Sesamoid bones in horses are small, nodular bones embedded within tendons, typically located in areas subjected to high mechanical stress. In equines, the primary sesamoid bones of interest are the proximal sesamoid bones, found at the back of the fetlock joint, and the distal sesamoid bone, commonly known as the navicular bone, located within the hoof. These bones function to protect tendons, reduce friction, and enhance the mechanical advantage of tendons during locomotion. The health and integrity of sesamoid bones are essential for normal limb function, and they are often examined in cases of lameness or injury. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, physiological role, and pathologies associated with sesamoid bones in horses.
Cornelissen BP, Rijkenhuizen AB, Kersten W, Németh F.In chronical proximal sesamoid bone lameness it is difficult to localise the exact site of pain. A specific diagnostic analgesia is not available because of a deficiency of detailed information about the nerve supply to the proximal sesamoid bones and surrounding area. A macroscopic study of the nerve distribution to the proximal sesamoid bones of 10 foals and 5 adult horses revealed that these bones are innervated by two branches, in this study called the medial and lateral sesamoidean nerve, respectively, originating from the medial and lateral palmar nerve. Histology of the left forelimbs o...
Grøndahl AM, Gaustad G, Engeland A.Radiographic examination of the metacarpo- and metatarsophalangeal joints was performed on 753 Standardbred trotters (6-21 months of age): 21 showed obvious changes in 26 proximal sesamoid bones on lateromedial projection. The radiographic changes were divided into 6 different types: (1) irregular abaxial margin (8 horses); (2) enlargement of the sesamoid bone (6 horses); (3) 'fracture' or separate centre of ossification of the apex (4 horses); (4) vertical, non-articular fracture of the plantar part of the sesamoid bone (1 horse); (5) a small bony fragment located in a defect in the apical pa...
Nixon AJ, Cummings JF.Serial sections of bone and soft tissue from the metacarpophalangeal joints of 2 mature and 2 immature horses were evaluated for substance P immunoreactive sensory nerve fibers. Formalin-fixed specimens were sectioned, either nondemineralized or demineralized with formic acid or EDTA. Rabbit antiserum to substance P (SP) was used in the streptavidin-biotin-peroxidase complex method for immunolocalization of SP antigen, and staining with 3,3'-diaminobenzidine was used for permanent identification of SP fibers. Abundant sensory nerve fibers were identified in the joint capsule, synovial membrane...
Richardson DW, Clark CC.Hexosamine concentration (an index of proteoglycan content), DNA content (an index of cellularity), and [35S]sulfate incorporation (an index of proteoglycan synthesis) of articular cartilage were measured in biopsy specimens from medial proximal sesamoid bone, medial condyle of the third metacarpal bone, and proximal dorsal rim of the proximal phalanx in both metacarpophalangeal joints of 6 adult horses. One limb was then placed in a fiberglass cast that extended down from the proximal portion of the metacarpus and enclosed the hoof; the other limb was not casted. After 30 days of stall confin...
Vacek JR, Welch RD, Honnas CM.An arthroscopic approach to the palmaroproximal or plantaroproximal pouch of the distal interphalangeal joint was developed in six cadaver limbs and seven limbs of three clinically normal horses. The dorsal aspect of the proximal border and the proximal articular margin of the distal sesamoid (navicular) bone, the palmar aspect of the distal articular margin of the middle phalanx, the collateral sesamoidean ligaments of the distal sesamoid bone, and the joint capsule attachments were readily accessible. Distending the joints with fluid gave access to portions of the articular surface between t...
Wisner ER, O'Brien TR, Pool RR, Pascoe JR, Koblick PD, Hornoff WJ, Poulos PW.Destructive lesions of the axial region of the proximal sesamoid bones were identified by radiography in eight fetlocks and seven lame adult horses. Lameness ranged from 2 to 5 (mean 4; scale 1 to 5) at the time of examination, with a duration of 10 days to two years (mean 5.6 months). Destructive lesions involved both proximal sesamoid bones when examined radiographically and were situated primarily at the level of the mid-body and apical region of the axial borders. Some lesions were cystic, whereas others eroded the axial border more diffusely. Scintigraphy revealed markedly increased activ...
