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Written by a medical acupuncture for veterinarians course graduate. Author’s name available upon request.  Signed release obtained from client/author/4959.

Abstract

Tag is a 30-year-old retired gelding that has generalized arthritis and edema of his hocks. His left side seemed to be more affected as multiple trigger points were palpated. Tag was treated with acupuncture and electro-acupuncture once weekly for 3 weeks. The acupuncture points used weekly were GB21, Bai hui, BL25, and B27. Various other points were used at each treatment. After treatment, Tag’s trigger points had been released, his hock edema had improved mildly and his gait was slightly longer and less stiff.

History/Presentation

Tag is a 30-year-old, Appaloosa gelding. Tag is mostly retired and lives in a pasture. Tag is arthritic and will occasionally choke if his feed is not soaked. Tag is up to date on all vaccines and has regular veterinary visits.

Physical Examination and Clinical Assessments

Tag presented with generalized stiffness in both forelimbs and hind limbs and a short stride. Tag was most resistant to lifting up his left forelimb. Tag had tense brachiocephalicus muscles bilaterally on myofascial palpation. There was a trigger point palpated in the left supraspinatus muscle and the left biceps femoris muscle at the first session. There was effusion in both hocks noted on the second and third session. There was a trigger point palpated in the left subclavian muscle on the third session.

Medical Decision Making

GB21 – Chosen as a calming point and to see how Tag would respond to dry needling. Trigger points palpated in the left supraspinatus and subclavian muscles were also released by dry needling this point.

Bai hui – Calming point, as well as a point for overall hind limb stimulation.

SI11 and SI12 – Both nerves stimulate the suprascapular nerve, chosen for shoulder stimulation as well as overall forelimb stimulation. SI12 was also selected specifically for the trigger point in the left supraspinatus muscle.

BL 25 and BL27 – Stimulates the midlumbar and S1 sacral nerves for overall hind limb stiffness/pain. Electro-acupuncture of these points was used to enhance pain relief.

GB30 – Stimulates the sciatic and caudal gluteal nerves, this point was chosen to release the trigger point palpated in Tag’s left biceps femoris muscle.

LI17 – Stimulates the midcervical spinal nerve and chosen specifically to release the tension in Tag’s brachiocephalicus muscles.

SP6 – Stimulates the tibial nerve and has been shown to help with edema. Chosen specifically to help with the edema in Tag’s hocks.

PC6 – Stimulates the median nerve and has been shown to help with both edema and digestive issues. Chosen to help with the edema in Tag’s hocks and his history of choke.

Left subclavian muscle trigger point – Chosen to release the trigger point palpated. Dry needling relaxed the muscle.

Acupuncture Treatment

First session 11/28/16: Dry needling was used with Sierin 30mm 0.18 gauge needles. Points selected were G21 as a calming point, SI12 and SI11 to address the trigger point in the supraspinatus muscle on the left shoulder and for generalized shoulder pain, Bai hui was selected for calming and for general stimulation of the hind end, BL25 for lumbosacral pain, BL27 for sacral pain, and GB30 to release the trigger point in the left biceps femoris muscle. Needles were kept in place for 20 minutes.

Second session 12/5/16: Dry needling was used with Sierin 30mm 0.25 gauge needles; electro-acupuncture was used on BL25 and BL27. Points selected were GB21 as a calming point, SI11 and SI12 for generalized shoulder pain, LI17 to address the tense brachiocephalic muscles, Bai hui was selected for calming and for general stimulation of the hind end, BL 25 for lumbosacral pain and BL27 for sacral pain. Electrostimulation was used from BL25 to BL27 for enhanced pain relief. GB30 was selected to relax the biceps femoris muscle and prevent trigger point reformation. Needles were kept in place for 20 minutes.

Third session 12/12/16: Dry needling was used with Sierin 30mm 0.25 and 0.18 gauge needles. Points selected were GB21 as a calming point, LI17 to address the tense brachiocephalic muscles, as well as an 0.18 gauge needle in the trigger point in the left subclavian muscle. Bai hui was selected for calming and for general stimulation of the hind end, BL 25 for lumbosacral pain and BL27 for sacral pain. PC6 and SP6 were selected for the edema in the hocks and stimulation of the esophagus for Tag’s history of choke. Needles were kept in place for 25 minutes.

Outcomes and Discussion

Tag responded fairly well to acupuncture. The first visit was mainly to assess Tag physically and see how he would respond to dry needling. Points were selected to address the generalized stiffness/pain as well as the trigger points palpated. Electro-acupuncture was used on the second visit for enhanced hind limb arthritis pain relief. Tag’s stride increased slightly and he seemed less stiff. The third session released a trigger point in Tag’s left subclavian muscle. PC6 and SP6 were also used for Tag’s hock edema. The owner reported that the edema in the hocks seemed to be improved, but not fully resolved. There were no adverse events in this case.

I feel the most important thing I learned from this case was not to be afraid to acupuncture horses’ limbs. I likely could have made a great difference if I had focused on specific joints rather than body points. I also feel that visits more than once a week may have helped relieve arthritis pain more quickly and may have had a longer lasting effect.

References

Robinson, Narda. Medical Acupuncture for Veterinarians, Equine Point Mini-Manual. 2015.

– Schoen, Allen M. Veterinary Acupuncture, Ancient Art to Modern Medicine. Second edition. 2001.