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Written by a Medical Acupuncture for Veterinarians course graduate.  Author’s name available upon request. Signed released obtained from client/author/4923.

Abstract:
A German Shepherd Dog mix presented for acute onset of neck and shoulder pain that led to lethargy and poor appetite. Acupuncture was used to help with pain control and improve range of motion of his neck and shoulders. When he first presented he had limited ability to move his neck or shoulders with out pain. He would cry out if touched on either side of the neck or shoulder region. After each acupuncture session he showed immediate improvement in appetite, energy level and ability to move more comfortably. He was treated weekly with acupuncture for four weeks. After the third acupuncture treatment the patient was able to be touched anywhere on neck and shoulder region with out crying out. He was able to move without pain, and was getting in and out of the car on his own. He was able to be off of oral pain medications by the second week of acupuncture treatments. This is a great example of how an acute musculoskeletal injury can be treated with acupuncture.

History:
A 12.5 year old, MN, German Shepherd Dog mix named Buddy, presented for sudden onset of poor appetite, pain when walking, and lethargy. Buddy was not on any medications and had no history of previously injuries or medical issues that required treatment. When Buddy first presented he had limited ability to move his neck or shoulders without pain.

Physical Exam and Clinical Assessments:
On examination Buddy would cry out if touched on either side of his neck or shoulder region, his range of motion of his neck was decreased with lateral motion to left and right with left side being worse than right. Both shoulders had decreased range of motion on flexion. He would cry out when the left biceps tendon was touched. Neurologic exam was within normal limits. Radiographs of neck, shoulder region, pelvis and lumbar spine were taken under sedation with a protocol that included dexdomitor.

Radiograph assessment from board certified radiologist:
Hazy opacities, bicipital groove, left forelimb. This is subtle and equivocal but can be associated with chronic bicipital tendinopathy.
Otherwise normal visualized portions of the cervical, lumbar, lumbosacral spine, pelvis and both coxofemoral joints.

After the radiographs were taken, Buddy was given Antisedan to partially reverse the sedation. He was not recovering well from the sedation. Acupuncture was done a few hours later, and he was able to start settle down and ate. He was discharged on gabapentin, tramadol, and methocarbamol with plan to return weekly for acupuncture treatments for at least four weeks.

Medical Decision Making:

With the physical exam and radiographic findings as stated above, acupuncture treatments for neck and shoulder pain were started. Acupuncture points were also used for mild stiffness in his lower back and hind end, likely from compensating for front limb pain. There were several areas in the neck and shoulder regions that were too painful to place acupuncture needles directly, so blue Seirin 0.2 needles were placed above and below these areas on specific channels. The trigger points in the neck and shoulders were too painful as well, so needles were placed where the same neurological pathways could be communicated with to get cross-talk in the spinal cord. By placing needles in these areas, channels that directly follow neurovascular pathways affecting the shoulders and neck were used to alleviate pain wind up and muscle tension. The microtrauma caused at these local sites allow for capillary dilation and physiological changes that fight inflammation from continuing to cause pain. The attached acupuncture drawing sheets show the specific points used. Buddy responded immediately to treatment the first week with improved appetite and energy level. He was, however, still painful to touch near neck and shoulders a few days after treatment. He returned one week later for a second treatment. We do not have a therapeutic laser available, but I was able to use some massage techniques in areas of tense muscle along his lumbar spine. He had better range of motion in his neck at the second acupuncture treatment but still had sore areas in neck and left shoulder.
After the third acupuncture treatment the patient was able to be touched anywhere on his neck and shoulder region with out crying out and he was able to move around pain free. He was able to jumping in and out of the car on his own! He continued to show improvement so after the fourth weekly treatment we were able to start increasing the time between appointments to every two weeks.

Outcomes/Discussions:
Buddy was treated once a week for four weeks. Each week he had increased range of motion in the neck and shoulders with less pain noted in both areas. He was able to get in and out of the car on his own without any signs of pain. One of the most encouraging aspects of this case was that Buddy was originally placed on tramadol, methocarbamol, and gabapentin, but after the first week of treatment, he was able to be off of the medications. I also learned the value of feeding the patient treats during acupuncture. This patient is difficult to work, touching his feet will cause him to growl and withdrawal from you and when touched in painful areas he would try to bite. However, he is so food motivated that by feeding him frozen baby food I was able to place acupuncture needles wherever they were needed including some points near his feet.