Surgery for horses encompasses a range of procedures performed to diagnose, treat, or manage various medical conditions. These procedures may involve soft tissue or orthopedic interventions and require specialized techniques to accommodate the unique anatomical and physiological characteristics of equines. Common surgical procedures in horses include colic surgery, fracture repair, and arthroscopy. The success of equine surgery depends on numerous factors, including the type of procedure, the horse's overall health, and post-operative care. This page compiles peer-reviewed research studies and scholarly articles that explore surgical techniques, outcomes, and advancements in equine surgical practices.
Pascoe JR, Ellenburg TV, Culbertson MR, Meagher DM.A 360-degree torsion of the left spermatic cord was diagnosed in a 2 1/2-year-old Quarter Horse colt. Clinical signs included abdominal discomfort, with slight elevations in heart and respiratory rates. The scrotum on the left side was moist and edematous. The left testicle was enlarged, firm, and retracted slightly toward the abdominal cavity. The colt resented palpation of the testicle. On rectal palpation, the left vaginal ring and the structures passing through the ring were edematous and painful to pressure. Surgical correction was achieved by emasculation. The tail of the epididymis and ...
Manohar M, Thurmon JC, Tranquilli WJ, Shawley RV, Froelich P.A technique was developed for long-term catheterization of the coronary sinus in calves and ponies. A catheter with a 10 to 12 cm-long stiff segment was implanted via right lateral thoracotomy. Catheters were kept patent up to 10 weeks after the surgical procedure. At that time, location of the catheter tip was confirmed both by determining oxygen tension of the anaerobically sampled blood and by radiography. Base-line values of oxygen venous blood of non-anesthetized calves and ponies are reported.
Haynes PF, Snider TG, McClure JR, McClure JJ.Chronic chondritis of the arytenoid cartilage was diagnosed in 7 male Thoroughbred horses examined for obstructive upper airway disorders. The history of the cases was characterized by a 3- to 6-month progression of exercise intolerance and inspiratory dyspnea during exercise. Endoscopy revealed marked asymmetry of the rima glottidis, partial or complete inability to abduct the involved cartilage, and axial displacement of the involved arytenoid cartilage. In less severe cases, the disorder was confused with laryngeal hemiplegia. Focal elevated lesions of the involved cartilage, which were fre...
Irwin DH, Howell DW.The clinical and laboratory findings of illness in a 2-year-old Thoroughbred filly are described. The treatment employed, including unilateral nephrectomy, and the macro- and microscopic findings in the diseases kidney are presented and this rare case is discussed briefly.
Bisgard GE, Forster HV, Klein JP.Resting ventilation (PaCO2) and ventilatory responses to acute hypoxia and to intravenous NaCN were assessed over a 4-yr period following cutting of the carotid sinus nerves and stripping the adventitia of the aortic arch. The data indicated essentially complete loss of peripheral chemoreceptor function immediately after surgery and hypoventilation during normoxia (delta PaCO2 = +8.7 Torr). There was a time-dependent, partial recovery of peripheral chemoreceptor function between 2 and 22 mo after surgery. Approximately 10% of the ventilatory response to iv NaCN returned, and 30-40% of the norm...
Turner TA, Fessler JF.Eleven horses with rectal prolapses were examined at Purdue University. Nine of the 11 prolapses were corrected by submucosal resection. Four of those were treated by a modified submucosal resection that apposes mucosa as well as submucosa. Follow-up of 8 cases, at intervals ranging from 4 months to 6 years, established that rectal prolapse did not recur following the resection.
Taylor TS, Vaughan JT.A study was conducted in an effort to explain why digital necrosis sometimes follows neurectomy in the horse. Six horses were subjected to unilateral section of the medial and lateral palmar nerves. Arteriography was done on each digit prior to surgery. Terminally, arteriography was repeated. Sections of bone, nerve, artery, skin, coronary band, and deep flexor tendon were examined histologically. Changes in arterial pattern and bone quality were noted. During the study, 2 of the horses had clinical signs of digital necrosis. The composite findings suggested trauma or infection, or both, of th...
