Recognize and Treat Sweeney Shoulder

Sweeney shoulder is injury to the suprascapular nerve that innervates the supraspinatus and infraspinatus muscles. Loss of function causes visible atrophy above the scapular spine and a swinging, out-from-the-shoulder stride with elbow winging and, often, toe drag. Nowadays, most cases are caused by trauma, as my mare Lady’s was. Historically, Sweeney was caused by ill-fitting harnesses and/or overwork in work horses.

When I wrote this blog post in 2017, there was little information available on the web. That is why I posted it! There is now MUCH more. I’ve added links in this updated version of the post.

Lady’s Story

Unfortunately, I lost Lady in 2019 to a pasture injury undoubtedly related to Sweeney. She broke her left humerus. It upset me very much so I did not update this post till now (August 2025). I’ve finally done so because this is still one of most popular posts. People view my Sweeney Shoulder videos on YouTube all the time. Information is clearly still needed.

Let’s start with what happened to my horse Lady. Despite having read about it in veterinary manuals, I had no idea of how to recognize and treat sweeney shoulder until it happened to my horse.

The crime and resulting injury

On August 10, 2017, my horse Lady was chased by dogs.  When my friend Melissa got home (I board at her place), she found Lady in the lower pasture.  She had tied up and had wounds all over, particularly on the left foreleg. She was very lame, but it was difficult to see where the problem(s) was(were).
Using logical deduction (just about the only thing that would cause her to run around frantically was a pack of dogs, and the wounds looked like bites), I stated that, although we had not seen what happened, I was 95% certain it was dogs. Several days later we captured one of the culprits; a young puppy (at least) had returned to the scene of the crime and was too stupid to get through the fence when the kids came out.

Above: Some pictures of the wounds Lady received. Most of the ones in the above pictures appeared to be dog bites.

To the vet

We called the vet and took her to the clinic. The apprentice vet suggested x-raying the left foreleg, but I was convinced it was superficial, and that belief was backed by senior vet who arrived later. The only relatively untouched lower leg was the right hind. She also had strange scrapes on her chest, and a swelling on her neck with punctures that could have been teeth. I thought she had run into a fence, but after walking the entire fence line, realized that was impossible.

Above: Pictures of Lady’s chest injuries.

Her blood work, unsurprisingly, was consistent with tying-up (duh, it was obvious). She stayed the night at the clinic and received a fortune’s worth of liquids. She also received Banamine, and the left fore was wrapped with DMSO and furacin (at an exorbitant cost, I should have done it before I left her).

Back home with questions

The next day I brought her home. The first few days, she didn’t know which leg to favor, she was so sore. She was confined to the stall for the most part, but I took her out to graze. By the third day I knew something was seriously wrong with her left fore. I had seen many horses tie up. This was not only exercise induced rhabdomyolysis. Unfortunately, I did not know how to recognize Sweeney Shoulder!
I did the best I could to take a video (ie I had my son do it) which I sent to my vet to convince him that yes, my horse was very broken, it was from the shoulder, and he needed to come out because I didn’t want to trailer her.

How to recognize Sweeney Shoulder

Above: This video was taken August 15, 2017, five days after the trauma. She already shows the characteristic swinging motion of Sweeney, but it got much worse. You can see hives on her neck. For about a month, she would sporadically get hives on the left side of her neck, starting where the “bite” was. She became allergic to fly sprays.

Characteristic movement of Sweeney Shoulder

For those of you who would want to be able to identify Sweeney Shoulder, and find it difficult to see in the videos: the horse will pull the leg forward in a swinging motion, out from the elbow/shoulder.  The toe may drag (Lady did this for about a month, 4-8 weeks post-injury). Once the foot is placed, the elbow will turn out as the horse steps forward with the sound leg. It’s unmistakable once you know what you’re looking for.

Of course, I did not know at the time.

