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Topic:Diagnosis

Diagnosis in horses involves the systematic identification of diseases and conditions affecting equine health. This process relies on a combination of clinical evaluations, laboratory tests, imaging techniques, and other diagnostic tools to assess the health status of horses. Veterinarians utilize these methods to identify symptoms, determine the underlying causes of health issues, and formulate appropriate treatment plans. Diagnostic procedures in equine medicine can include blood tests, ultrasound, radiography, endoscopy, and more specialized tests such as genetic screening or advanced imaging modalities like MRI and CT scans. This page aggregates peer-reviewed research studies and scholarly articles that explore various diagnostic techniques, their applications, and advancements in the field of equine veterinary medicine.
A first report on the microbial colonisation of the equine oesophagus.
Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft    November 6, 2009   Volume 192, Issue 1 42-51 doi: 10.1016/j.aanat.2009.10.004
Meyer W, Kacza J, Schnapper A, Verspohl J, Hornickel I, Seeger J.Based on cryo-SEM, standard and high resolution TEM, glycoconjugate histochemistry, and microbiological differentiation, the present study demonstrates the colonisation of the epithelium of the equine oesophagus with microorganisms. As particularly apparent using cryo-SEM to illustrate natural conditions, the present microbiota were clearly dominated by bacteria, forming a one-layer system, as attached to and embedded in concentrated mannose/mannan substances covering the outer stratum corneal cells. Bacterial numbers ranged from 5600 to 7200 per mm(2) in the central part of the oesophagus, th...
The effect of siRNA treatment on experimental equine herpesvirus type 1 (EHV-1) infection in horses.
Virus research    November 5, 2009   Volume 147, Issue 2 176-181 doi: 10.1016/j.virusres.2009.10.017
Brosnahan MM, Damiani A, van de Walle G, Erb H, Perkins GA, Osterrieder N.Available vaccines fail to induce lasting and protective immunity to equine herpesvirus 1 (EHV-1) associated diseases. RNA interference is a novel approach showing promise for therapeutic use in outbreak situations. This study examined the effect of small interfering RNA (siRNA) on clinical signs as well as the presence of live virus and viral DNA in nasal secretions and peripheral blood mononuclear cells (PBMCs) in horses experimentally infected with EHV-1. siRNA targeting two EHV-1 genes (glycoprotein B and the origin binding protein) was administered 12h before and 12h after intranasal infe...
Equine herpesvirus type 1 quantification in different types of samples by a real-time PCR.
Polish journal of veterinary sciences    November 5, 2009   Volume 12, Issue 3 311-315 
Dzieciatkowski T, Przybylski M, Cymerys J, Turowska A, Chmielewska A, Tucholska A, Banbura MW.Equine herpesvirus type 1 (EHV-1) is one of the major viral agents causing diseases in horses common worldwide. A variety of techniques, including PCR, have been used to diagnose EHV-1 infections. In this paper, an attempt of real-time PCR has been described, which uses specific fluorochrome-labeled TaqMan probes for detection of viral DNA. This method does not require post-amplification manipulations, thereby reducing the risk of cross-contamination. The assay was sensitive enough to detect EHV-1 sequences in different clinical samples, as well in mice neuronal cell cultures. The technique wa...
Proliferation of Streptococcus zooepidemicus and Pseudomonas aeruginosa within a simulated subpalpebral lavage flushed with equine serum.
Veterinary ophthalmology    November 4, 2009   Volume 12, Issue 6 343-349 doi: 10.1111/j.1463-5224.2009.00725.x
Jacobi S, Townsend WM, Bolin CA.To evaluate whether equine serum administered via a simulated subpalpebral lavage system (SPL) supports proliferation of Streptococcus zooepidemicus or Pseudomonas aeruginosa within the tubing. Methods: A sterile i.v. catheter with injection cap was inserted into sterilized silicone tubing (Mila). To mimic an SPL within the dorsal conjunctival fornix, the tubing was secured to an elevated platform. The tip of the tubing extended from the platform into a vial containing culture medium just inoculated with approximately 1.5 x 10(8) CFU/mL P. aeruginosa or S. zooepidemicus. To mimic administratio...
Evolutionary patterns of eastern equine encephalitis virus in North versus South America suggest ecological differences and taxonomic revision.
