Equine Suspensory Ligament Focal Lesion

Clinician: Megan Mathias, DVM

CASE HISTORY AND CLINICAL SIGNS

Sadie first presented as a consultation on January 30, after two months of benign neglect and turn out following a traumatic injury in the field that occurred two months prior. At the time of my initial examination, she had a significant lameness at the trot which was more apparent when traveling in a circle to the left as well as a prominent swelling on the lateral aspect of her right hind metatarsus that was warm, edematous, and painful on palpation. Ultrasound of the area revealed a focal lesion in the suspensory ligament adjacent to a fractured lateral splint bone as well as significant soft tissue inflammation and thickening. According to Sadie’s owner, neither the swelling nor the lameness showed any significant improvement over the previous 60 days of turn out.  

Transdermal carbon dioxide treatments were started immediately. No other medications or changes in turn out or management were altered until after the subsequent recheck. At the first recheck three weeks later, on February 20, the swelling appeared to be mildly improved and the lesion fibers appeared slightly more hyperechoic than the initial examination. The most dramatic improvement of the recheck was the marked improvement in the lameness examination. Equinosis readouts from a lameness examination showed a 73% improvement in push off lameness and a 51% improvement in right hind impact lameness since the initial examination. 

Following the February 20 examination, gastroprotectants were prescribed as the owner had noticed Sadie to be more irritable and positive albumin and hemoglobin were found on fecal occult blood testing. She began treatment with omeprazole 2.2mg / q24h, sucralfate tablets 10g/q12h, and ranitidine paste 10mg / q24h. Additionally, topical diclofenac gel was prescribed for topical application to the swelling of the limb as well as 10-15 minutes of hand walking per day. 

The subsequent recheck examination on April 2nd revealed a dramatic improvement in the local swelling, dramatic improvement in the lesion on ultrasound as the lesion appeared to be filled in and a resolution of the right hind impact lameness with an >90% improvement of the right hind impact lameness.

Before the transdermal carbon dioxide treatments she would only trot 2 or 3 steps and then come back to a walk even if the herd was trotting. After treatments began, she was trotting with the herd and as the weeks went by would stay with the herd at the trot (sometimes canter) and looked sound.

Throughout May if more than 3 days passed between treatments she did not move as freely, her stride shortened. By the end of May, she was sound at the walk/trot in a straight line was still lame at the trot on a circle to the left. By the end of June, she was sound and she has remained sound with regular riding.

SUMMARY

There is significant evidence based on the history of Sadie’s trauma, her treatments and the progression of the lameness, swelling and lesion that the transdermal carbon dioxide treatments had a direct and positive effect on improving degree of lameness and a likely positive effect by accelerating lesion healing and reducing inflammation. Transdermal carbon dioxide treatments are likely to be an appropriate adjunctive therapy for treating soft tissue inflammation and distal suspensory ligament injuries to accelerate healing, reduced inflammation, with a result of improved overall lameness scores.