Diagnosis (finally)

I sent the video to my vet, Dr. Trent Bliss at Interstate Equine, the next day. He said give her bute (I’d already done that on my own initiative). Two days later I texted him and said she was worse, and couldn’t get up properly, so he came out the next Monday (August 21, 11 days after the injury).

To be fair, I’d been regularly having the clinic look at Lady because of lamenesses I detected (and in one case, detected by two endurance ride vets –lameness pull) that were invisible or insignificant every time they looked at her. I have very sensitive unevenness radar.

The really good thing was that as soon as Dr. Bliss saw Lady walk on the 21st, he said “Sweeney.” (aka suprascapular neuropathy, or damage to the shoulder nerves). I was really lucky that he recognized it for what it was!

Sweeney is rare nowadays and frequently misdiagnosed

I have since learned that many cases of sweeney are misdiagnosed because it is relatively rare nowadays.  I had never seen a case outside of the veterinary encyclopedias I used to study to prepare for the written exam portions of Youth of the Year contests.  My understanding (from my teenage days) was that it resulted from ill-fitting harnesses (collars); it was a disease of working horses (ironically, so was tying-up, or Monday morning disease, common in work horses that were given Sundays off on full rations).

Dr. Bliss also said, “wow, you’re right, it is the shoulder.” (The shoulder is often blamed for lower limb lameness, probably because from the saddle it feels like the shoulder isn’t working properly when the horse fails to fully extend the leg).

Lady’s case

Lady had an acute and severe case of sweeney. Taking into consideration the hematoma and bite marks on the lower left leg, we believe she was grabbed by a dog and fell, over-extending the left fore leg behind the rear legs (one cause of trauma-induced sweeney). 

Treatment for Sweeney Shoulder

Medication

Lady was prescribed stall rest and EQUIOXX. a NSAID that can be administered long term to horses, for the foreseeable future.  At least three months and probably twelve.  At this time, she could barely get up, and couldn’t get up at all from the bad side (I had to roll her over when she fell).  She fell several times in the week before the sweeney diagnosis, because she didn’t understand she was disabled.(Fortunately, she soon learned to balance.) It was very discouraging. Not only would I not be able to ride her, she wouldn’t even be able to carry a foal if she couldn’t get up.

Above are pictures from September 3rd, 3.5 weeks after injury. You can clearly see the atrophy.

What else could I do?

I asked advice on the AERC Facebook page, had my mom ask her vet clinic, asked friends… There seemed to be no established procedure and no guaranteed cure. Lady was insured, and they would have covered surgery, but I really did not want to do this (even though my vet did mention the option). The general consensus was that the best bet would be acupuncture–which of course the insurance did not cover.

Acupuncture

One month after the original trauma, I finally got an acupuncturist, Dr. Julia White,  out. We did an initial video (below). Lady required sedation, and was still twitchy with flies, but Dr. White did electro-acupuncture and then left the needles in for another 20 minutes.

I had my doubts, and we still don’t know the extent to which the treatment aided recovery (no random assignment, etc), but one thing is certain: it must have felt good, because Lady loved her needle sessions. The second time Dr. White came, after one week, Lady recognized her as soon as she got out of the truck, and stood quietly for the needles. We never had to sedate her again, even though she turned into a bit of a fire-breathing dragon when she started feeling better.

Electro-acupuncture session:

Above: An electro-acupuncture session. See all those needles (Taken November 1st)? Lady didn’t move a muscle during application. She also got a chiropractic adjustment; rearing and levitating is not good for you when you are already damaged.

Other methods to treat Sweeney: TENS, balance trainers

Dr. White also advised using balance trainers (see picture below). Lady is also getting megadoses of Vitamin E and flax seed meal (for the omega acids). I use a TENS/EMS unit on her every day while cleaning stall, etc. (ideally one hour, but often less). At first I got no reaction from the atrophied muscle, but it has slowly improved. In the picture below, the TENS unit is in that blue bag, which I attached to Lady by slipping it under and old racing overgirth. (Link is to Amazon, and that one is probably fine, but I buy them from racing tack places–BigD Web has them too–for use in races!)

