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A

B

Figures 3A and 3B: Ultrasound images of enlarged PSLs. The PSL should be roughly wedge or triangle shaped and lie within a line drawn between the splint bones (white arrows). These are rounded and enlarged with hypoechoic change. a. The PSL imaged with the limb weight-bearing. b. The PSL imaged with the limb non-weight-bearing. This is performed with the limb flexed and the flexor tendons relaxed. The foot can be placed in a stand or held by an assistant.

be removed with alcohol or water soaked gauze and ultrasound gel applied. The ligament should be ultrasounded in transverse, longitudinal and non-weight-bearing positions as described in previous literature (Figures 3 and 4) (5, 6, 7). Damage is indicated by enlargement of the ligament beyond the borders of the medial and lateral splint bones and increased hypoechogenicity (Figure 3a and 3b). At least two views (lateromedial, and dorsoplantar) should be taken of each hock on a limb with suspected suspensory ligament desmitis. The proximal third of the cannon bone should ideally be included in each view to evaluate for bony changes that can occur with proximal suspensory ligament desmitis, including sclerosis or avulsion of the underlying bone (Figure 5a). The hock joints should be evaluated for evidence of arthritis as well, as the plantar pouches of the distal hock joints are in close proximity to the areas being blocked, as discussed above. For horses evaluated with nuclear scintigraphy or bone scan, increased IRU is often seen at the proximoplantar aspect of the cannon bone, commonly focused on the head of the lateral splint bone, on horses with proximal suspensory ligament desmitis (Figure 5b). Surgery, extracorporeal shockwave therapy (ESWT), and regenerative therapy are a few of the many treatment modalities that have been reported for PSL desmitis. Only 14% of horses return to full work following rest alone, therefore rest is not considered a sufficient option (1). Different surgical options for hind limb PSL desmitis, such as desmoplasty/fasciotomy, and neurectomy/fasciotomy have been reported (1). A recent retrospective study compared shockwave therapy to neurectomy of the deep branch of the lateral plantar nerve and fasciotomy and found similar success rates approaching 70 percent for each. The initial rehabilitation protocols are different for horses undergoing shockwave and surgery. Horses that undergo surgery are

Figure 4: Normal PSL in transverse and longitudinal weight bearing views. Vessel edge artifact is marked by white arrows.

28  The Practitioner  Issue 4 • 2017

Profile for FVMA

Practitioner Issue 4, 2017  

A publication by the Florida Association of Equine Practitioners, an equine-exclusive division of the FVMA. Your Invitation to Attend the Oc...

Practitioner Issue 4, 2017  

A publication by the Florida Association of Equine Practitioners, an equine-exclusive division of the FVMA. Your Invitation to Attend the Oc...

Profile for fvma_faep