association between the branches of insertion of the suspensory ligament (SL) and metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints has been reported. However, there has been no assessment of the lengths of the SL branches which are subsynovial with respect to the joints or reports of involvement of the MCP/MTP joints in injuries of the SL branches. Objective: To establish proportions of SL branches subsynovial with respect to the MCP/MTP joints and report clinical and arthroscopic findings in horses with desmitis of SL branches identified as having an articular component...
Hewes CA, White NA.To determine outcome of percutaneous ultrasound-guided desmoplasty with simultaneous fasciotomy for proximal suspensory desmitis (ie, desmitis of the origin of the suspensory ligament) in horses that have not responded to stall rest. Methods: Retrospective case series. Methods: 27 horses. Methods: Medical records of horses with proximal suspensory desmitis treated by means of desmoplasty with fasciotomy were reviewed. Follow-up information was obtained through telephone conversations with owners and trainers of the horses or by examination of horses at the hospital. Results: 23 of the 27 (85%)...
Bowker RM, Linder K, Van Wulfen KK, Sonea IM.The anatomy of the distal interphalangeal (DIP) joint in the adult horse is described in relationship to the suspensory ligaments of the navicular bone, the neurovascular bundle and the sensory nerves to these periarticular regions. Using polymer plastic injections, the synovial cavity of the DIP joint was observed to have a complex relationship to the proximal suspensory or collateral sesamoidean ligament (CSL) of the navicular bone with the cavity forming cranial and caudal compartments around the CSL abaxially. Sensory nerves, as identified by peptide immunocytochemistry and silver/gold chl...