Above: Lady on balance trainers (she’ll stay there 10+ minutes if you are beside her, but gets off as soon as I go to clean the stall), with TENs Unit

Exercise and feed

I also took Lady out to roll in sand almost every day (sometimes in mud, if it had rained).

She is on free choice grass hay (I fill four hay nets a day, and she has about half a net leftover in 24 hours), and one cup of Nutrena Safe Choice (split in two feedings). She gets about 1/3 cup Nutrena Pro-force fuel with her EQUIOXX and 4000 IU Vitamin E. I started hand-walking in early October, with the goal of “not making her more lame” each time; ie I was supposed to stop before she got worse, which at the beginning was about one minute.

Read about my experience with another neurological disorder, EPM:

Detecting subtle signs of EPM in horses and Treating EPM in horses: Options and my choice for River.

Getting better!

The reason I am finally completing this blog is that I am hopeful, at last, after nearly four months, that I might be able to not only breed Lady, but potentially ride her as well. On Monday, Lady went nuts after her roll. Rearing, jumping, scootching around like an 850 lb greyhound in back of me. So I left her in the round pen to get a longe rope (she ground ties just fine even when she won’t lead). I sent her around me in both directions, bucking and snorting for about 30 seconds, to get her manageable. Then I took the video below.

She’s a different horse! Even after already having played more than she had in four months, she was barely lame, and had only a tiny bit of sweeney in the elbow at the walk. I was very excited and shared the video with Dr. Bliss.

Dr. White came out yesterday and agreed with me that she was doing fantastic, considering the severity of the injury and the short time that has passed. Of course, she was much more lame on Tuesday, but already improving again yesterday. Still sore today, but not too bad. Dr. Bliss says I’ll know she’s mostly recovered when she does the crazy two days in a row.

Safety first

Of course, now comes the difficult part: keeping her from damaging the rest of her body while she recovers, and/or redamaging the nerve by being stupid. She has to stay in the stall, on EQUIOXX, and have controlled exercise (i.e.,  hand-walking), until she’s in no danger of injuring herself. I am fantasizing with occasional turnout on good (not slippery or muddy) terrain, with horses near but not in with her, at around six months. I cannot wait to get her out of the stall permanently though, so I don’t want to rush things.

Above: Video of a therapy session with the TENS unit.

I will add to this in a few months, to document the changes.

Update July 2018

Lady was in a pasture starting March 2018. She was fairly quiet and primarily walked. My vet (Dr. White) told me at the end of May, after Lady’s last acupuncture session, that I could start working her if I wished, but I didn’t… she trotted out well that day, in hand in a straight line, but that left shoulder is still very atrophied. 

On July 21st, 2018, I worked her briefly in the round pen. She trotted soundly to the left, but was a little bit lame to the right, and bent out.  She may –in fact, undoubtedly would– need regular adjustment if I were to use her. At the moment, she’ll stay in the pasture, and hopefully I’ll be able to breed her next year, finances permitting. At some point I may try to bring her back into use, but not now.
Below are the two videos I took yesterday.

Above: Lady trotting to the left, apparently sound (the blood is from fly bites)

Above: Lady trotting to the right, lame on right (secondary issue; she’s crooked): 

Update 16 August 2018

One year and six days post-injury, Lady was not as lame in the round pen as she was about 3 weeks ago (the ground was softer and she was excited), but she was still sore. She had been trimmed Sunday, and her heels were sore (to testers); Lady has always been high-low, with her low foot (right) very thin-soled. She was also still crooked, and sensitive on both sides (shoulder).

I could begin riding/working if I wanted. It would take time, much attention to balance, and regular chiropractic adjustments and acupuncture. I don’t have the money or time right now, and I’ve got another horse to entertain me, so Lady will continue her pasture life in a nice horse resort.

Update 3 September 2018

2 February 2019: She gallops around the pasture, and is eager to be worked. I put a saddle on today (after lots of trotting, so she wouldn’t buck).