Journal of virology    November 4, 2009   Volume 84, Issue 2 1014-1025 doi: 10.1128/JVI.01586-09
Arrigo NC, Adams AP, Weaver SC.The eastern equine encephalitis (EEE) complex consists of four distinct genetic lineages: one that circulates in North America (NA EEEV) and the Caribbean and three that circulate in Central and South America (SA EEEV). Differences in their geographic, pathogenic, and epidemiologic profiles prompted evaluation of their genetic diversity and evolutionary histories. The structural polyprotein open reading frames of all available SA EEEV and recent NA EEEV isolates were sequenced and used in evolutionary and phylogenetic analyses. The nucleotide substitution rate per year for SA EEEV (1.2 x 10(-4...
Evaluation of athletic performance in horses with jugular vein thrombophlebitis: 91 cases (1988-2005).
Journal of the American Veterinary Medical Association    November 3, 2009   Volume 235, Issue 9 1073-1078 doi: 10.2460/javma.235.9.1073
Moreau P, Lavoie JP.To evaluate effects of thrombophlebitis of 1 or both jugular veins on athletic performance of horses. Methods: Retrospective case series. Methods: 91 horses with jugular vein thrombophlebitis. Methods: Medical records of horses with jugular vein thrombophlebitis examined between 1988 and 2005 were reviewed for signalment, history, clinical signs, diagnosis, and treatment. Performance was evaluated in 2 ways. A questionnaire was used to obtain a subjective assessment from the owner or trainer of the horse's performance after thrombophlebitis, compared with the performance before thrombophlebiti...
Comparison of characteristics and enzymatic products of leukocytes in the skin and laminar tissues of horses administered black walnut heartwood extract or lipopolysaccharide.
American journal of veterinary research    November 3, 2009   Volume 70, Issue 11 1383-1390 doi: 10.2460/ajvr.70.11.1383
Riggs LM, Krunkosky TM, Noschka E, Boozer LA, Moore JN, Robertson TP, Peroni JF.To compare characteristics and enzymatic products of leukocytes detected in the skin and laminar tissues of horses administered black walnut heartwood extract (BWHE) and horses administered purified lipopolysaccharide (LPS). Methods: 25 healthy 5- to 15-year-old horses. Methods: Horses were randomly assigned to receive LPS (20 ng of O55:B5 Escherichia coli endotoxin/kg; n = 5) IV or 6 L of BWHE (10) or water (control group; 10) via nasogastric intubation. Horses were euthanatized 12 hours after treatment or at onset of Obel grade 1 lameness. Laminar tissue samples and skin samples from the mid...
Cloning, sequencing and expression analysis of the equine hepcidin gene by real-time PCR.
Veterinary immunology and immunopathology    November 2, 2009   Volume 135, Issue 1-2 34-42 doi: 10.1016/j.vetimm.2009.10.027
Oliveira Filho JP, Badial PR, Cunha PHJ, Cruz TF, Araújo JP, Divers TJ, Winand NJ, Borges AS.Equine serum or plasma iron concentration drops quickly during inflammation. Accumulation of iron inside macrophages and reduction of the intestinal absorption of this element cause hypoferremia during systemic inflammatory processes. These mechanisms are mediated by hepcidin, a 25 amino acids peptide synthesized mainly in the liver in response to iron stores and inflammation. Hepcidin is an important peptide for systemic iron homeostasis and also has antibacterial and antifungal activities. Hepcidin up-regulation is particularly useful during acute inflammation, especially before adaptive imm...
A non-invasive technique for standing surgical repair of urinary bladder rupture in a post-partum mare: a case report.
Irish veterinary journal    November 1, 2009   Volume 62, Issue 11 734-736 doi: 10.1186/2046-0481-62-11-734
Stephen J, Harty M, Hollis A, Yeomans J, Corley K.An 11-year-old mare presented 36 hours after foaling with a ruptured bladder. Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid. Bladder endoscopy demonstrated tissue necrosis and a rent in the dorsocranial aspect of the bladder. Following stabilisation, including abdominal drainage and lavage, the mare was taken to standing surgery. Under continuous sedation and epidural anaesthesia, and after surgical preparation, a Balfour retractor was placed in the vagina. Using sterile lubricant and moderate force, it was possible to insert a hand int...