Henninger RW, Bramlage LR, Schneider RK, Gabel AA.Case records of 25 horses with transverse fractures of the proximal sesamoid bone were reviewed to evaluate the success of treatment. All fractures were repaired by use of lag screw fixation and an autogenous cancellous bone graft because the fracture fragments were considered too large for surgical removal and reconstruction of the suspensory apparatus was necessary. Radiography was performed in all cases, and the fractures were classified into 3 types: (1) proximal midbody fractures, which included all fractures in the proximal aspect of the sesamoid bone that resulted in fragments involving...
Hardy J, Marcoux M, Breton L.Radiographs of all 4 fetlocks of 71 Standardbred racehorses were obtained at 3-month intervals for 1 year. Radiographic findings in the abaxial surface of the proximal sesamoid bones were classified into 3 types according to the severity of lesions, and correlation was made with clinical findings at time of examination. Type-1 lesions (1 or 2 linear defects less than or equal to 1 mm wide) were detected in 55% of horses at the start of training; clinical signs of disease were not manifested, and lesions did not become clinically relevant. Type-2 lesions (3 or more linear defects less than or e...
Martin BB, Nunamaker DM, Evans LH, Orsini JA, Palmer SE.Circumferential wiring was used to repair 12 mid-body fractures and four large basilar fractures of proximal sesamoid bones in 15 horses. Eighteen-gauge stainless steel wire was placed around both fragments in five horses, and through the proximal fragment and around the distal fragment in 10 horses. The horses were returned to work when they were clinically sound and fracture healing was evident radiographically. Eleven horses resumed athletic performance, three horses were used as breeding animals, and one horse was retired. Five horses performed at an athletic level equal to or better than ...
Németh F.The aetiology and pathogenesis of navicular bone disease and sesamoidosis are discussed on the basis of findings reported in the literature and research. A marked similarity is found to be present between the clinical presentation, aetiology and pathogenesis of these two diseases. In addition, the intra and juxta-articular signs of degeneration as seen in these diseases are similar to those seen in various forms of arthrosis. Circulatory disturbances resulting from partial or complete arterial occlusion, caused by arteriosclerosis, are likely to play an important role in the cause of degenerat...
Palmieri G, Sanna L, Asole A, Farina V, Bo Minelli L.The origin and course of the collateral sesamoidean (suspensory navicular) ligament of the horse and ass and its attachment to the distal sesamoid bone were studied by means of dissection. Particular attention was given to the topographic relations between this ligament and the deep digital flexor tendon. Numerous sensitive nerve endings are present in this anatomical district. The free and encapsulated nerve endings, displayed by impregnating techniques, are mostly concentrated in the ligament tract connected to the above-named tendon and close to its attachment to the distal sesamoid angle. ...
Palmer SE.Five horses with apical and abaxial fractures of the proximal sesamoid bones were treated arthroscopically. Ipsilateral and contralateral triangulation were used to remove abaxial fragments; apical fragments were removed by ipsilateral triangulation. Excellent visibility of the fracture fragments was obtained with each method. Dissection and removal of fragments was accomplished with standard arthroscopic instruments, tendon-splitting knives, and curved scissors. Excellent functional and cosmetic results were achieved in all cases.
Pool RR, Meagher DM, Stover SM.Navicular syndrome is a degenerative disorder of the distal half of the flexor surface of the proximal sesamoid bone that is predisposed by faulty foot conformation. In horses that become symptomatic, the faulty conformation results in sustained application of nonphysiologic pressure by the deep digital flexor tendon against the flexor cortex of the bone. This force stimulates an intense bone remodeling response in order to attenuate the pressure. An unfortunate sequela of this response is active hyperemia and edema formation in the medullary cavity of the bone. The edema is organized by fibro...
Reeves MJ, Yovich JV, Turner AS.The etiology, clinical presentation, radiographic findings, diagnostic criteria, differential diagnoses, treatment, and prognosis are reviewed for several clinically important conditions of the equine foot. These include pedal osteitis, sheared heels, distal sesamoid bone (navicular) fractures, subchondral bone cyst of the distal phalanx, distal interphalangeal joint subluxation, congenital phalangeal hypoplasia, bipartite and tripartite distal sesamoid bones, keratoma, ossification of the cartilages of the distal phalanx (sidebones), necrosis of the cartilages of the distal phalanx (quittor),...
