Horse Side Vet Guide ®

Equine Health Resource

Strain or Injury Distal Ligaments Proximal Sesamoid

Synonyms: Oblique or Straight, or Cruciate Sesamoidean Ligament Strain

The distal ligaments of the proximal sesamoids are short, thick ligaments on the back of the pastern that attach the sesamoid bones on the rear of the fetlock joint to the pastern bones. There are several sets of ligaments, any of which can be injured.

These are relatively uncommon injuries that are better recognized today with the development of modern ultrasound equipment and techniques that can adequately image this anatomically complicated area.

These injuries can still be difficult to tell from other injuries in the pastern area – the ultrasound changes are notoriously subtle in many cases. MRI is the gold standard for precise diagnosis of these injuries.

Signs may not be obvious but may consist of slight swelling, pain to pressure on the back of the pastern, and positive response to lower limb flexion. Lameness is localizes to this region using nerve blocks. X-ray is usually negative and ultrasound makes the diagnosis (sometimes).

Prolonged rest is the cornerstone of treatment, although many other treatments are used today in the interest of providing higher quality and faster healing.


  • What are the treatment options, and the costs, advantages and disadvantages of each option?
  • Is there any proof that more sophisticated treatment options are better than rest and rehabilitation?

    Prevention involves many of the same factors that reduce the likelihood of other tendon and ligament injury. Appropriate shoeing and shoeing intervals is critical to reducing excessive leverage on this area. Horses should be fit for the job.

    Helpful Terms & Topics in HSVGWritten, Reviewed or Shared by Experts in Equine Health

    Author: Doug Thal DVM Dipl. ABVP


    Higgins AJ, Snyder JR eds. The Equine Manual. 2nd Ed. Edinburgh: Elsevier Saunders 2006.


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