{"id":691,"date":"2026-06-24T12:09:53","date_gmt":"2026-06-24T12:09:53","guid":{"rendered":"https:\/\/talklameness.org\/proximal-suspensory-injuries-in-horses\/"},"modified":"2026-08-10T12:12:27","modified_gmt":"2026-08-10T12:12:27","slug":"proximal-suspensory-injuries-in-horses","status":"publish","type":"post","link":"https:\/\/talklameness.org\/us\/proximal-suspensory-injuries-in-horses\/","title":{"rendered":"Proximal suspensory injuries in horses"},"content":{"rendered":"

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Why they’re difficult to diagnose and how MRI changes the outcome<\/h3>\n\n

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Has your horse been “not quite right” for a while? A bit unlevel on a circle? Resistant in collection? Or maybe just not performing the way you know they can? It might be more than a training issue or a bad back. A proximal suspensory injury is one possible cause that can sometimes be challenging to diagnose. <\/p>\n\n

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Proximal suspensory injuries are a common cause of lameness<\/a> and poor performance<\/a> in horses. Clinical signs can vary depending on whether the forelimbs or hindlimbs are affected. A thorough lameness<\/a> examination is essential to localise the source of pain<\/a>. Once the region has been localised, radiography and ultrasonography are typically used to assess the area. Although these techniques can provide important information about both the bone and ligament, each has limitations that can make full assessment of the injury challenging. <\/p>\n\n

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What is the proximal suspensory?<\/h4>\n\n

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The proximal suspensory ligament originates at the top of the cannon bone (Fig 1) and forms the upper portion of the suspensory ligament, a structure that extends down the back of the limb between the splint bones before dividing into branches that attach to the proximal sesamoid bones. The proximal region contains ligamentous tissue interspersed with muscle and fat, and injury may involve the ligament itself, the adjacent bone at its origin, or both. <\/p>\n\n\n\n

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In some cases, pathology may also affect the branches or their attachment to the proximal sesamoid bones. This is one reason why a thorough assessment of the area is often required to fully understand the nature and extent of an injury. <\/p>\n\n\n\n

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Injuries affecting the proximal aspect of the suspensory ligament are commonly referred to as proximal suspensory desmitis (PSD) or proximal suspensory disease. They can affect either the forelimbs or hindlimbs and the clinical signs may vary depending on the limb involved and the severity of the injury. <\/p>\n<\/div>\n\n\n\n

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Fig. 1: The cannon bone is the main load‑bearing bone in the horse’s lower limb, running between the knee and the fetlock <\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n

Why is it so hard to spot?<\/h4>\n\n

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Several things make proximal suspensory injuries difficult to recognise, even for experienced vets. <\/p>\n\n

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The lameness<\/a> is often subtle and inconsistent. Your horse might look perfectly fine on a straight line but show discomfort on a circle, particularly on one rein<\/a>. They might warm up out of it, seeming better after 20 minutes of work rather than worse. This pattern can make owners (and vets) question whether they’re dealing with lameness<\/a> at all or something more like stiffness or a training problem. <\/p>\n\n

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When both hindlimbs are affected, the picture changes again. A horse that is equally uncomfortable on both sides can look remarkably level, because there’s no dramatic contrast between the two limbs. Instead, you might notice a shortened stride, a reluctance to engage behind, a loss of impulsion or power or a general flattening of performance that’s hard to put your finger on. <\/p>\n\n

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If you’ve noticed any of these things in your horse, our article Why lameness<\/a> isn’t always obvious<\/a> explains why subtle signs matter just as much as dramatic ones. <\/p>\n\n

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What does a vet workup involve?<\/h4>\n\n

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Your vet will watch your horse move – in hand, on a lunge, on different surfaces and in different directions – to build a picture of where and when the discomfort appears. They may use nerve blocks (local anaesthetic injections) to systematically narrow down the source of pain<\/a>. <\/p>\n\n

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This process is explained well in our webinar The value of nerve blocks in the lameness<\/a> examination<\/a>. <\/p>\n\n

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What’s the challenge with proximal suspensory injuries?<\/h4>\n\n

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The challenge with proximal suspensory injuries is that confirming the source of pain<\/a> is not always straightforward. Diagnostic analgesia (nerve blocks) is often used to help localise lameness<\/a>, but several techniques are available for assessing the proximal suspensory region, each with its own advantages and limitations. In some cases, local anaesthetic may affect adjacent structures, such as the carpal or tarsal joints, which can also be sources of pain, making interpretation of the results more challenging. For this reason, diagnostic analgesia is interpreted alongside the clinical examination and lameness<\/a> assessment. <\/p>\n\n

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Once the proximal suspensory region has been identified as the likely source of pain<\/a>, radiography and ultrasonography are typically used to investigate the area further. While these modalities provide valuable information about the bone and soft tissue<\/a> structures, confirming the full extent of the injury can sometimes remain challenging. <\/p>\n\n

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Radiography and ultrasonography provide complementary information about the proximal suspensory region:<\/p>\n\n