Colahan P, Piotrowski G, Poulos P.A kinematic analysis of the instant centers of rotation analysis was performed on 21 metacarpophalangeal joints from 11 horses. Manual and computerized methods were used to locate the instant center of rotation on photocopies of transparent composite tracings of a series of radiographs of each joint. The instant centers of rotation of the proximal phalanx about the distal portion of the third metacarpal bone were located consistently on or near the eminence for attachment of the collateral ligaments. The instant centers of rotation of the sesamoids about the distal portion of the third metacar...
Greet TR.The case histories of three young thoroughbred racehorses with displaced lateral condylar fractures combined with an axial fracture of the lateral sesamoid bone are described. In two cases the condylar fracture was repaired surgically but both horses developed severe degenerative joint disease and remained lame. The third horse was destroyed humanely. It is important that axial fractures of the sesamoid bone are recognised so that a poorer prognosis can be given for treatment of condylar fractures in racing thoroughbreds.
Bukowiecki CF, Bramlage LR, Gabel AA.Forty-eight limbs of 12 freshly euthanized horses were used to generate data on the strength of the equine suspensory apparatus. The point of failure of the suspensory apparatus of each limb was determined. Immediately before euthanasia, 6 of the 12 horses (thoroughbreds and standardbreds) had been engaged in active training or racing, and six horses in stall and/or pasture activity. In the actively training or racing horses, the point of acute failure of the suspensory apparatus was within the proximal sesamoid bones in 20 (83%) limbs (resulting in 17 apical fractures, 2 basilar fractures, an...
Barclay WP, Foerner JJ, Phillips TN.Axial sesamoid injuries were found in 4 of 18 horses with lateral condylar fractures of the metacarpus or metatarsus. The injuries appeared as axial sesamoid fractures or progressive demineralization of the axial border of one of the sesamoids. None of the horses with axial sesamoid injuries returned to performance soundness. Axial sesamoid injury appeared to be an indication of severe fetlock trauma due to condylar fracture. Such injuries appeared to indicate a poor prognosis for return to performance soundness.
Fretz PB, Barber SM, Bailey JV, McKenzie NT.The case records of 49 horses with proximal sesamoid bone fracture were studied. The population consisted of 20 Thoroughbreds, 20 Standardbreds, 5 Quarter Horses, 2 Arabians, and 2 grade horses. The fractured bones were classified into 5 categories: apical fractures, basilar fractures, abaxial fractures, middle one-third fractures, and bilateral comminuted-distracted fractures. Apical fractures occurred most frequently in the Standardbred, with the prevalence of medial fracture being equal to that of lateral fracture. Basilar fractures occurred predominantly in the Thoroughbred, with the highe...
Blythe LL, Kitchell RL, Holliday TA, Johnson RD.Normal nerve conduction velocity values in 10 ponies were determined for sensory nerve fibers in the median and ulnar nerves. A percutaneous signal-averaging technique was developed and used. Medial and lateral palmar digital nerves on the abaxial surface of the proximal sesamoid bones were used as the sites for percutaneous stimulation, whereas recording sites included the medial and lateral palmar nerves just distal to the carpus and the median and ulnar nerves in the middle of the radius. Sensory nerve conduction velocities can be evaluated simply and clinically in the limbs of horses, usin...
Spurlock GH, Gabel AA.One-hundred and nine apical fractures of the proximal sesamoid bones were diagnosed in Standardbred racehorses at the Ohio State University Veterinary Hospital during a 5-year period ending December 1978. Lateral sesamoids of the hindlimbs accounted for 61 of the 109 fractures, which was a significantly (P less than 0.05) greater proportion than that for fractures in all other sesamoid bones. Two- and three-year-old horses accounted for 73 of the 109 apical sesamoid fractures. The remaining 36 apical sesamoid fractures were in horses 4 to 9 years old. The apical fragment was removed in 80 of t...
Dik KJ.Several clinical and radiological studies of the proximal sesamoid bones were done in eleven horses from the age of one month to three years. The X-ray findings were found to be inconstant. The number of nutrient canals visualized increased or decreased, and the bone structure gradually became more irregular. Bone deposits along the borders of the sesamoid bones usually did not become apparent until the second or third year of life. Particularly this growth of new bone was found to be a significant clinical feature. On the other hand, nutrient canals and irregular bone structures were also obs...
