Suspensory Ligament Desmitis
Learn what the condition is, how it may be detected early, how it is treated or managed, and which breeds or species are linked to it.
Condition snapshot
A concise guide to the condition’s pattern, detection, management and urgency.
This snapshot is a general guide, not a diagnosis or treatment plan. New, severe or worsening signs require veterinary assessment.
About the condition
Suspensory ligament desmitis is injury to the ligament supporting the fetlock and preventing excessive extension under load. Lesions are classified as proximal, within the body or in one or both branches attaching to the proximal sesamoid bones. Location, limb and discipline materially affect signs and prognosis.
Proximal forelimb disease can cause sudden mild-to-moderate lameness with little swelling. Hindlimb proximal disease is often bilateral and subtle, presenting as poor impulsion, unwillingness to collect, canter problems or loss of action. Body lesions occur particularly in racehorses and may produce heat and enlargement. Branch injury causes focal swelling beside the fetlock, sometimes with joint or tendon-sheath effusion, yet lameness can be absent.
Overload, fatigue, footing, fetlock hyperextension and hoof imbalance contribute. In some breeds, degenerative suspensory ligament desmitis is a systemic progressive disorder involving multiple ligaments and is distinct from an isolated athletic strain. Pain on pressing the proximal suspensory area alone is not diagnostic because normal horses and those with other lameness can react there.
Ligament fibre heals slowly and scar may reduce elasticity. Acute forelimb proximal lesions often return well after adequate rehabilitation, whereas chronic hindlimb proximal disease and branch fibrosis have a more guarded outlook. Recurrence commonly follows a return based on elapsed time rather than objective healing. The diagnosis must name the affected portion and concurrent bone or fetlock pathology rather than using “suspensory” as a generic explanation for poor performance.
The suspensory apparatus supports the fetlock through its proximal body, branches and distal attachments. Injury location changes both signs and prognosis: proximal hindlimb disease can be difficult to localise, while branch enlargement is visible near the fetlock. Bilateral hindlimb cases may present as poor impulsion rather than an obvious one-sided lameness.
Screening & Early Detection
Lameness is assessed on straight lines and circles over more than one surface; proximal suspensory pain can be more evident with the affected limb outside a circle on soft ground. Palpation compares heat, size and pain with the opposite limb. Diagnostic nerve blocks localise the region but can also desensitise adjacent joints, so follow-up imaging is essential.
Ultrasound evaluates size, fibre pattern and branch insertion, always comparing limbs while recognising bilateral disease. Radiographs assess avulsion, enthesopathy and sesamoid attachment. MRI detects subtle proximal lesions and concurrent bone injury when ultrasound is inconclusive; scintigraphy can highlight active attachment remodelling.
Serial scans follow repair at the same anatomical levels. In horses with bilateral hindlimb signs, back, hock and stifle disease must also be investigated. Progressive dropped fetlocks in several limbs, family history or diffuse enlargement raises concern for degenerative suspensory disease rather than one exercise injury. Screening findings are connected to localised pain before invasive treatment is chosen.
Comparison with the opposite limb helps interpret normal variation in ultrasound fibre pattern and branch size.
Treatment & Management
Initial treatment uses a short period of reduced activity, cold therapy and NSAIDs when the lesion is acute and painful. A structured controlled-exercise programme then applies gradually increasing load for at least several months. Hoof balance is corrected, particularly mediolateral imbalance affecting a branch. Progression depends on lameness and imaging rather than a fixed calendar.
Shockwave therapy, platelet-rich plasma, stem-cell products or other biologics are used in selected lesions with variable evidence. Periligamentous corticosteroid is approached cautiously and intraligamentous corticosteroid can impair healing. Chronic hindlimb proximal disease may be treated surgically with plantar fasciotomy and neurectomy in carefully selected horses after imaging and exclusion of broader degenerative disease; loss of sensation carries risks and does not repair the ligament.
Branch injuries often need six months or longer and meticulous fetlock and foot mechanics. Large avulsions or severe fetlock hyperextension worsen prognosis. Degenerative suspensory ligament desmitis is managed for comfort with exercise adjustment, support and analgesia rather than promised a cure. Return to work is staged, and speed, jumping or collection resumes last. Premature training is a leading cause of persistent pain and reinjury.
Breeds or species affected
Akhal-Teke
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Anglo-Arabian
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Arabian
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Barb
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Caspian
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Kathiawari
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Marwari
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Shagya Arabian
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Thoroughbred
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American Quarter Horse
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American Paint Horse
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Appaloosa
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Australian Stock Horse
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Brumby
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Waler
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Morgan
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Standardbred
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American Saddlebred
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Tennessee Walking Horse
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Missouri Fox Trotter
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Rocky Mountain Horse
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Peruvian Paso
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Criollo
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Mustang
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Canadian Horse
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Andalusian
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Lusitano
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Lipizzaner
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Friesian
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Dutch Warmblood
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Hanoverian
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Holsteiner
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Oldenburg
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Westphalian
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Trakehner
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Selle Français
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Belgian Warmblood
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Danish Warmblood
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Swedish Warmblood
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Swiss Warmblood
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Australian Warmblood
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Irish Sport Horse
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Cleveland Bay
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Württemberger
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Zangersheide
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Knabstrupper
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Orlov Trotter
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Camargue
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Icelandic Horse
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Pony of the Americas
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Quarter Pony
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Miniature Horse
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Clydesdale
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Shire
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Percheron
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Belgian Draft
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Suffolk Punch
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American Cream Draft
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Ardennes
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Breton
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Boulonnais
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Comtois
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Dutch Draft
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North Swedish Horse
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Norwegian Fjord
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Haflinger
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Gypsy Cob
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Irish Draught
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Welsh Pony and Cob
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Connemara Pony
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New Forest Pony
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Dartmoor Pony
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Exmoor Pony
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Shetland Pony
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Highland Pony
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Fell Pony
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Dales Pony
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Australian Pony
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Finnhorse
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Black Forest Horse
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