Bryans JT.The immunogenic potency and safety of a chemically inactivated equine herpesvirus 1 vaccine with added adjuvant was evaluated by testing serum-neutralizing and complement-fixation antibody responses of pregnant Thoroughbred mares. The vaccinated population comprised 321 pregnant mares on 7 farms; 3 in Normandy, France; 1 in Kildare, Ireland; and 3 in central Kentucky. The pattern of antibody response to vaccination was found qualitatively and quantitatively similar to that of pregnant mares previously vaccinated and determined by challenge exposure to be immune to abortigenic infection under e...
van Veenendaal JC, Moffatt RE.Eight cases of sessile, intra-articular soft tissue masses originating from the cranio-dorsal attachment of the capsule of the fetlock joint of horses are presented. In 4 of these cases an osteochondral fracture of the first phalanx was also present. Clinically the condition closely resembled villonodular synovitis; however the microscopic changes did not correspond to those reported. The clinical signs included lameness after exercise, joint effusion and pain on manipulation. The offending masses were surgically resected and their histology indicated a chronic proliferative synovitis. The res...
Mason TA.A case of bicipital bursitis in a six-year-old mare is described. The horse was presented with acute lameness, pyrexia and hot swelling over the right shoulder region. Although antibiotic treatment relieved these signs, a firm cold swelling remained which had to be removed by surgical resection and drainage.
Lowe JE, Sellers AF, Brondum J.Pelvic flexure fistulas (2.5 cm diameter) were established in eight 160 kg Shetland X ponies. Impaction was induced at the pelvic flexure 25 times in the 8 animals through partial obstruction by a 1 litre rubber rebreathing bag fixed at the fistula site. Blood flow probes were implanted on the dorsal and ventral colic arteries (right colic artery and colic branch of ileocolic artery) in two of the ponies. Intraluminal pressure changes were measured at 8 different locations in the large colon during episodes of colic and following administration of flunixin or xylazine. Episodes of colic charac...
Riggott JM, Quarmby WB.A surgically excised tumour from the thoracic wall of a hunter mare was diagnosed as a fibrosarcoma on histological examination. Its recurrence necessitated further surgery 6 weeks later. Because of the invasive nature of the lesion a prolonged course of chemotherapy was administered postoperatively. The tumour did not recur a second time.
Barclay WP, Foerner JJ, Phillips TN.Volvulus of the large colon was diagnosed at surgery in 25 horses during a 4-year period. Two horses had a recurrence of the condition after successful correction. Mucosal necrosis was found to be a grave prognostic sign, as it was a consistent finding in horses that died at the time of surgery. Long-term colon dysfunction was not clinically evident in surviving horses.
British medical journalSeptember 13, 1980
Volume 281, Issue 6242 699-702 doi: 10.1136/bmj.281.6242.699
English TA, Cooper DK, Cory-Pearce R.The major factors contributing to the recommencement of clinical heart transplantation in the United Kingdom last year were the steadily improving results from Stanford University, the clarification of the diagnosis of brain death, and advances in preserving donor hearts. Twelve men aged 16 to 52 years received heart transplants at Papworth Hospital from January 1979 to July 1980. Six had cardiomyopathies and six ischaemic heart disease. The donors were aged 16 to 35 (mean 21) years. A combination of road and air transport was used to transport the heart to Papworth in seven cases. The total d...
Tate LP, Evans LH.Cryoneurectomy was performed experimentally on 10 digital plantar nerves of normal horses. All nerves were frozen to -30 C, using a double freeze-thaw cycle. Nerves were harvested at 10 days and at 4, 12, 16, and 24 weeks and were examined histologically for evidence of regeneration. The terminal portion of the transected nerves treated with cryosurgery did not have any signs of regeneration or neuroma formation at these periods. Cryoneurectomy was performed on 101 nerves of 32 horses with diseases requiring neurectomy. Twenty-seven of these nerves had been subjected to previous neurectomy, an...
Dória RGS, Reginato GM, Hayasaka YB, Fantinato Neto P, Passarelli D, Arantes JA.Percutaneous decompression of the cecum is a procedure that could be considered for horses with cecal gas distension. The aim of this study was to identify complications such as peritonitis and clinically relevant peritonitis (CRP) after transabdominal cecal trocarization in healthy horses using a cattle trocar and a cecal needle. Mixed breed horses were assigned to three groups (n = 6): horses that underwent trocarization with a cecal needle (G1) or a cattle trocar (G2), and a control group (CG) without cecal trocarization. The same horses were used in each group, respecting a three-month was...