Spurlock GH, Gabel AA.One-hundred and nine apical fractures of the proximal sesamoid bones were diagnosed in Standardbred racehorses at the Ohio State University Veterinary Hospital during a 5-year period ending December 1978. Lateral sesamoids of the hindlimbs accounted for 61 of the 109 fractures, which was a significantly (P less than 0.05) greater proportion than that for fractures in all other sesamoid bones. Two- and three-year-old horses accounted for 73 of the 109 apical sesamoid fractures. The remaining 36 apical sesamoid fractures were in horses 4 to 9 years old. The apical fragment was removed in 80 of t...
Van Wulfen KK, Bowker RM.To localize substance P (SP) and neurokinin A (NKA) and their receptors in the insertion of the distal sesamoidean impar ligament (DSIL), deep digital flexor tendon (DDFT), and dorsal hoof wall of healthy feet of horses. Methods: 18 healthy feet from horses. Methods: Samples from the dorsal hoof wall and insertion of the DSIL and DDFT of 10 feet were processed for immunocytochemical analysis, using rabbit polyclonal antisera raised against SP and NKA. Tissue sections from 8 feet were incubated with 125-labeled SP to localize tachykinin receptors and their specificity and with control solutions...
Peat FJ, Kawcak CE, McIlwraith CW, Berk JT, Keenan DP.Changes in the proximal sesamoid bones (sesamoids) and the insertional region of the adjacent suspensory ligament branch (branch) are of particular importance in young Thoroughbreds sold at public auction. Little is known about the prevalence of concurrent ultrasonographical branch change, relative to the various grades of radiological sesamoid appearance. Objective: To examine the existence of concurrent radiological and ultrasonographical findings in individual sesamoid-branch units in sales horses; to determine whether there are any radiological findings that are consistently accompanied by...
Boros K, Dyson S, Pollard D, Nagy A.There are limited data on long-term follow-up of radiographic changes of the proximal sesamoid bones (PSBs) in Thoroughbred racehorses. The effect of training and racing on radiodensity of the PSBs in live Thoroughbreds has not been described. Objective: To follow radiographic changes of the PSBs in racehorses over 2 years and describe alterations in overall radiodensity. Methods: Prospective cohort study. Methods: Forty yearlings were enrolled at the first examination (T0). Re-examinations were performed four times, approximately 6 months apart, on 31 (T1), 23 (T2), 13 (T3) and 8 (T4) horse...
Yeomans A, Cramp P, Carpenter R, Bladon B.Proximal sesamoid bone fractures (PSBFs) are a leading cause of economic losses. Post-operative racing prognosis is multi-factorial; however, recent studies are lacking. Objective: To provide an update on racing outcomes for horses undergoing surgical management of PSBFs, analyse variables affecting performance and compare post-operative racing performance with pre-operative data and case-matched controls. Methods: Retrospective case series. Methods: Thoroughbred racehorses that underwent PSBF repair (2008-2022) were included. Data retrieved included fracture type, limb, axiality, treatment, a...
Martin BB, Nunamaker DM, Evans LH, Orsini JA, Palmer SE.Circumferential wiring was used to repair 12 mid-body fractures and four large basilar fractures of proximal sesamoid bones in 15 horses. Eighteen-gauge stainless steel wire was placed around both fragments in five horses, and through the proximal fragment and around the distal fragment in 10 horses. The horses were returned to work when they were clinically sound and fracture healing was evident radiographically. Eleven horses resumed athletic performance, three horses were used as breeding animals, and one horse was retired. Five horses performed at an athletic level equal to or better than ...
Brokken MT, Schneider RK, Tucker RL.To describe a surgical approach for the removal of nonarticular base sesamoid fragments in performance horses and to report the outcome. Methods: Retrospective study. Methods: Horses (n=11), 7 months to 10 years of age, with lameness because of nonarticular base sesamoid fragments. Methods: Lameness was localized to the metacarpophalangeal/metatarsophalangeal region by clinical examination or response to diagnostic local anesthesia. Radiographs confirmed the diagnosis of a nonarticular base sesamoid fragment. Surgical removal was performed with an incision over the base of the affected sesamoi...
Busschers E, Richardson DW, Hogan PM, Leitch M.To describe the characteristics of unilateral mid-body proximal sesamoid bone (PSB) fractures, to determine factors associated with the outcome of horses after surgical repair, and to describe a technique for arthroscopically assisted screw fixation in lag fashion. Methods: Retrospective case series. Methods: Horses (n=25) with unilateral mid-body PSB fracture. Methods: Medical records (1996-2006), radiographs, and arthroscopic videos of horses with surgically repaired unilateral mid-body PSB fractures were reviewed. Retrieved data included signalment, affected limb and PSB, fracture character...
