Excision of the deep branch of the lateral palmar nerve of horses to resolve lameness caused by proximal suspensory desmitis.
Authors: Guasco Paolo Gay, Kelly Ger, Schumacher James, Henry Robert W
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Chronic proximal suspensory desmitis (PSD) remains a challenging diagnosis in equine lameness, particularly when conservative management fails to restore soundness. This case series examined four mature show-jumpers with persistent forelimb lameness unresponsive to standard therapy, where ultrasonographic examination revealed proximal suspensory ligament enlargement without obvious fibre disruption; regional anesthesia confirmed the suspensory apparatus as the pain source before surgical intervention. Deep branch of the lateral palmar nerve (DBLPaN) neurectomy performed under general anaesthesia in dorsal recumbency resulted in all four horses achieving soundness within six weeks, with maintained functionality for a minimum of 12 months post-operatively. Whilst this represents a small case series with inherent limitations, the consistent positive outcomes suggest that DBLPaN neurectomy warrants consideration as a salvage procedure for horses with chronic, refractory PSD—particularly those not demonstrating significant fibre disruption on imaging, where pain mechanisms may involve nerve inflammation rather than structural failure alone. Practitioners should note that rigorous localisation via regional anesthesia is essential before pursuing neurectomy, and longer-term follow-up data from larger cohorts would strengthen evidence for this approach in performance horses.
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Practical Takeaways
- •Deep branch lateral palmar nerve neurectomy is a viable surgical option for chronic proximal suspensory desmitis cases that fail conservative therapy, with excellent short and medium-term outcomes
- •Pain localization via regional anesthesia should guide surgical decision-making in these cases
- •This procedure may restore functional soundness in sport horses where conservative management has proven ineffective
Key Findings
- •All 4 horses with chronic proximal suspensory desmitis became sound at 6 weeks post-neurectomy of the deep branch of the lateral palmar nerve
- •Lameness resolution was maintained for at least 12 months following surgery
- •All horses were refractory to conservative management prior to surgical intervention
- •Ultrasonographic examination showed proximal suspensory ligament enlargement in all cases without observed fiber disruption