A 1.8-year-old maiden Thoroughbred filly, without previous history of mating or reproductive management, was referred for clinical inspection due to the presence of sanguineous vaginal discharge and severe abdominal pain. Transrectal palpation indicated uterine asymmetry, and transrectal ultrasonography revealed a mass near the cervix measuring 8.3 cm in diameter, with heterogeneous echogenicity, a trabeculated center, and a well-defined hyperechoic border. Smaller masses surrounded the larger uterine mass. During the examination, the mare expelled a uterine mass through the vulva. Histologica...
Stick JA, Slocombe RF, Derksen FJ, Scott EA.Esophageal healing was studied in 12 ponies after cervical esophagotomy. The esophagus was sutured, feed and water were withheld for 48 hours, and then all ponies were permitted to eat. In group I (n = 6), a longitudinal esophagotomy was made. In group II (n = 6), a rotational esophagotomy was made with the mucosal incision 180 degrees away from the incision in the esophageal muscle. Three ponies in each group were fed a soft diet ad libitum for 9 days, and then were allowed access to hay and grain. The remaining ponies were fed hay and grain. The esophagotomies of all hay-fed ponies dehisced ...
Murray RC, Gaughan EM, DeBowes RM, Mosier DA, Hoskinson JJ.Biaxial palmar digital neurectomy of all limbs was performed on 6 mixed-breed castrated adult male horses, using a standard guillotine method. Using a Teflon catheter, 20 mg (2 ml) of sodium hyaluronate (group 1), 2 ml of phosphate-buffered saline solution (group 2), or catheter placement with no infusion (group 3) was applied to 4 (group 1) or 2 (groups 2 and 3) of 8 incisions/horse. Treatments were administered after closure of the neurectomy incision, and the catheter was removed. Horses were evaluated daily for 1 week, then weekly over a 9-week period for evidence of lameness, swelling, an...
Spier SJ, Meagher DM.Rational perioperative management improves the success rate of abdominal surgery. Important aspects of management are discussed, including principles of fluid therapy, nutrition, intravenous catheterization, antimicrobial prophylaxis, and the use of nonsteroidal anti-inflammatory medication. Current advances in the area of immunotherapy are mentioned.
Sod GA, Mitchell CF, Hubert JD, Martin GS, Gill MS.To compare monotonic biomechanical properties and fatigue life of a 5.5 mm broad limited-contact dynamic compression plate (5.5-LC-DCP) fixation with a 4.5 mm broad LC-DCP (4.5-LC-DCP) fixation to repair osteotomized equine third metacarpal (MC3) bones. Methods: In vitro biomechanical testing of paired cadaveric equine MC3 with a mid-diaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. Methods: Adult equine cadaveric MC3 bones (n=18 pair). Methods: MC3 were divided into 3 test groups (6 pairs each) for: (1) 4-point bending single cycle to failure testing; (2) 4-point bendi...
Alves BG, Alves KA, Hyde KA, Aguiar FLN, Souza SS, Brandão FAS, Garcia EC, Pinto Y, Gastal MO, Figueiredo JR, Teixeira DIA, Gastal EL.Ovarian tissue transplantation (OTT) is a technique well established and successfully applied in humans using mainly orthotopic or heterotopic transplantation sites. In livestock, OTT is still in its infancy and, therefore, different aspects of the technique, including the efficiency of different heterotopic OTT sites as well as the potential effect of age (i.e., young vs. old mares) in the ovarian graft quality, need to be investigated. The present study investigated the efficacy of the intramuscular (IM) or the novel subvulvar mucosa (SV) heterotopic autotransplantation sites to maintain the...
Thurston CC, Stefanovski D, MacKinnon MC, Chapman HS, Richardson DW, Levine DG.The objective of this study was to determine the diagnostic ability of serum amyloid A (SAA) and fibrinogen for early detection of surgical site infection (SSI) after equine internal fixation. Horses undergoing internal fixation for fracture, arthrodesis, or osteotomy with internal fixation for limb deformity were included in the study. SAA and fibrinogen were measured on blood samples preoperatively and on days 1, 3, 5, 7, 10, and 14 postoperatively. Statistical analysis included use of Spearman's rank correlation, logistic regression, and calculating the area under the receiver operating cha...
