Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained from client/author/4984.
Case History: Canine patient presented for chronic left hind (LH) lameness following a failed lateral imbrication surgery and a tibial-plateau-leveling osteotomy (TPLO) surgery.
Summary of Results: A course of 8 treatments (2 per week for 4 weeks) yielded no improvement in LH lameness.
8 year old female spayed Labrador Retriever referred for acupuncture for LH lameness. Body Condition Score 4.5/9. Patient had a grade II/IV LH medial patellar luxation diagnosed at 14 months of age at which time a tibial crest transposition surgery was performed. Patient lameness increased in late summer of 2015, had a mildly positive cranial drawer test, and had a lateral imbrication surgery in September 2015 which failed. A second surgery was performed in October 2015 to remove suture from lateral imbrication surgery and perform a TPLO. Patient started weekly hydrotherapy approximately 2 weeks after surgery and also received an intra-articular (IA) Platelet Rich Plasma (PRP) injection in the left stifle in November 2015. Owner reports that patient was more lame following surgeries than prior to surgery. TPLO plate was removed per surgeon recommendation in March 2016. Following this surgery, owner reports patient improved slightly. Owner had weekly laser therapy performed on the stifle and hip region shortly after plate removal and reported some improvement in lameness. In July 2016, owner noticed patient chewing at her left stifle. The left stifle was injected at that time with triamcinolone and hyaluronic acid (HA). Owner reports that this helped the lameness as well. Patient has been on oral daily Dasaquin since 14 months of age, daily oral Omega-3 supplements, and monthly intramuscular (IM) injections of Adequan for general arthritis management.
Physical Examination and Clinical Assessments:
Patient does not stand bearing full weight on LH limb. Patient stands with a toed out LH with the left hock almost touching the right hock. Cranial phase of gait is similar bilaterally, however, the stance phase of the LH is short in comparison to the right. Mild LH gluteal muscle atrophy. Mild to moderate stifle effusion.
– Left side: Palpation of cervical region within normal limits (WNL). Mildly taught bands in the triceps region. Mild to moderate sensitivity and moderate taught bands along epaxial muscles. Mildly taught muscle bands and mild sensitivity to palpation along iliopsoas, gluteal, biceps femoris, and gracilis muscles.
-Right side: Cervical region WNL. Mild to moderately taught bands in the triceps region. Mild to moderately taught bands along epaxial muscles. Moderately taught muscle bands and moderate sensitivity to palpation along iliopsoas, gluteal, and biceps femoris, and gracilis muscles.
Medical Decision Making: Based on myofascial palpation, the main area of treatment was the LH and right hind (RH) limb and hip region. Epaxial muscle area and triceps region were treated as well.
-Treatment points were based on myofascial palpation. Electroacupuncture (EAC) was attempted on the 3rd treatment, however, even at the lowest frequency, patient jumped up and would not settle into the EAC treatment. Dry needle acupuncture sessions were performed for 20 minutes.
-Cervical and cervicothoracic region: GV 14 was used as a calming point at each session.
-Shoulder: On a weekly basis, SI 9, 10, and TH 12 and 13 were treated bilaterally.
-Back: BL 19-21 were treated bilaterally. Bai Hui was treated at each session. BL 20-23 were treated bilaterally. BL 25-28 were treated bilaterally as well.
-Hip: Hip triad bilaterally (BL 54, GB29, GB30).
-LH limb: ST34 and 36, SP10, GB31, 32, BL36.
-RH limb: SP10, GB31,32, and BL 37.
Outcome, Discussions, and References:
In this case, the owner’s goal was to improve the patient’s stance and lameness. Acupuncture did little to improve this. However, patient’s muscles did palpate more supple (especially on the RH limb) following a course of acupuncture treatment and may have helped release muscle tension caused by compensation for the LH lameness. The patient was very relaxed and seemed to enjoy her acupuncture sessions. Owner has recently noticed that patient is chewing at her LH stifle again. Owner reports that of all the treatments patient has received, the most significant improvement has been with laser therapy and IA injection. This case demonstrates how there are multiple locations of pain and multiple mechanisms of pain. Therefore, it is important to explore multiple treatment modalities to address healing and pain. It is also possible that in this case, there is a mechanical component to the LH gait which will always remain despite different treatment modalities. Owner reports that in retrospect, she would have preferred to try medical management with joint injections, laser therapy, and acupuncture had she been given these options instead of following the advice of surgery being the “gold standard.”
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- Robinson, N. Questioning Canine Cruciate Ligament Surgery. Veterinary Practice News November 2012.
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- Hong, Chang-Zern. Myofascial Trigger Points: Pathophysiology and Correlation with Acupuncture Points. Acupunct Med 2000;18:41-47