Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017056

Abstract
Tail pull injury is a relatively frequent occurrence in cats, the result of excessive force on the cauda equina secondary to traction on the tail.1 Routine Western medicine is limited in treating these cases, as the current options include pain management, anti-inflammatory therapy, and pharmacological intervention to aid with bladder expression during a prolonged recovery period. Acupuncture lends itself to a different approach by directly stimulating nerves and reducing pain and inflammation. The combination provides a complementary treatment plan and may speed recovery times.

History and Presentation
A 2-year old male neutered Domestic Shorthair cat presented for suspected tail pull injury 24 hours earlier. He had a history of being an indoor/outdoor cat that returned home with a paralyzed tail. The owners were unsure about his ability to urinate as he did not have an indoor litter box.

Physical Examination and Clinical Assessment
Pertinent physical exam findings included a quiet cat with a limp, flaccid tail. He had motor to all four limbs and normal limb proprioception, though he did walk crouched in the rear. He had minimal pain sensation to his tail and decreased anal tone. His bladder was small and soft. Myofascial palpation elicited a pain response in his lumbosacral area, worsened by lifting his tail. Our assessment was that he had an acute sacral nerve injury (S1-S3). Radiographs to rule out pelvic and/or spinal fractures and luxations were declined by the owner due to financial constraints.

Medical Decision Making
This was an acute onset incident, and the prognosis was unclear at the time of presentation due to the unknown status of his urination. The decision was made to initiate intense therapy using both traditional and acupuncture therapy. The goal was to stimulate nerve activity to the sacral spinal segments affecting bladder, anorectal and tail function, as well as general pain relief. It was noted that he did voluntarily urinate while in the hospital.

Differential Diagnoses
Acute nerve injury, Tail fracture or luxation, Pelvic fracture or luxation

Definitive (or Putative) Diagnosis (or Diagnoses)
Sacral spinal segment injury (S1-S3)

Acupuncture Treatments
K-Laser® therapeutic laser was incorporated into the treatment focusing on the same points to reduce inflammation and encourage healing. The laser was set for acute injury. Each session lasted approximately 10-15 minutes and was well tolerated. The patient was relaxed and settled, purring and even dozing off during his treatment.
Acupuncture 0.16mm x 15mm tubeless needles
Bai Hui, GV-20, BL-23, BL-27, BL-28, BL-35, BL-36, BL-40, SP-6, GV-2, GV-14, ST-36, KI-1
This was repeated twice daily for 3 days, at which time the owners elected to discontinue therapy due to finances and noted improvement.

Outcomes, Discussions, and References
This was a success story, despite only having had 6 treatments over the course of three days. At the end of his final session, his mobility had improved, he was much less painful in his lumbosacral region, and his anal tone was normal. His tail was still flaccid, though regaining sensation. Weekly phone conversations revealed a complete recovery by the end of four weeks. Much of the recovery is attributed to the fact the he did still have some anal tone as well as voluntary bladder control. The situation may have been much different if the injury had been more severe. Tail pull injuries can result in mild (neuropraxia) to moderate (axonotmesis) to severe (neurotmesis)2. Given the specific location of the nerve trauma and inflammation, points were selected to correspond to the corresponding spinal cord segment. By needling the directly affected area, we were able to inhibit nociceptive pain at the level of the dorsal horn of the spinal cord3. One treatment modality that could have been added (but was not available at the time) was electrical stimulation of the acupuncture points. This would have provided a more intense stimulation of the nerves and likely shortened recovery time to full tail function. It has been noted that use of an acupuncture needle resulted in a more rapid nerve regeneration following injury4. The findings support the upregulation of β-endorphins occurring in the brain from low frequency EA (1-7 Hz) and the upregulation of dynorphin in the spinal cord occurring from high frequency EA (15-100 Hz). Electroacupuncture delivers a stronger dose of acupuncture, more effectively upregulates the endogenous opioid mechanisms.

1.Tail pull injury, VetStream, Felis ISSN 2398-2950, Contributor(s): Laurent Garosi, Simon Platt
2.Management of Pelvic Trauma, Neurological Damage, Urinary Tract Disruption and Pelvic Fractures, Richard Meeson MA VetMB MRCVS∗, Sandra Corr, BVMS CertSAS PhD DipECVS FHEA MRCVS, May 1, 2011
3.Western Medical Acupuncture in Neurological Conditions, ClinicalGate, Admin,
The effects of electro-acupuncture on peripheral nerve regeneration in rats. Japanese Journal of Physical Fitness and Sports Medicine. 52. 391-406. 10.7600/jspfsm1949.52.391. INOUE, MOTOHIRO. (2003).


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