Dias IR, Maia LM, Quaresma M, Cotovio M, Silva FC.Complete fractures of the third metacarpal/metatarsal bones (Mc/t3) are not common, but can occur in various situations and all types of horses, contributing for approximately one third of all long bone fractures in the horse, mostly related to external trauma or to high energy injuries. To stabilize Mc/t3 fractures in the horse, conservative management with walking casts and/or open reduction and internal fixation techniques are referred in the scientific literature, these last one generally by double platting application to bone surface in 90 degrees. In the present case will be described a ...
Dinev D, Andonova M.To compare the effect of anesthesia alone with anesthesia and abdominal surgery on plasma thromboxane B(2) concentrations in horses. Methods: Non-randomized experimental study. Methods: Six male mixed-bred horses (5-12 years, 350 +/- 18 kg). Methods: All horses were anesthetized for 2.5 hours using halothane, and a month later abdominal surgery was performed using the same anesthetic technique with a similar duration. The schedule of anesthesia included pre-medication with diazepam (0.1 mg kg(-1) IM), followed by xylazine (2.2 mg kg(-1) IV), and 10 minutes later anesthesia was induced with ket...
Woodger K, Stone EA.This article seeks to examine the history of equine surgery at the Ontario Veterinary College (OVC) in the context of the changing horse economy during the first half of the 20th century. We argue that despite the transition to livestock medicine, public health and small animal practice, the horse, especially as a surgical topic, retained a (diminished) place at OVC due to the lucrative new recreational equine market, the deep links between horses and veterinary medicine, and the equine focus for nearly half a century of Dr. W.J.R. Fowler, the College's primary surgical instructor.
Van Hoogmoed LM, Snyder JR, Nieto JE, Vatistas NJ, Harmon FA.To determine efficacy of an extracorporeal circuit to maintain a segment of equine large colon for 3.5 hours and to evaluate the effect of low arterial flow on histologic and metabolic variables. Methods: Segments of large colon from 15 healthy adult horses. Methods: The pelvic flexure was surgically removed and maintained in an isolated circuit. In the control group, tissue was evaluated for 3.5 hours, whereas in the low-flow group, arterial flow was reduced to 20% of baseline for 40 minutes followed by 2 hours of reperfusion. Various metabolic and hemodynamic variables were evaluated at 30-m...
Riggs CM, Riggs SJ, Cheung TY, Tsang F, Oldaker L.Equine surgical facilities are not always available, even in situations where high-value horses are involved in relatively high-risk activities. Objective: To develop a self-contained equine surgical unit that can be relocated and transported by road. Methods: Proof of concept. Methods: A modular operating suite for horses, which included a theatre, scrub room, instrument preparation and storage room, and an anaesthetic induction/recovery box: Transportable Equine Operating Theatre (TEOT) was designed, constructed and tested. A second, larger unit was then built following the same design crite...
Rubio-Martínez LM, Bracamonte JL, Tompkins S, Villarino NF.To describe a transthecal approach to the palmar pouch of the distal interphalangeal joint (DIPJ) in horses and compare it with the conventional blind arthroscopic technique. Methods: Ex vivo study. Methods: Cadaver forelimbs (n = 26 pairs) from mature horses. Methods: One limb from each pair was randomly assigned to each arthroscopic approach (conventional or transthecal). The conventional arthroscopic approach was performed as previously described and the transthecal approach was performed through sharp dissection of the distal reflection of the digital flexor tendon sheath (DFTS). The propo...
Delacalle J, Burba DJ, Tetens J, Moore RM.To report an neodymium:yttrium-aluminum garnet (Nd:YAG) laser-assisted modified Forssell's surgical technique and outcome for treatment of cribbing (crib-biting) in horses. Methods: Retrospective clinical study. Methods: Ten adult horses with stereotypic cribbing behavior. Methods: Data were obtained from medical records and telephone conversations with owners, trainers, and veterinarians. Surgical technique involved an approximately 34-cm ventral median skin incision starting rostral to the larynx and extending caudally. A 10-cm section of the ventral branch of the spinal accessory nerve was ...
Becker M.During the last 10 years 268 laparotomies by a midline incision were performed. A high incidence of seromas, fistulas caused by suturing material and wound ruptures were observed. After finding only a small number of publications in the veterinary medicine about wound healing disturbances an analysis of the human medical literature was done. This induced the change of our surgical procedure and suturing technique: The midline incision and surgical management during the laparotomies in 14 horses suffering from colic were performed by a minimized trauma. The abdominal wall was closed layer by la...
