Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017051

Abstract: Bunny, a 4 year old FS Chihuahua, has been under my care for acupuncture treatments
to aid in comfort and function relative to luxating patellas and secondary myofascial dysfunction.
Her acupuncture treatments, in conjunction with other rehabilitation modalities, have improved
her overall comfort and stamina.

History and Presentation: Bunny is a 4 year old FS Chihuahua that first presented to our hospital
on 7/6/17 for rehabilitation and pain control. Bunny was adopted from a shelter 4 months prior,
and has been diagnosed with severe luxating patellas by her regular veterinarian. Radiographs
were taken at the referring veterinarian’s office in March 2017, and although they were not
available for review, they were read as generally unremarkable other than evidence of arthritis in
both stifles. Since adoption, she has not been able to sit, has difficulty getting into the down
position, and is unable to jump up. She prefers to stand and enjoys short walks. The owner’s
main goal is to avoid surgery by improving overall strength, flexibility, and pain control.

Physical Examination and Clinical Assessments: Physical examination revealed a moderate
kyphotic posture. Bunny weight shifts to the thoracic limbs and has a wide based stance in the
pelvic limbs. Discomfort was noted in extending both hips and extending the left shoulder. She
was noted to have bilateral stifle crepitus with bilateral grade III/IV medial patellar luxation. On
myofascial palpation, trigger points were noted in the lumbar paraspinal muscles, bilaterally in
the Sartorius and Tensor Fasciae Latae muscles, and left Suprascapular muscle. She is
ambulatory in all limbs with a mild weight bearing lameness in the left thoracic limb and wide
based asymmetrical gait in the pelvic limbs. Neurologic examination was unremarkable. She has
muscle atrophy in both pelvic limbs, but more significantly in the right pelvic limb.

Medical Decision Making: A multimodal treatment protocol was initiated. We started Bunny on
Adequan injections to help with joint health. Our Certified Canine Rehabilitation Practitioner
started hydrotherapy sessions in the underwater treadmill to help promote improved muscle
conditioning, and instituted low level laser therapy with a class IIIb laser to help with
inflammation and chronic pain. Acupuncture was started to help with general comfort and pain.
My approach with acupuncture was to help stimulate the parasympathetic nervous system and
down regulate the over stimulation of the sympathetic nervous system due to constant tension
and pain. I wanted to locally treat areas of inflammation and subsequent myofascial dysfunction
as well as trying to relieve trigger points that had developed.

Differential Diagnoses: Grade III/IV luxating patellas, cruciate/collateral ligament damage, hip
and/or left shoulder dysplasia, secondary osteoarthritis (stifles, hips, left shoulder), intervertebral
disc disease, chronic soft tissue/muscle strain and nerve entrapment.

Definitive Diagnoses: As diagnostics are limited in this case, the only definitive diagnoses are
the luxating patellas and the trigger points. The discomfort at the above locations could be due to
a combination of the differentials listed above, but it was deemed appropriate to start treating the
focal disease and secondary myofascial dysfunction, and reassess the patient’s progress.

Acupuncture Treatments: Dry needling was used (electroacupuncture unit not available at this
time). After trial and error, we found that 0.12 X 15mm coated seirin needles were tolerated best
by the patient. Points used include ST 34, ST 36, GB 33, GB 34 for stifle pain; GB 29, GB 30 for
hip pain; BL 20, BL 21, BL 22, BL 23, BL 25, BL 27, BL 28, Bai Hui for spinal pain; SI 11, SI
12, LI 15, TH 14 for shoulder pain; GV 20, GV 14, ST 36, LI 11 for sympathetic regulation and
relaxation/agitation control. We are unable to do all points at each session, and are still working
on the best combinations per treatment. We are treating weekly, concurrently with her
rehabilitation therapy that was described above, and have had six appointments so far.

Outcomes, Discussions: The owner has reported that the patient has increased overall energy, and
is able to walk longer on leash with the other dog. She is also able to get comfortable more
quickly when resting, and sleeps more deeply. After her first acupuncture appointment, she was
sleeping so soundly that she actually urinated in her bed.


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