Written by a Medical Acupuncture for Veterinarians course graduate.  Author’s name available upon request.  Signed release obtained from client/author.  4382

Abstract

Osteoarthritis is a progressive and degenerative condition.  An estimated 25% of dogs are diagnosed with osteoarthritis, and as many as 60% of dogs have radiographic evidence of this condition.1

Cybil is senior shelter dog with clinical signs consistent with osteoarthritis.  She was treated with acupuncture and had a positive result with improvements in mobility and mentation.

History and Presentation

Cybil is an approximately 7 year-old female spayed shepherd mix that has been suffering from osteoarthritis.  Her history is unknown since she was brought to the shelter as a stray.  When found as a stray she was unable to walk or stand up, however when she arrived at the clinic she was able to walk although it was a stiff gait.  She was being treated with 50 milligrams of carprofen twice daily.

Physical Examination and Clinical Assessments

On presentation, Cybil was bright, alert and responsive.  She was thin with a BCS of 3/9.  She walked with a stiff gait and shortened stride, especially in the hind end.  Her gluteal muscles were atrophied.  On myofascial palpation, pain was elicited on thoracolumbar and lumbosacral palpation.  She had decreased mobility in her hip, especially in extension.  No pain or crepitus were found on stifle flexion or extension.  In addition, trigger points were found in neck, shoulders, and triceps bilaterally.  No pain or crepitus were found on orthopedic exam of the forelimbs.  Also, patchy alopecia was present that was suspicious of allergies.  All other aspects of physical examination were within normal limits.

Medical Decision Making

Based on physical exam and myofacial palpation, acupuncture points that provided neuromodulation to the pelvic limbs, thoracolumbar and lumbosacral regions were chosen.  Neuromodulation to these regions will provide anti-inflammatory effects and increased blood flow thus promoting healing and analgesia.  In addition, trigger point deactivation was indicated.

Differential Diagnoses

Differential diagnoses include osteoarthritis of the hips, thoracolumbar and lumbosacral regions.  Another differential for pain along the bladder line include visceral pain or pathology.  In addition, allergic dermatitis (atopy) was suspected.

Definitive (or Putative) Diagnosis

Radiographs would be indicated to confirm the diagnosis of osteoarthritis.  However, radiographs were not available at the shelter.  In addition, a senior profile (complete blood count and serum chemistry) would be indicated to rule out other differentials but this was not available at the shelter as well.  Based on physical exam, signalment and history, osteoarthritis of the hips, thoracolumbar, and lumbosacral regions are most likely.  In addition, allergic dermatitis is highly suspected.  The patient was on flea prevention, and skin scraping and Wood’s lamp exams were negative.  Therefore, flea allergy dermatitis, ectoparasites, and dermatophytosis are lower on the differential list.

Acupuncture Treatments

It was unknown if this patient had ever received acupuncture treatments before; it was likely that this patient had not.  For this reason, Seirin coated needles were used.  Acupuncture treatment began with GV 20 and 14 for calming effects. Then, the hip triad points (BL 54, GB 29 and 30) were applied bilaterally to locally target the hip arthritis and associated sciatic and cranial gluteal nerves.2  Next, BL 21 was applied bilaterally to target thoracolumbar spinal nerves and any associated arthritis in the region.  Bai hui was also used for further neuromodulation of lumbosacral and pelvic limb pain.2  BL 25 was also used bilaterally to target lumbar pain and arthritis.  Moreover, BL 25 and Bai Hui are central points that affect the targeted sciatic nerve for hip and pelvic limb pain; the nerve roots at these areas eventually give rise to the sciatic nerve.  Finally, ST 36 was used bilaterally for autonomic input and treatment of pelvic limb dysfunction.2

At this point, the patient became a little bothered and did not like it when it was attempted to insert more needles.  I would have liked to do more peripheral points, trigger point deactivation, and points for allergy treatment (ie. LU 7).  The patient showed her limits and instead the trigger points in her neck and forelimbs were massaged while the needles were in place.  Ideally laser therapy could have been used to treat these trigger points, but laser therapy was not available.  After about 30 minutes of having the needles in place, the patient perked up, was brighter, and became more active in the treatment area.  These positive signs marked the end of treatment and the needles were removed.

The patient was only treated once a week and treatment was terminated due to the patient being adopted.  Further acupuncture treatment including electroacupuncture would be very beneficial for this patient.

Outcome and Discussion

According to the veterinary technicians, volunteers, and kennel staff at the shelter, Cybil was perkier and ambulated easier after acupuncture treatment.  Because Cybil had been on carprofen prior to and after treatment, the positive outcome could not only be attributed to acupuncture.  However, Cybil had been on carprofen for a couple of weeks before acupuncture treatment and these improvements in mobility and mentation were not noted until after acupuncture treatment was performed.

Studies have been performed to evaluate the efficacy of acupuncture treatment in canine arthritis.  In one study, chronic arthritis was induced in multiple dogs.  Acupuncture was applied once a week for 4 weeks.  Response to treatment was evaluated using thermography.  After 3 weeks of acupuncture treatment, the skin temperature difference (DeltaT) in the treatment group returned to normal while the DeltaT in the control group remained high, validating the efficacy of acupuncture treatment for canine arthritis.3

Cybil’s case is an example of how beneficial acupuncture can be in patients with osteoarthritis.  Osteoarthritis is very prevalent in our veterinary patients and many different medications are available for treatment.  However, because many of the patients with arthritis are older and often have concurrent illnesses, acupuncture really is a vital modality that should be added to the treatment plan.

References

  1. Morgan, R. V., DVM, DACVIM, DACVO. (2016). Degenerative Joint Disease.
  2. Robinson, N. G., DO, DVM, MS, FAAMA. (2016). Medical Acupuncture for Veterinarians: Canine Point Manual.
  3. Thermographic evaluation for the efficacy of acupuncture on induced chronic arthritis in the dog. (2005). The Journal of Veterinary Medical Science, 67(12).
WANT MORE INFO?
If you’re frustrated with “in-the-box” solutions and you’re ready to enhance your skillset as a medical professional or veterinarian, we welcome you to join us.

Together, we can change medicine.