Development of an enzyme-linked immunosorbent assay for equine neutrophil elastase measurement in blood: preliminary application to colic cases.
Veterinary immunology and immunopathology    October 29, 2009   Volume 135, Issue 3-4 282-288 doi: 10.1016/j.vetimm.2009.10.023
de la Rebière de Pouyade G, Franck T, Salciccia A, Deby-Dupont G, Grulke S, Heyden LV, Sandersen C, Serteyn D.Equine neutrophil elastase (NE) is a protease released in inflammatory diseases and participating in tissue destruction. To measure NE in horse plasma to assess its role in pathological conditions, we purified elastase from equine neutrophils by a double step chromatography and obtained a pure protein of 27 kDa, 4 kDa smaller than the NE 2A previously purified (Scudamore et al., 1993; Dagleish et al., 1999), which was likely to be NE 2B. We developed an ELISA by using two specific polyclonal antibodies obtained from rabbit and guinea pig. The sandwich complex was detected using a secondary ant...
Effect of the administration of an oral hyaluronan formulation on clinical and biochemical parameters in young horses with osteochondrosis.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    October 29, 2009   Volume 22, Issue 6 455-459 doi: 10.3415/VCOT-09-01-0001
Carmona JU, Argüelles D, Deulofeu R, Martínez-Puig D, Prades M.The aim of this study was to evaluate the clinical and biochemical effects of the administration of oral hyaluronan (Hyal-Joint [HJ]) on young horses with osteochondrosis (OC). Our hypotheses were that HJ administration is safe, would decrease the degree of synovial effusion and the concentration of nitric oxide (NO) and prostaglandin E2 (PGE2) in synovial fluid, and would increase the concentration of hyaluronic acid (HA) in plasma and synovial fluid. Eleven young horses with tarsocrural OC were included in a randomised, double-blinded, placebo-controlled pilot clinical trial. Six horses rece...
Spinal kinematics in horses with induced back pain.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    October 29, 2009   Volume 22, Issue 6 448-454 doi: 10.3415/VCOT-08-09-0088
Wennerstrand J, Gómez Alvarez CB, Meulenbelt R, Johnston C, van Weeren PR, Roethlisberger-Holm K, Drevemo S.Back problems are important contributors to poor performance in sport horses. It has been shown that kinematic analysis can differentiate horses with back problems from asymptomatic horses. The underlying mechanism can, however, only be identified in a uniform, experimental setting. Our aim was to determine if induction of back pain in a well-defined site would result in a consistent change in back movement. Back kinematics were recorded at a walk and trot on a treadmill. Unilateral back pain was then induced by injecting lactic acid into the left longissimus dorsi muscle. Additional measureme...
Characterization of pentraxin 3 in the horse and its expression in airways.
Veterinary research    October 29, 2009   Volume 41, Issue 2 18 doi: 10.1051/vetres/2009066
Ramery E, Fievez L, Fraipont A, Bureau F, Lekeux P.The long pentraxin 3 (PTX3) plays an important role in host defence and its over-expression may contribute to airway injury. The aim of the present study was therefore to characterize in more detail PTX3 and its expression in the horses' airway. Six healthy horses and six horses affected by recurrent airway obstruction (R.A.O.) were submitted to a dusty environment challenge. PTX3 DNA and cDNA were cloned and sequenced. PTX3 expression was evaluated by RT-qPCR, Western blotting and immunohistochemistry in bronchoalveolar lavage fluid (BALF) cells, BALF supernatant and bronchial epithelial cell...
Equine neutrophil elastase in plasma, laminar tissue, and skin of horses administered black walnut heartwood extract.
Veterinary immunology and immunopathology    October 29, 2009   Volume 135, Issue 3-4 181-187 doi: 10.1016/j.vetimm.2009.10.024
de la Rebière de Pouyade G, Riggs LM, Moore JN, Franck T, Deby-Dupont G, Hurley DJ, Serteyn D.Laminitis is a local manifestation of a systemic inflammatory response that is characterized by neutrophil activation and movement of neutrophils into the laminar tissues. Given the evidence for the involvement of neutrophils in the development of laminitis, we measured concentrations of neutrophil elastase, a serine protease released from the azurophilic granules of neutrophils, in plasma, skin and laminar tissues obtained from control horses and horses given black walnut heartwood extract (BWHE) to induce laminitis. Healthy horses (5-15 years old) were randomly assigned to 4 groups: 3 experi...
