Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained from client/author/4967.
Weekly acupuncture treatments were performed on a 12 ½ year old dog with left hind (LH) limb monoparesis. The goal of treatment is to improve LH limb sensory perception and motor function. Acupuncture treatments began 8 months after the acute inciting incident. The specific site and cause of monoparesis was never established due to owner financial constraints.
After 3 acupuncture treatments, one week apart, patient’s sensory and motor function greatly improved.
Holly, a 12 ½ year old female spayed Wheaten Terrier presented to the emergency room (ER) for acute hind limb changes. Holly was normal while on a road trip. She became anxious during the drive and the owner took her for a bathroom break. No clinical abnormalities were noted at that time. Holly then jumped back into the car. No traumatic event was observed. Shortly after that, Holly was noted to be unable to use her hind limbs. Holly had no other medical history. She had not been known to get into anything toxic or unusual and she was current on all vaccinations. At presentation to ER, Holly’s temperature, pulse and respiratory rate were mildly elevated. Normal ears, eyes, nose and throat were noted. Respiratory, alimentary, lymphatic, urogenital and integumentary examination were noted to be normal. Musculoskeletal examination noted Holly to be ambulatory on 3 limbs. Good range of motion was appreciated in all 4 limbs. Spinal or cervical pain did not appear to be present. There was no apparent muscle atrophy. Neurological examination noted normal mentation, normal cranial nerves, and normal withdrawals. Absent conscious proprioception (CP) was present on the LH limb. LH limb motor was absent. The other three limbs had normal CP’s and motor function.
Neurologist Consultation noted Holly to have LH limb monoparesis localized to L4-S1 with a strong suspicion for fibrocartilaginous embolism (FCE). Other differential diagnoses included intervertebral disc disease, neoplasia, trauma, meningitis and discospondylitis.
Due to financial constraints, Holly’s owner declined additional diagnostics and opted for medical management. Holly was started on a tapering dose of prednisone, tramadol for pain and omeprazole. Strict cage rest was initiated. Physical rehabilitation was recommended, although not initiated by owner.
Holly’s owner reported her to gain limited use of her LH limb after 3 months following the initial injury. Six months following the initial injury, Holly became non-weight bearing on her LH limb. Physical examination findings at that time noted Holly to be holding up her LH limb. She was unable to support herself on her LH limb when the RH limb was lifted off the ground. LH CP was absent, deep pain was present. Vertebral radiographs noted multifocal spondylitis deformans with narrowed intervertebral disc space at T12-L1 suggestive of intervertebral disc disease. No significant findings were noted upon complete blood count and chemistry profile analysis. Owner declined further diagnostics. Based on positive results from past treatment, Holly was started on a prednisone taper, in addition to Gabapentin 100 mg BID and tramadol 50 mg BID.
Two months later, Holly presented for a soft tissue mass on her right front limb (RF), just cranial to digit 1. Musculoskeletal findings at the time noted significant middle gluteal muscle hypertrophy with myofascial pathology bilateral, LH worse than RH. LH paresis was present, although Holly was no longer holding up her LH limb. The soft tissue mass was removed without biopsy, and acupuncture treatments were initiated.
Physical Examination and Clinical Assessment:
LH limb paresis with CP deficits and absent LH limb withdrawal. Significant middle gluteal muscle hypertrophy with myofascial pathology, bilateral.
Medical Decision Making:
The sciatic nerve is targeted via acupuncture points to promote sensory perception of the LH limb. The femoral nerve is targeted via acupuncture points to promote motor function of the LH limb. Local points are targeted to offer analgesia and promote circulation. Myofascial trigger points are targeted via acupuncture to release muscle tension and promote circulation to affected area. Acupuncture treatments were performed weekly for 5 weeks. Due to the positive response, the frequency of treatment has been decreased to every other week. The plan is to taper treatment frequency with the goal of completing treatment once the patient’s progress is static.
Acupuncture points used to target the sciatic nerve include: BL 54, BL 67 via the tibial nerve and fibular nerve, and BL 40 via the tibial nerve. Acupuncture points used to target the femoral nerve include: ST 34 and GB 30. Local points used to target thoracolumbar intervertebral disc disease and surrounding regions include: BL 23, BL 28, GB 29 and Bai Hui. GV 14 is stimulated to supports the thoracic limbs from excess stress placed upon them. A single needle is placed within the middle gluteal muscle trigger point, bilaterally. GV 20 is stimulated as a calming point. Dry needle technique has been used for each acupuncture treatment.
Outcomes, Discussion and References:
The patient’s response to acupuncture is favorable. After the second acupuncture treatment, the owner reported the patient to be “more balanced” on her hind end. After the third treatment, changes noted upon physical and neurological examination included: withdrawal of foot upon attempted placement of BL 67, LH limb absence of CP deficit, increased LH limb motor function at walk and trot and the ability to hold up hind end when RH limb is lifted off the ground.
The patient’s improving clinical signs are a direct response to acupuncture. Data supporting this statement is based on the science behind acupuncture; needling provokes neurostimulation, resulting in restoration of damaged neurological input and consequential output.
This case has taught me first hand, the benefit of acupuncture for treatment of limb weakness. Targeting the nerves that are responsible for the desired outcome is vital for formulating a treatment plan.
References: Schoen, Allen M. Veterinary Acupuncture. Mosby Inc. 2001.