Bueno AC, Galuppo LD, Taylor KT, Jensen DG, Stover SM.To compare the mechanical shear strengths and stiffnesses obtained from in vitro testing of a simulated complete third carpal bone (C3) frontal plane radial facet slab fracture (osteotomy) stabilized with either a 4/5 Acutrak (AT) compression screw or a 4.5-mm AO cortical bone (AO) screw inserted in lag fashion. Drilling, tapping, and screw insertion torques, forces, and times also were compared between AT and AO implants. Methods: In vitro biomechanical assessment of site preparation, screw insertion, and shear failure test variables of bone screw stabilized simulated C3 slab fracture in pair...
Davis JG, Ragle CA, Hanna A, DeNome AT.To determine the location of the deep and superficial caudal epigastric arteries in relation to 3 midline positions and the relationship between the location of these arteries, body circumference, and body condition score. Methods: Descriptive anatomical study. Methods: Nine horses, aged 1-28 years (mean 10.61 ± 8.89 SD). Methods: Body condition score and body circumference were measured prior to euthanasia. Angiographic studies of the deep and superficial caudal epigastric arteries were performed on resected abdominal walls. The distances between the deep and the superficial caudal epiga...
Quinteros DD, García-López JM, Abuja GA, Tarkanian M, Maranda LS, Bubeck K, Kowaleski MP.To determine if the mechanical properties (strength and stiffness) of a new prototype 4.5 mm broad locking plate (NP-LP) are comparable with those of a traditional 4.5 mm broad limited-contact self compression plate (LC-SCP), and to compare the bending and torsional properties of the NP-LP and LC-SCP when used in osteotomized equine third metacarpal bones (MC3). Methods: The plates alone were tested in four-point bending single cycle to failure. The MC3-plate constructs were created with mid-diaphyseal osteotomies with a 1 cm gap. Constructs were tested in four-point bending single cycle to fa...
Ramzan PHL, Wylie CE.Arthroscopy is considered the treatment of choice for dorsal osteochondral chip fractures of the metacarpo/metatarsophalangeal (MCP/MTP) joints in the racehorse; however, there is no published research on non-surgical management of this injury. Objective: To compare clinical features, intra-articular medication use and return to racing in Thoroughbred racehorses with non-surgically (non-SX) or surgically (SX) managed MCP/MTP dorsal chip fracture. Methods: Retrospective observational study conducted between 2006 and 2014. Methods: Radiographs of Thoroughbred racehorses were reviewed to identify...
Roe HA, Biedrzycki AH, Davenport PW, Freeman DE, Porter EG, McCarrel TM.To develop 3D models of larynges to compare arytenoid abduction measurements between specimens and models, and to investigate the anatomic feasibility of placing an implant across the cricoarytenoid joint (CAJ) with or without arthrotomy. Methods: Cadaveric equine larynges (n = 9). Methods: Equine larynges underwent sequential CT scans in a neutral position and with 2 arytenoid treatments: bilateral arytenoid abduction (ABD) and bilateral arytenoid abduction after left cricoarytenoid joint arthrotomy (ARTH). Soft tissue, cartilage, and luminal volume 3-dimensional models were generated. Rima g...
Miller S, Carstens A.Laryngoplasty is commonly used to treat laryngeal hemiplegia in Thoroughbred racehorses. Evaluation of the success of the laryngoplasty is traditionally determined using endoscopy. Laryngeal ultrasonography and normal ultrasonographic appearance have been reported in the standing horse, but post-laryngoplasty and ventriculectomy ultrasonographic evaluation has limited literature coverage. A prospective case series of 10 Thoroughbred racehorses with left laryngeal hemiplegia was examined ultrasonographically and endoscopically prior to 3-10 days, 30-50 days, and 6-12 months after laryngoplasty ...
Dujardin CL, Gootjes P, Moens Y.To quantify the isoflurane measurement error arising from the use of short wavelength infrared (IR) anaesthetic gas analysis during low flow anaesthesia in horses. Methods: Prospective clinical study. Methods: Sixty-four client-owned horses referred for elective or emergency surgery (age 1-16 years, body mass 400-650 kg). Methods: Horses were divided into four groups based on duration of pre-anaesthetic food deprivation period (FDP) and fresh gas flow during anaesthesia: a high flow group with normal FDP (n = 16) and three groups with low flow and normal (n = 29), long (n = 5) or no (n = 14) F...