Case report: Repair of a type IV Monteggia fracture in a foal.
Australian veterinary journal    October 28, 2009   Volume 87, Issue 11 463-466 doi: 10.1111/j.1751-0813.2009.00508.x
Jalim SL, McKinnon AO, Russell TM.A Monteggia fracture is a humero-radial luxation combined with a fracture of the ulna. It is a rare injury, infrequently reported in the horse. This case report describes the surgical repair of such a fracture in a 4-month-old filly.
Differences in replication kinetics and cell tropism between neurovirulent and non-neurovirulent EHV1 strains during the acute phase of infection in horses.
Veterinary microbiology    October 28, 2009   Volume 142, Issue 3-4 242-253 doi: 10.1016/j.vetmic.2009.10.015
Gryspeerdt AC, Vandekerckhove AP, Garré B, Barbé F, Van de Walle GR, Nauwynck HJ.Equine herpesvirus 1 (EHV1) replicates in the respiratory tract of horses, after which infected leukocytes transport virus throughout the body, resulting in abortion or nervous system disorders. Two EHV1 strains circulate in the field: neurovirulent and non-neurovirulent. To investigate differences in replication in the upper respiratory tract (URT), an experimental inoculation study in ponies was performed with both strains. Two groups of six ponies, were inoculated intranasally with 10(6.5) TCID(50) of either strain. Clinical signs, nasal shedding and viremia were evaluated. At early time po...
Evaluation of indwelling intravenous catheters for the regional perfusion of the limbs of horses.
The Veterinary record    October 27, 2009   Volume 165, Issue 17 496-501 doi: 10.1136/vr.165.17.496
Kelmer G, Catasus CT, Saxton AM, Elliot SB.The feasibility of maintaining indwelling intravenous catheters in the saphenous, cephalic or palmar digital vein of horses for seven days to infuse antimicrobial drugs was investigated in 18 horses. The horses were randomly assigned to six groups according to the vein catheterised and whether they received amikacin or erythromycin. None of the catheters was replaced more than once, and 11 of the 18 catheters remained patent for all seven days. Neither the drug administered nor the vein catheterised significantly affected the survival of the catheter. In all but three cases, complications, inc...
Postpartum Massive Hematoma within the Broad Ligament of the Uterus in a Broodmare Possibly Caused by Rupture of the Uterine Artery.
Journal of equine science    October 23, 2009   Volume 20, Issue 3 41-46 doi: 10.1294/jes.20.41
Oikawa MA, Nambo Y, Miyamoto M, Miura H, Kikuchi M, Ohnami Y.A broodmare showed mild signs of abdominal discomfort and anemia after normal delivery. Ultrasonographic examination revealed a massive hematoma within the broad ligament adjacent to the uterine horn. Internal bleeding into the peritoneal cavity (hemoabdomen) was not seen. Following treatment, the clinical signs improved. Hemorrhage caused by rupture of the arteries within the broad ligament of the uterus may be a cause of hematoma. Prepartum and postpartum rupture of the arteries supplying the reproductive organs in the mare, which is not uncommon, can be fatal if severe hemoabdomen occurs. I...
Detection of Chlamydophila caviae and Streptococcus equi subsp. zooepidemicus in horses with signs of rhinitis and conjunctivitis.
Veterinary microbiology    October 23, 2009   Volume 142, Issue 3-4 440-444 doi: 10.1016/j.vetmic.2009.10.011
Gaede W, Reckling KF, Schliephake A, Missal D, Hotzel H, Sachse K.At a stud farm of Trakehner horses, all 33 foals of a birth cohort developed conjunctivitis and serous to muco-purulent rhinitis, and 7 older horses showed recurrent signs of conjunctivitis. Examination of nasal and conjunctival swabs by bacterial and cell culture, as well as real-time PCR, ArrayTube microarray analysis and DNA sequencing led to the identification of Chlamydophila (C.) caviae (first description in horses) and Streptococcus (S.) equi subsp. zooepidemicus. We presume a synergistic effect associated with these two agents by hypothesising that primary lesions were set by C. caviae...
