Written by a CuraCore Veterinary Medical Acupuncture course graduate. Signed release obtained from client/author. 4D2018051053
Abstract:
Zeb is a 7 year old terrier cross that has been previously diagnosed with bilateral cranial cruciate disease. No medications or other therapies have been attempted.
On initial examination, Zeb was walking fairly comfortably. Both stifles had evidence of thickening (left worse than right). On myofascial examination, Zeb’s main trigger points were along his thoracolumbar musculature. Points in this region, focal trigger points and around his stifles were the focus of his treatments. Three treatments were performed at weekly intervals were performed with monthly treatments recommended in the future.
History and Presentation:
Zeb is a 7 year old male castrated terrier cross that has been previously diagnosed with bilateral cranial cruciate disease. Owner reports that Zeb appears uncomfortable after moderate walks and favors the left hind limb more than the right. She is concerned that Zeb is more uncomfortable and expressed interest in acupuncture treatment for management of discomfort associated with his diseased stifles. No medications have been administered
Physical Examination and Clinical Assessments:
On April 8th, Zeb presented for his initial acupuncture treatment. His physical examination revealed normal vital parameters. He was walking fairly comfortably but would occasionally bunny hop in the hind end when running around. His myofascial examination revealed moderate trigger points along the thoracolumbar epaxial muscles with the right side being more sensitive than the left. He also had focal trigger points along his caudal neck and around his stifles.
Differential Diagnoses:
Pelvic limb lameness
– Traumatic (Cranial cruciate disease, fracture, soft tissue injury)
– Neoplastic (osteosarcoma, fibrosarcoma, chondrosarcoma, multiple myeloma in spine)
– Infectious (osteomyelitis of pelvic limbs or spine)
– Degenerative (IVDD, arthritis)
– Congenital (hip dysplasia, patella luxation)
Wind up pain due to compensation for pain in hind limbs
Definitive (or Putative) Diagnosis (or Diagnoses):
Chronic bilateral cranial cruciate disease (previously diagnosed)
Medical Decision Making:
The plan discussed with the owner was to do dry needling with focus on stifle points and focal trigger points.
Acupuncture Treatments:
Planned weekly acupuncture for 3 treatments, then once monthly if Zeb tolerated and benefited from the treatments.
4/8: Neck points: GV 14. Back points: BL 19-23, Bai Hui, Stifle point: ST 36
4/15: Neck points: GV 14. Back points: BL 18 and 20 (severe trigger point at BL 19), 22, 23, 25, 27, 28, and Bai Hui, Stifle point: ST 36
4/26: Neck points: BL 10, GV 14. Back points: BL Bl 18- 20, 22, 23, 25, 27, 28, and Bai Hui
The neck and back points were selected due to sensitivity on myofascial examination. ST36 was used for direct treatment of the cranial cruciate disease.
Needles Used: Seirin 0.16 x 30mm. Electrostimulation not used due to smaller needle size.
Outcomes, Discussions, and References:
Zeb tolerated his acupuncture treatments well. His owner reports that Zeb tolerated longer walks even after only two treatments. His back was less sensitive to palpation with each session.
Cranial Cruciate ligament disease is a commonly recognized ailment in the veterinary field. Surgical correction after rupture of the ligament remains the current treatment recommendation. However, a new focus relies on earlier diagnosis of the disease in order to prevent progression of the disease. Acupuncture may provide additional pain modulation and circulatory modulation for management of this debilitating disease. This case taught me the importance of the myofascial exam and to view my patient as a whole. It is easy to focus on the main problem at hand, but the subsequent discomfort in Zeb’s back and neck from compensation was not something I was expecting.
Over the years, dry needling has become a popular treatment technique in physical therapy for myofascial pain and trigger points. The advantages include reduction in local, referred and widespread pain, restoration of range of motion and muscle activation patterns, and normalization of immediate chemical environment of active myofascial trigger points. “Inactivation of latent trigger points with dry needling or with manual pressure techniques may prevent the development of active trigger points and reduce and in many cases remove their nociceptive input, normalize the synaptic efficacy, and reduce peripheral and central sensitization”. In humans, dry needling has showed comparable effects to injections of lidocaine with a longer-term reduction of pain. Acupuncture is now very commonly used in human medicine for the treatment of osteoarthritis in the knee.
Dommerholt, Jan. “Dry needling – peripheral and central considerations.” The Journal of manual & manipulative therapy vol. 19,4 (2011): 223-7. doi:10.1179/106698111X13129729552065
Describe Your Impressions of this Medical Acupuncture Experience:
This was a great first acupuncture experience. Zeb was a great patient and thoroughly enjoyed his acupuncture treatment. It was very rewarding to see the changes in his comfort for the days following his acupuncture treatments.