Shopping list:

Some things that can be useful to treat Sweeney shoulder:

TENS Unit
You will need extra electrodes and gel. Amazon no longer sells the electrodes I bought, but this gel is great.  Gel is very important, as it conducts electricity. The longer the horse’s hair, the more gel you need (I actually clipped her hair short in the winter).
Theraband Balance & Stability Trainer
See my list that includes good general horse shopping sites
Vitamin E. Vitamin E will help horses recover from nerve damage. Choose natural (d-alpha-tocopherol) rather than synthetic (dl-alpha-tocopherol). Natural is more bioavailable (e.g., Kane et al., 2010).). I used Puritan’s Pride Vitamin E (1,000IU each) with Lady. I now use  KER Elevate (each scoop has 1,000IU).

FAQ

What is Sweeney shoulder in horses (suprascapular neuropathy) and how does it affect gait?

Sweeney shoulder is injury to the suprascapular nerve that innervates the supraspinatus and infraspinatus muscles. Loss of function causes visible atrophy above the scapular spine and a swinging, out-from-the-shoulder stride with elbow winging and, often, toe drag.

What causes Sweeney shoulder?

Modern cases most often follow trauma—such as blunt impact at the point of shoulder or overstretching the limb during a fall. Historical harness-related compression is now less common. Dog-related incidents or pasture mishaps can precipitate injury.

What are the early signs of Sweeney shoulder in horses?

Common early signs include a swinging forward motion of the limb from the shoulder, elbow pointing outward as the opposite leg advances, intermittent toe scuffing, difficulty rising on the affected side, and progressive hollowing over the shoulder.

How do veterinarians diagnose Sweeney shoulder and when should I call the vet?

Diagnosis is usually clinical: gait observation and palpation of shoulder musculature, with imaging or electrodiagnostics in select cases. Call your veterinarian promptly if you see marked toe drag, elbow winging, or trouble getting up—early rest and management reduce secondary injury.

What is the best treatment plan for acute Sweeney shoulder in a horse?

Typical management includes stall rest, anti-inflammatories as prescribed (e.g., firocoxib/Equioxx), Vitamin E supplementation, controlled hand-walking, safe footing, and preventing falls. Adjuncts such as electro-acupuncture, TENS/EMS, and targeted rehab can support comfort and muscle activation. Surgical decompression of the suprascapular nerve is reserved for selected cases.

How long does recovery from Sweeney shoulder take and what is the prognosis?

Nerves heal slowly. Many horses improve over 3–12 months, with outcome depending on injury severity and careful rehab. Some horses return to work with residual asymmetry; others remain pasture-sound. Regular re-evaluation guides expectations.

Does acupuncture (including electro-acupuncture) help a horse with Sweeney shoulder?”

Electro-acupuncture is commonly used as an adjunct to reduce pain and stimulate neuromuscular activity. Evidence is limited but many cases show improved comfort and muscle recruitment. Use it under veterinary supervision as part of a comprehensive plan.

Can a TENS or EMS unit help Sweeney shoulder in horses and how do I apply electrodes?

TENS/EMS can assist with muscle stimulation and comfort. Clip long hair or use conductive gel, place pads over the atrophied shoulder muscles per veterinary guidance, start with low intensity, and monitor skin. Do not use over open wounds and do not leave the horse unattended while the unit runs.

Safe rehab exercises for a horse recovering from Sweeney shoulder (week-by-week basics)?

Begin with short, straight-line hand-walking that does not increase lameness. Progress gradually, adding gentle balance work (e.g., stability pads) and later controlled hills if approved. Avoid tight turns, slippery footing, and excited turnout until stability improves.

What supplies help during Sweeney shoulder rehab (balance pads, conductive gel, supplements)?”

Useful items include conductive gel and replacement electrodes for TENS/EMS, balance or stability trainers, protective boots, fly management that avoids sensitive areas, and veterinarian-guided nutrition (e.g., adequate vitamin E and omega-3s). (See the shopping list above!)