Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 10D2017033

Abstract:
Pearl has been a patient of the Veterinary Hospital since October 2016 and has had prior episodes of pain and clinic signs associated with possible intervertebral disc disease. In November of 2017 she presented t for evaluation of left forelimb lameness. She was treated twice weekly with acupuncture for 4 weeks with resolution of clinical signs.

History and Presentation:
Pearl is an approximately 5 year Shih-tzu that presented on 11/17/2017 for left forelimb lameness for 3 days duration. Pearl does have prior history of intervertebral disc disease symptoms she was treated for at a local emergency hospital with corticosteroids, muscle relaxers, and gabapentin. She has continued hind limb ataxia and weakness as a result of that episode.

Physical Examination and Clinical Assessments:
Physical examination revealed a grade III lameness on the left forelimb. Taught bands were located along the left cervical region. Pearl would shake the limb when scapular musculature was palpated. She also exhibited tenderness along the same musculature and the caudal thoracic paraspinal muscles. Using treats to elicit flexion of the neck, Pearl would flex 75% of the way to her right but resisted flexion to her left side. The pelvic limbs have maintained a mild ataxia and weakness as well.
Neurological examination revealed weakness and slower placement and hopping reflexes on the left forelimb.

Medical Decision Making:

Even though Pearl had a left forelimb lameness I did not find physical/neurological examination findings consistent with a lesion/injury primarily affecting the limb. The findings of her neurological evaluation with the orthopedic findings led me to suspect a lesion involving a caudal cervical intervertebral disc. My acupuncture plan consisted of choosing points that would directly stimulate the cervical spinal nerves affecting the left forelimb along with local points and trigger point therapy that would release the myofascial entrapment occurring in the limb as a secondary consequence of spinal nerve impingement. Points were also chosen to decrease sympathetic tone that can increase with the pain response.
Pearl was treated twice weekly for three weeks with acupuncture then weekly for 4 weeks.

Differential Diagnoses:
Cervical Intervertebral Disc Disease
Spinal Neoplasia
Auto-immune meningitis
Nerve entrapment

Definitive (or Putative) Diagnosis (or Diagnoses):
Caudal Cervical Intervertebral Disc- Unfortunately the owner did not wish to purse diagnostics at the time of Pearl’s presentation nor a neurology referral for advanced imaging, e.g. MRI. Due to her prior other episodes involving her thoracolumbar spine, she wished to proceed with acupuncture therapy to alleviate Pearl’s pain and symptoms. I also arrived at my diagnosis due to significant response to treatment. Other possibilities that could cause Pearl’s signs would not necessarily have responded to acupuncture therapy and would have progressed over the 7 weeks we treated Pearl.

Acupuncture Treatments:
11/17/2017- points chosen: Cervical spinal points, GV14, BL10, BL14, BL15, BL18, BL19, Bai Hui, trigger point therapy of the Cleidobrachialis. These points were chosen to treat the local myofascial restriction of the left forelimb, the cervical spinal nerves along with the taught bands along the left side of the neck. Additionally, the thoracic paraspinal myofascial restriction was directly treated along with points to help with pelvic limb dysfunction.
Patient was treated with dry needle only using Serin 0.16 X 15 mm needles
Patient was additionally treated with short course prednisolone therapy with her usual gabapentin twice daily.
11/21/2017- points chosen: All prior points; added BL21, BL22, BL28, BL54. Additional points were added for thoracolumbar pain and myofascial restriction along with additional points for hip pain and pelvic limb dysfunction.
Patient was treated with dry-needle only using DBC 0.16 X 15 mm needles
Owner was out of town for Thanksgiving holiday, hence 8 days passed between treatments.
11/29/2017- points chosen: BL10, GV14, BL14, BL15, BL21, BL54, GB21, SI12, SI11, trigger point therapy in the Cleidocephalicus for taught bands. SI11 and SI 12 added today for local myofascial pain/restriction along with direct stimulation of those spinal nerve segments.
Patient was treated with dry-needle only using DBC 0.16 X 15 mm needles.
Additional treatments were at twice weekly for two more weeks, then once weekly involved the same points utilized. Reasoning for those points chosen have been provided in previous treatments.

Outcomes, Discussions, and References:
By performing acupuncture treatments on Pearl, we were able to directly stimulate trigger points in the cervical musculature, disrupting the malfunctioning motor end plates and allowing them to regenerate. By stimulating the chosen points listed, we directly treated the restricted myofascia and nerve impingement causing pain to those areas. Once these treatments were performed, reevaluation revealed release of the musculature, immediate pain relief, and improved function of the left forelimb. These repeated treatments have allowed the pain, inflammation, and swelling of the affected cervical disc to subside and allow normal thoracic limb function. Additionally, by treating the secondary thoracolumbar and pelvic limb points, we helped her compensatory muscle tension and provided addition pain relief and improved mobility.

Acupuncture for Small Animal Neurologic Disorders
Vet Clin North Am Small Anim Pract. 2018 Jan;48(1):201-219. doi: 10.1016/j.cvsm.2017.08.003. Epub 2017 Oct 14.
Electro-acupuncture and Chinese herbs for treatment of cervical intervertebral disk disease in a dog.
J Vet Sci. 2007 Mar;8(1):95-8.


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