Rahm C, Ito K, Auer J.To compare acute fixation stability and insertion effort of cortex bone screws with and without a shaft inserted in lag fashion in equine metacarpal (metatarsal, MC(T)III) bone. Methods: Screw types with independent variables of screw diameter (4.5 or 5.5 mm) and shaft type (without shaft, with 20-mm shaft, or with 25-mm shaft) were studied. Bone specimens cut from distal equine MC(T)III condyles were used. After screw insertion in lag fashion into 2 bone blocks with an instrumented device, shear tests were conducted in a mechanical testing machine. Outcome variables of peak insertion torque, ...
Mariën T, Adriaenssen A, Segers L.A modified colon tray to perform large colon evacuations in horses was designed. A funnel-shaped accessory was constructed to create a mechanical separation between the sterile and nonsterile part of the tray. Sterile hooks were used to make a temporary and stabile colostomy. Thirty horses with surgical correction of nonstrangulating large colon obstruction underwent a large colon evacuation with this modified tray. The surgical procedure was uncomplicated and resulted in a positive outcome in 29 horses. This less labour-intensive way to evacuate the large colon results in minor contamination ...
Bodaan CJ, Riley CB, Engeli E.The objectives of this study were to evaluate the likelihood of successful arthrocentesis of the equine elbow joint using the caudolateral approach and to determine if the deep branch of the radial nerve (DBRN) varies in its proximity to the site of centesis. Methylene blue (MB) was injected into 71 elbow joint specimens immediately caudal to the lateral collateral ligament using a 3.8-cm needle advanced to its hub. The elbow joints were dissected, staining of the synovial structures assessed and the proximity of DBRN to the site of centesis evaluated. The articular cartilage of all 71 joints ...
Held JP, Patton CS, Toal RL, Geiser DR.A thyroid carcinoma was diagnosed in a 14-year-old competitive trail horse with a 3-month history of work intolerance. Abnormal findings included low base-line triiodothyronine (T3) and thyroxine (T4) values, a large thyroid gland and decreased work tolerance. Nuclear medicine scanning revealed displacement of the right thyroid gland by a mass. Needle biopsy of the mass revealed neoplastic changes compatible with thyroid carcinoma. After removing the tumor surgically, T3 and T4 values returned to normal. Subsequently, the horse was able to compete successfully. Horses with work intolerance com...
Major MD, Grant BD, White KK, Ratzlaff MH, Gallina AM, Crawley GR.Mechanical properties of equine suspensory apparatus preparations and three braided synthetic prostheses were evaluated in vitro. Force versus displacement plots and failure modes were recorded from single load-to-failure testing in 18 cadaver limbs before and after replacement of each suspensory apparatus with a prosthesis. Mean load at failure, energy to failure, and stiffness values of polytetrafluoroethylene (PTFE) prostheses were lower than those of the suspensory apparatus and aramid prosthesis. The PTFE prosthesis failed by elongation or rupture of the prosthesis. Mechanical properties ...
McAndrews A, Zarucco L, Hopster K, Stefanovski D, Foster D, Driessen B.Maxillary nerve blocks (MNBs) commonly facilitate dental surgeries in standing horses. The goal of this prospective, blinded, cross-over design trial including 15 client-owned horses was to evaluate 3 methods of sensory function testing for confirming a successful MNB. Testing was performed bilaterally before sedation, 5 min after sedation, and 15 and 30 min after MNB with 0.5% bupivacaine and involved a needle prick dorsal to each naris, hemostat clamping of each nostril, and gingival algometry (measuring sensitivity to pain). Responses to stimulation were numerically scored and scores were s...
Huber MJ, Grisel GR.An 18-month-old 450-kg [990-lb] sexually intact male Holsteiner was evaluated for lameness of the left forelimb of 3-months' duration. We were unable to localize the site of lameness, using intra-articular and perineural anesthesia, and radiography of the shoulder and cubital joint (elbow) did not reveal radiographic abnormalities. Nuclear scintigraphy was performed. An increase in radio-isotope uptake was evident at the lateral epicondyle of the left humerus. Radiographs of the region 3 weeks later revealed a 1.5-cm focal lucency surrounded by a 1.0-cm rim of necrotic bone. The lesion was con...