Németh F.The aetiology and pathogenesis of navicular bone disease and sesamoidosis are discussed on the basis of findings reported in the literature and research. A marked similarity is found to be present between the clinical presentation, aetiology and pathogenesis of these two diseases. In addition, the intra and juxta-articular signs of degeneration as seen in these diseases are similar to those seen in various forms of arthrosis. Circulatory disturbances resulting from partial or complete arterial occlusion, caused by arteriosclerosis, are likely to play an important role in the cause of degenerat...
Ehrlich PJ, Dohoo IR, O'Callaghan MW.To document anatomic patterns of scintigraphic uptake and related orthopedic disease associated with racing activity in Standardbred horses. Methods: Retrospective study. Methods: 64 Standardbred horses evaluated for lameness. Methods: Medical records at the time of discharge were reviewed, and information regarding signalment; history; results of lameness examination, scintigraphy, and radiography; diagnosis; and treatment were obtained. Results: 274 areas of increased radiopharmaceutical uptake were identified. Scintigrams of 218 limbs (106 forelimbs, 112 hind limbs) were available for revie...
Schumacher J, Cole RC, DeGraves FJ, Cofield LG.To compare the speed of onset and analgesic effect of mepivacaine deposited within or immediately outside the neurovascular bundle at the base of the proximal sesamoid bones in horses. Methods: 6 horses with naturally occurring forefoot-related lameness. Methods: In a crossover study design, horses were randomly assigned to receive 1 of 2 treatments first, with the second treatment administered 3 to 7 days later. Trotting gait was analyzed with an inertial sensor-based motion analysis system immediately before treatment to determine degree of lameness. Afterward, ultrasound guidance was used t...
Sasaki N, Takakuwa J, Yamada H, Mori R.To evaluate effectiveness of allogeneic bone screws and pins for internal fixation of midbody transverse fractures of equine proximal sesamoid bones (PSBs) in vitro. Methods: 14 forelimbs from cadavers of 3-year-old Thoroughbreds. Methods: Allogeneic cortical bone fragments were collected from the limbs of a male Thoroughbred, and cortical bone screws were prepared from the tissue by use of a precision desktop microlathe programmed with the dimensions of a metal cortical bone screw. A midbody transverse osteotomy of each PSB was performed by use of a bone-shaping oscillating saw and repaired v...
Cornelissen BP, Rijkenhuizen AB, Barneveld A.The sesamoidean nerve branches from the palmar nerve and runs towards the proximal sesamoid bone. To study the structures innervated by this nerve, a technique for blocking it was developed. The effect of this nerve block was determined in ponies with an induced lameness located in the lateral proximal sesamoid bone (5 ponies) or in the distal part of the lateral branch of the suspensory ligament (5 ponies), and in 10 horses with clinical sesamoidosis. A lameness provoked by the implantation of an expansion plug in the proximal sesamoid bone could, to a large extent, be anaesthetized by a sesa...
Miyakoshi D, Senba H, Shikichi M, Maeda M, Shibata R, Misumi K.This study aimed to evaluate the influence of radiographic abnormalities of 2-year-old Thoroughbred horses that were listed at in-training sales in Japan, on whether they started to race or not at 2-3 years of age. Radiographs of 850 2-year-old Thoroughbreds in the in-training sales repository from 2007 to 2010 were reviewed, and 26 categories of radiographic abnormalities were found. Forty-three horses (5.1%, 43/850) did not start a race at 2-3 years of age. In accordance with the racing results for this age category, as determined by Fisher's exact test and multiple logistic regression analy...
Henninger RW, Bramlage LR, Schneider RK, Gabel AA.Case records of 25 horses with transverse fractures of the proximal sesamoid bone were reviewed to evaluate the success of treatment. All fractures were repaired by use of lag screw fixation and an autogenous cancellous bone graft because the fracture fragments were considered too large for surgical removal and reconstruction of the suspensory apparatus was necessary. Radiography was performed in all cases, and the fractures were classified into 3 types: (1) proximal midbody fractures, which included all fractures in the proximal aspect of the sesamoid bone that resulted in fragments involving...
