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Suspensory Desmitis (PSD): A Case Study

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Diagnosis of proximal suspensory desmitis (PSD) can be challenging (Dyson and Genovese, 2011). Local anaesthesia of the deep branch of the lateral plantar nerve (DB-LPN) was performed to assist with diagnosis in this case. Nerve blocks are not considered completely diagnostic for PSD as other surrounding structures are likely to be blocked following a single injection to block the DB-LPN (Hinnigan et al., 2014). However, the significant improvement in lameness shown in response to the block in this case was highly suggestive of PSD. Incidence of bilateral hindlimb PSD is much greater than in the forelimbs (Dyson and Genovese, 2011). Lameness in the hindlimb caused by PSD often remains persistent in the face of conservative treatment such as …show more content…

On ultrasonography of “Maddie’s” suspensory ligaments no gross abnormalities were found, both ligaments were slightly enlarged but still within normal limits. Often with PSD there would be an increase in cross sectional size but it is possible for the conformation of the limbs to prevent the imager from acquiring an ideal cross sectional view (Dyson and Genovese, 2011). The lack of gross changes in “Maddie’s” suspensory ligaments were in line with the fact that focal areas of reduced echogenicity are unusual in hindlimb PSD (Dyson and Genovese, 2011). On radiography the only abnormality was a small area of bony lysis on the right proximal 4th metatarsal bone at the origin of the suspensory ligament, again supporting the diagnosis of PSD. The minimal findings on radiography and ultrasonography were positive indicators for a good surgical outcome. The chance of a good surgical outcome would be reduced by a pre-existing conformation of excessively straight hocks or hyperextension of the fetlocks (Dyson and Murray, 2011), horses falling into this category would not be good surgical candidates. “Maddie’s” conformation was slightly straighter behind but not excessively so and there was no hyperextension of the fetlock therefore the horse went ahead to

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