Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017047
Tina is a dressage horse that had a previous incident causing neck pain. She presented for mild right forelimb lameness. She had been given banamine and has had body work done by a technician to try and relieve some muscle tension. Through 3 courses of acupuncture, her muscle tension in her neck significantly decreased and her mild lameness was no longer visible. She would benefit from regular acupuncture sessions to continue to work on muscle tension in her neck
History and Presentation:
Tina is an 8 year old Morgan-Friesian mare who presented for a suspected right forelimb lameness. She has no history of lameness.The only previous healthy issues are an allergic dermatitis episode, where she then got her head stuck in a panel trying to itch herself a few months prior. No lameness occurred after that, but she did have some body work done after this episode – myofascial release on her neck and shoulders. She is used for dressage.
Physical Examination and Clinical Assessments:
Tina was BAR on examination. Walking on gravel, she demonstrated a mild right forelimb lameness. On Lunging to the left on soft ground, no lameness was seen. Lunging to the right, showed the lameness again. Myofascial palpation demonstrated tight bands across her caudal neck. Mild muscle fasciculations occurred when palpating over her caudal neck region bilaterally. She reacted to pressure more cranially on her neck near LI 18 on the right side. Trigger point found in deltoid muscle near SI 9
Medical Decision Making:
Tina’s lameness is mild, and her owner has already worked extensively on her neck muscles. She also is seen by a vet who does not perform acupuncture, and has given her banamine. My goal was to complement the treatment she had already received. I suspected she was sore in her foot due to examination findings as well as lack of pain response on flexions. I wanted to try and release trigger points and tight muscle in her neck from previous injury as well as compensating from favoring her right limb. She had never had acupuncture and we had to start slowly with number of needles
Neck vertebral injury, laminitis, other causes of forelimb lameness such as sweeny.
Definitive (or Putative) Diagnosis (or Diagnoses):
None made but suspect sole bruise on right fore limb in addition to some leftover neck pain and neck muscle tightness from previous injury
The first treatment was short – I brought the E-Stim unit to the barn, but Tina only tolerated the needles for about 10-15 minutes before becoming agitated and it was not used
GV 14 – central point that has neuro communications with muscles in the thoracic limb. I Also wanted to start with this point to judge Tinas’s acceptance of needless, and this point has a strong autonomic component that may calm her and make her more amenable to further needling.
Bai Hui – Tina Tolerated GV 14 well but was still pretty wound up so wanted to try Bai Hui as another good autonomic point to see if we could get her some parasympathomimetic stimulation
LI 16 and LI 17 -Fore forelimb lameness and pain. Also good for caudal cervical muscle tightness. I did LI 17 on both sides.
Bl 11-12 – over Scapulae to try and access neuromodulation near the brachial plexus.
LI 11 (probably placed closer to LI 10) – for forelimb lameness and pain as well as for autonomic stimulation. She was sensitive to this needle. It stayed in for about 3 minutes before she repeated tried to flick it out with her mouth.
After she shook out needles and attempted to bite others out, massage was used over her neck and shoulder muscle and down her spine
The next session 7 days later- similar myofascial exam. Still taut bands on caudal neck. Began with GV 14. Less sensitive to elbow points – LI 10, this one staying in for the duration of treatment Still showing reactivity to LI 18 area, a strong indicator of hoof pain. Repeated treatment at that point. Added GB 21 bilaterally to try and address caudal cervical pain. E-stim from LI 18 → GB 21 on the right side. Trigger point around SI – 9 – used this point for caudal cervical spinal nerve points as well as local to the shoulder. This session lasted about 15 minutes
Third Session 4 days later -Did not appreciate lameness when walking on the gravel as I did on the first day. Began with GV 14 again. During exam, I did not elicit soreness in LI 18 region. This was needled still and was accepted well. Muscle tension in her caudal neck also seemed to be decreased bilaterally, though still present. Fewer taut bands were felt in her neck region. E-stim from LI 17 → GB 21 this time bilaterally to continue to release any tension in her caudal neck region. Li 11 repeated on right side.
Outcomes, Discussions, and References:
Acupuncture can be a great tool for pain in horses, especially for clients who have given their horses chronic phenylbutazone or banamine treatments. Xie et al found that three sessions of electroacupuncture had better results of relieving pain, than did using phenylbutazone. Bute can be an overused medication, and though reasonably safe, may not be the best option in some of our patients.
This was my first acupuncture session on an equine patient (and only so far), as they are not a large part of my practice. It was a learning experience for me on how quickly horses can decide they are done with treatment. I think for me, working with the other veterinarian in the practice who sees horses regularly to try and encourage him to recommend acupuncture, as well as putting myself out there more for equine acupuncture, will make me more successful in treating equine patients.
Xie, H, et al. “Evaluation of Electroacupuncture Treatment of Horses with Signs of Chronic Thoracolumbar Pain.” Journal of the American Veterinary Medical Association., U.S. National Library of Medicine, 15 July 2005, www.ncbi.nlm.nih.gov/pubmed/16047667.