Southwood LL, Trotter GW, McIlwraith CW.To determine the outcome of horses after arthroscopic removal of abaxial fracture fragments of the proximal sesamoid bone and association of fracture grade with outcome. Methods: Retrospective study. Methods: 47 horses. Methods: Information obtained from dorsopalmar and dorsoplantar radiographic views of metacarpophalangeal and metatarsophalangeal joints was used to classify fractures as grade 1 ( 25 mm long) and type 1 (abaxial) and type 2 (apical-abaxial). Outcome was determined by whether the horse returned to its intended use, raced in the same class or higher (racehorses), or performed sa...
Merchán A, Voss JK, Dubois MS.The satisfactory outcome of fungal osteitis in an 8-year-old American Quarter Horse is described. The horse was admitted with a grade 4 out of 5 lameness and exhibited metacarpophalangeal synovial effusion, indicative of a mild suppurative inflammation. Results of initial radiographic and ultrasonographic examination were unremarkable. Intra-articular anesthesia of the metacarpophalangeal joint allowed localization of the insult. It was not until day 6 of hospitalization when lytic changes on the axial aspect were observed on radiographic examination. Arthroscopic examination permitted identif...
Stiglhuber A, Breit S, König HE.The equine fetlock joint cavity shows ten pouches. The dorsal recess, which is oriented to the proximal side, is separated from those three pouches, which show to the distal direction, by several capsular folds. These folds are documented by means of sagittal sections through the fetlock joint. A medial/lateral recess is covered by the deep part of the collateral ligament of the fetlock joint. The collateral ligaments as well as the sesamoidean collateral ligaments are closely connected with the joint capsule, from which two capsular folds are separated. Between the part of the sesamoidean col...
Palmer SE.Five horses with apical and abaxial fractures of the proximal sesamoid bones were treated arthroscopically. Ipsilateral and contralateral triangulation were used to remove abaxial fragments; apical fragments were removed by ipsilateral triangulation. Excellent visibility of the fracture fragments was obtained with each method. Dissection and removal of fragments was accomplished with standard arthroscopic instruments, tendon-splitting knives, and curved scissors. Excellent functional and cosmetic results were achieved in all cases.
Sato F, Endo Y, Horiuchi N, Tominari M, Murase H, Ishimaru M, Korosue K.Although radiographic findings at the apical portion of the proximal sesamoid bone (PSB) are often observed in young Thoroughbred foals, conflicting findings, either fractures or apparent secondary ossifications centers, have been reported. Three cases (aged 2, 5, and 7 weeks) were identified in 30 necropsied foals (0-31 weeks old). Histopathologically, the subchondral trabecular woven bone was fractured and exhibited focal necrosis of woven bone, fibrin exudate, and/or fibrosis within the foci. In the 7-week-old case, proliferations of chondrocytes were also observed. These findings suggest t...
Hickman J.Sir Frederick Hobday's service as a Veterinary Officer in the Army Veterinary Corps during the Great War 1914-1918 is recorded. This is followed by a description of the fractures of the distal forelimb which can be treated satisfactorily by surgery, and includes fractures of the carpal, the small metacarpal, the proximal sesamoid bones, the first phalanx and the extensor process of the third phalanx.
Honnas CM, Crabill MR, Mackie JT, Yarbrough TB, Schumacher J.Six horses with septic navicular bursitis or distal sesamoid osteomyelitis were treated by means of surgical debridement and lavage, followed by packing of the wound created in the bottom of the foot with an autogenous cancellous bone graft. Two horses were euthanatized, one 18 months after surgery because of complications in the contralateral support limb, and one 68 days after surgery because of continuing severe lameness. Four horses were alive 9, 16, 21, and 42 months after surgery. One horse was used as a broodmare and did not have observable lameness. Two horses were being ridden. The re...
O'Brien TR, Hornof WJ, Meagher DM.Subchondral lesions were identified in the distal palmar region of the third metacarpus in 21 fetlock joints of 15 Thoroughbred horses. The lesions were more commonly identified on the lateromedial and flexed lateral projection, with the flexed lateral projection permitting optimal visualization of the lesion. Lesions appeared as poorly marginated, radiolucent defects and were located at the level of the base of the proximal sesamoid bones. The shape and distribution of the radiolucent defects were: crescent, 4; flattened, 4; shallow concavity, 5; deep concavity, 3; oval, 3; and circular, 2. S...