Evaluation of prolactin receptor (PRLR) as candidate gene for male fertility in Hanoverian warmblood horses.
Reproduction in domestic animals = Zuchthygiene    October 23, 2009   Volume 45, Issue 5 e124-e130 doi: 10.1111/j.1439-0531.2009.01533.x
Giesecke K, Hamann H, Sieme H, Distl O.Stallion fertility has increasing importance as the artificial insemination is employed in horses more intensely. Molecular genetic markers may be useful tools to evaluate the stallion fertility before breeding. The prolactin receptor gene (PRLR) was chosen as a candidate for stallion fertility because of its influence on testicular and accessory sex gland function. Screening the equine PRLR gene for polymorphisms in Hanoverian stallions revealed two single nucleotide polymorphisms (SNPs). Association and haplotype analyses were performed in 162 Hanoverian warmblood stallions for these intrage...
Determination of the stiffness of the equine cervical spine.
Veterinary journal (London, England : 1997)    October 21, 2009   Volume 186, Issue 3 338-341 doi: 10.1016/j.tvjl.2009.09.015
Pagger H, Schmidburg I, Peham C, Licka T.This aim of this study was to test the hypothesis that the stiffness of the equine cervical spine depends on the direction of force applied and on spinal position. Muscles and nuchal ligament were removed from the cervical spines of 17 horses that were without a history of cervical or neurological disease. The cervical spines were then flexed/extended dorsoventrally (with the spine straight and with the occiput rotated 30° against T1) and laterolaterally. Mean dorsoventral stiffness was 297 N/m (± 135) in flexion, 1347 N/m (± 2083) in extension, 421 N/m (± 164) in lateral flexion, 279 N/m ...
Questions claims in unwanted horse survey report.
Journal of the American Veterinary Medical Association    October 20, 2009   Volume 235, Issue 7 819-820 
Dodman N, Heyde C.No abstract available
An EIAV field isolate reveals much higher levels of subtype variability than currently reported for the equine lentivirus family.
Retrovirology    October 20, 2009   Volume 6 95 doi: 10.1186/1742-4690-6-95
Craigo JK, Barnes S, Zhang B, Cook SJ, Howe L, Issel CJ, Montelaro RC.Equine infectious anemia virus (EIAV), a lentivirus that infects horses, has been utilized as an animal model for the study of HIV. Furthermore, the disease associated with the equine lentivirus poses a significant challenge to veterinary medicine around the world. As with all lentiviruses, EIAV has been shown to have a high propensity for genomic sequence and antigenic variation, especially in its envelope (Env) proteins. Recent studies have demonstrated Env variation to be a major determinant of vaccine efficacy, emphasizing the importance of defining natural variation among field isolates o...
Nuchal crest avulsion fracture in 2 horses: a cause of headshaking.
Journal of the South African Veterinary Association    October 17, 2009   Volume 80, Issue 2 111-113 doi: 10.4102/jsava.v80i2.183
Voigt A, Saulez MN, Donnellan CM.The medical records of 2 Thoroughbred horses that developed headshaking after blunt trauma to the occipital region are reviewed. The history, signalment, clinical signs, diagnostic methods, diagnosis and treatment were recorded in each case. Both horses displayed headshaking, while one horse repeatedly lifted its upper lip and pawed excessively at the ground. In both horses, diagnostic imaging of the occipital region revealed avulsion fragments of the nuchal crest and a nuchal desmitis in association with hyperfibrinogenaemia. The presence of an avulsion fragment of the nuchal crest with assoc...
Factors associated with likelihood of horses having a high serum Streptococcus equi SeM-specific antibody titer.
Journal of the American Veterinary Medical Association    October 16, 2009   Volume 235, Issue 8 973-977 doi: 10.2460/javma.235.8.973
Boyle AG, Sweeney CR, Kristula M, Boston R, Smith G.To identify factors associated with an increased likelihood that horses would have a serum Streptococcus equi SeM-specific antibody titer > or = 1:1,600. Methods: Cross-sectional study. Methods: 188 healthy client-owned horses. Methods: A single serum sample from each horse was tested for SeM-specific antibody titer with an ELISA. Multivariate logistic regression was used to identify factors associated with having a titer > or = 1:1,600. Results: Age, breed, and vaccination status were significantly associated with the likelihood of having a titer > or = 1:1,600. The odds of having a ...
