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

Abstract: Clint is currently used a barrel racing horse by his owner. In August of 2017 his owner noticed that during his events, Clint would pull up his head about ¾ of the way around each barrel when racing. She had her veterinarian examine him and believed it to be sacroiliac disease. Then in January he was diagnosed with neutral palmar angles on both rear feet and neutral plantar angle on his right forelimb. He also has been resistance on flexion of his left shoulder for some time now as well. Various treatments, joint injections, and therapeutic shoeing have not been effective to date. Clint’s owner believes in acupuncture and hence sought out treatment. He was treated once weekly for three weeks with improvement in the rear limbs but little to no effect on his left forelimb.

History and Presentation:
Clint is a 12 year old Quarter horse stallion that is used for barrel racing. His owner is Pam Bell, a veterinary at a local veterinary hospital. Ms. Bell stated that her stallion has had in the last few events he has competed in the last 8 months that ¾ of the way around the barrel he will lift his head as if uncomfortable. He will then continue on and finish the event. He also recently developed an abscess on the plantar aspect of his left rear hoof that the owner has treated at home but patient still has some residual discomfort. He has no previous history of injury otherwise.

Physical Examination and Clinical Assessments:

Routine physical exam was unremarkable. On myofascial palpation, there was tenderness over masseter muscle, caudal cervical musculature was tender with taught bands, tender areas along caudal thoracic paraspinals along entire lumbar region as well, and patient did have a positive flick test and decreased mobility on manipulation of spine. Patient experienced weakness and pain when each sacroiliac joint was manipulated and palpated. On the left forelimb, patient was tender on deep palpation of the pectorals, and highly resistant to flexion of the right shoulder. On the left hindlimb, the patient was tender on palpation of the distal aspect of the flexor tendon near its attachment in the area of the previous abscess.
Neurologic examination was unremarkable.

Medical Decision Making:
After examining Clint, I developed a treatment plan that would treat both local and distal points relative to those tissues and areas affected. Points to decrease sympathetic tone were first placed. Points used were TH16, GB21, and BaiHui. Then, on the left forelimb, local points that would neuromodulate tissues surrounding the shoulder joint were utilized, along with distal points along the scapula and bladder points along the spine that influence the nerves providing innervation to the region.
Bladder points along the paraspinals were used to modulate and release the myofascial restriction creating the pain found along the vertebral area and sacroiliac region.
On the real limbs, points along the hip triad and distal limb were used to neuromodulate the tissues around the hip and the nerves that provide the majority of innervation to the limb itself.

Differential Diagnoses:
Neutral Plantar/Palmar Angle
Sacroiliac disease
Intervertebral Disc Disease
Osteochondrosis
Osteochondritis Dissecans
Bicipital Tendonitis
Recurrent soft-tissue injury
Laminitis

Definitive (or Putative) Diagnosis (or Diagnoses):
Due to Clint’s involvement in athletic events he participates in, I believe his left shoulder is subject to recurrent soft tissue trauma causing the restriction on flexion. I believe that he also has secondary myofascial restriction along his paraspinals and sacroiliac disease due to gait abnormalities in his rear limbs due to the neutral plantar angle. The neutral angle of the navicular bone creates abnormal stresses along the entire musculature of the rear limbs and normal placement of the limb is affected.

Acupuncture Treatments:
3/3/2018: GB21, TH16, LU1, LI11, SI11, BL21 for shoulder pain, local muscle tender points, pectoral tender points and caudal cervical/neck pain. BL22, BL23, BL25, Bai Hui for paraspinal myofascial restriction and local tender points. BL54, GB29, GB30, BL40, KI1, Ting Points for hind limb myofascial restriction and pain associated with secondary dysfunction due to the neutral plantar angle. Treated with 0.3 X 30mm and 0.23 X 30 mm Seirin needles
3/10/2018: GB21, TH16, LU1, LI11, BL13, BL14, BL15, PC6; similar points as before with others added for respiratory issues that day and PC6 for mild agitation that day. BL23, BL24, BL25, BL54, GB29, GB30, BH, BL40 and rear limb ting points; same as first session
3/17/2018 LU1, LI11, TH14, LI15, GB21, SI11, SI12; other points used for shoulder pain. BL23, BL24, BL25, BH, GB29, GB30, BL54, BL40, ST36; similar reasons as first session for rear limb dysfunction associated with neutral plantar angle.

Outcomes, Discussions, and References:
Overall, I would say Clint did respond to the acupuncture treatments. Unfortunately, his left shoulder did not respond adequately to acupuncture alone. My recommendation would be to have further diagnostics performed to evaluate this limb. Since this area has not had radiographs performed this would be a first step. If undiagnostic then bone scintigraphy, or musculoskeletal ultrasound would be warranted. If the owner did not elect further diagnostics consultation with veterinarian that performs rehabilitation for equine patients could be helpful. His resistance to flexion of the left shoulder did not improve with the treatments. On the other hand, the myofascial restriction in his caudal lumbar/sacral area responded very well to the treatments. After the first treatment, the tender points found in that area improved, and at the next treatment were improved. Clint’s flexibility in that area improved with each treatment as well. On his right rear limb, the swelling and tenderness in the area of the previous abscessation has resolved as well. The owner stated that after each treatment, the following week Clint’s performance in the field improved as well. After the third treatment, Clint was to race that evening at an event. I have not heard from his owner whether he performed well that night or experienced the same gait issue. The owner was happy though with the hind limb response Clint had to the treatments.

Efficacy of a single-formula acupuncture treatment for horses with palmar heel pain

Can Vet J 2015 Dec; 56(12): 1257-1260

Response to acupuncture treatment in horses with chronic laminitis

Can Vet J 2017 Aug; 58(8): 823–827.


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