Immunohistological demonstration of Rhodococcus equi in a trotter foal.
DTW. Deutsche tierarztliche Wochenschrift    October 10, 2009   Volume 116, Issue 9 335-339 
Retteg Pauls S, Jottini S, Takai S, Venner M, Wohlsein P.A 3-month-old female trotter foal was euthanized due to severe dyspnoea. Pathomorphologically a chronic granulomatous to necrotizing pneumonia was found and Rhodoccocus (R.) equi was isolated microbiologically. An immunohistological method using a murine monoclonal antibody against a 15-17 kDa antigen of virulent R. equi was established in formalin-fixed and paraffin-embedded tissue sections using various antigen retrieval techniques to optimize the staining results. Microwave treatment was most suitable for the demonstration of bacterial antigen localized predominantly in intralesional macrop...
Structural and functional-annotation of an equine whole genome oligoarray.
BMC bioinformatics    October 8, 2009   Volume 10 Suppl 11, Issue Suppl 11 S8 doi: 10.1186/1471-2105-10-S11-S8
Bright LA, Burgess SC, Chowdhary B, Swiderski CE, McCarthy FM.The horse genome is sequenced, allowing equine researchers to use high-throughput functional genomics platforms such as microarrays; next-generation sequencing for gene expression and proteomics. However, for researchers to derive value from these functional genomics datasets, they must be able to model this data in biologically relevant ways; to do so requires that the equine genome be more fully annotated. There are two interrelated types of genomic annotation: structural and functional. Structural annotation is delineating and demarcating the genomic elements (such as genes, promoters, and ...
Regional distribution of collagen and haemosiderin in the lungs of horses with exercise-induced pulmonary haemorrhage.
Equine veterinary journal    October 7, 2009   Volume 41, Issue 6 586-591 doi: 10.2746/042516409x429419
Derksen FJ, Williams KJ, Pannirselvam RR, de Feijter-Rupp H, Steel CM, Robinson NE.Regional veno-occlusive remodelling of pulmonary veins in EIPH-affected horses, suggests that pulmonary veins may be central to pathogenesis. The current study quantified site-specific changes in vein walls, collagen and haemosiderin accumulation, and pleural vascular profiles in the lungs of horses suffering EIPH. Objective: In the caudodorsal lung regions of EIPH-affected horses, there is veno-occlusive remodelling with haemosiderosis, angiogenesis and fibrosis of the interstitium, interlobular septa and pleura. Methods: Morphometric methods were used to analyse the distribution and accumula...
Trypanosoma evansi infection in mainland Spain.
Veterinary parasitology    October 7, 2009   Volume 167, Issue 1 74-76 doi: 10.1016/j.vetpar.2009.09.050
Tamarit A, Gutierrez C, Arroyo R, Jimenez V, Zagalá G, Bosch I, Sirvent J, Alberola J, Alonso I, Caballero C.An outbreak of Trypanosoma evansi infection that occurred in mainland Spain is described. The outbreak occurred on an equine and camel farm to which dromedary camels from an infected area of the Canary Islands had recently been introduced. One of these camels developed clinical signs and T. evansi was discovered in a blood smear examination. The herd was evaluated in order to determine the extent of the disease. The results showed that 76% of the camels, 35% of the donkeys and 2% of the horses were affected. The animals were isolated and treated using Cymelarsan((R)) (0.5mg/kg). After treatmen...
Arthroscopic visualisation of the third metacarpal and metatarsal condyles in the horse.
Equine veterinary journal    October 7, 2009   Volume 41, Issue 6 526-533 doi: 10.2746/042516409x386976
Vanderperren K, Martens A, Haers H, Duchateau L, Saunders JH.Arthroscopy of the fetlock joints is a routine surgical procedure in the horse. It is unclear how much of the articular surface of the condyles of the metacarpal (MCIII)/metatarsal (MTIII) bone can be visualised using either the dorsal or palmar/plantar arthroscopic approach. Objective: To investigate which part of the articular surface of the MCIII/MTIII condyles of the fetlock joints can be evaluated arthroscopically using: 1) dorsal approach in combination with flexion; 2) standard palmar/plantar approach; or 3) additional portal at the base of the sesamoid bone with joint extension. Method...