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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/4982.

Abstract:

“Bandy”, an American Quarter Horse (AQH) used for barrel racing has a fused left distal inter-tarsal (DITJ) joint, back soreness and poll discomfort.  His back soreness has recovered and the poll has become more palpable in response to treatment.

History/Presentation:

“Bandy” is a 6 year old AQH gelding active in barrel racing who is maintained on intermittent tarsal injections and feed supplements.  He has a one year history of head shyness after having ticks attached and removed from his ears.  His owner has used “Aculife” patches multiple times in preparation for a race addressing poll, lumbar and tarsal discomfort.

Post-purchase radiographs on February 2, 2016 showed a completely fused left DITJ.  Evaluation with the Lameness Locator, a computerized lameness assistant, revealed no left hind lameness, and none was visualized.

Therapeutic injections of hyaluronic acid, amikacin and triamcinolone were placed on February 11, 2017 in the left tarsometatarsal joint (TMTJ) and tarsocrural joints and the right TMTJ and DITJ.  This was done to increase comfort and decrease resistance turning the left barrel. Symptoms had been present for about 8 months.  No lameness was visibly present.

Physical Examination and Clinical Assessments:

“Bandy” was examined on February 24, 2017 for primarily back, but also poll, discomfort.  Myofascial (MF) exam revealed a very sensitive poll bilaterally, restriction bilaterally over the thoracolumbar bladder line, and increased sensitivity over the coxofemoral joints and gluteal muscles.  I believe that the poll discomfort may be psychological or secondary to cervical strain after pulling back during ear examination a year ago.  The thoracolumbar and gluteal discomfort is likely secondary to tarsal pain or restricted tarsal joint movement.

Medical Decision Making:

The acupuncture treatment has been based on the source of primary pain and compensatory pain.  Local points were used where MF tension or increased sensitivity were found.  Central points were used to draw communication of peripheral nerve stimulus to the brain.  Peripheral points were used to enhance sympathetic stimulus of the appropriate nerves toward the central nervous system.  Points of autonomic influence were used to decrease sympathetic tone.  Myofascial points were chosen based on palpation of areas of restriction during each treatment.

Acupuncture Treatment:

The first treatment was performed on February 24, 2017 and sequential ones every 2-3 days.   Not all points listed below were used in every treatment.

Central point Bai Hui was used because it is a major contributor to the hind end.  Governor Vessel (GV) 4, 14 and 20 were used to decrease sympathetic tone along the affected spinal locations.

Peripheral points included ting points triple heater (TH) 1 on both front limbs and stomach (ST) 45 on the hind.  Large intestine (LI) 20 was chosen for cranial influence of the trigeminal and facial nerves.  BL40 was used as the master point for the lumbar spine.

Local points included bladder (BL) 10, 19, 21, 23, 24, 25 and 26 for spinal neuro-modulation, LI 16 and 17 and TH 16 for cervical neuro-modulation.  ST 7 was used as an accessible point on the head with major trigeminal and facial nerve influence that should address the poll discomfort.

Autonomic points include LI 11 and GV20.

Myofascial points included small intestine (SI) 11 and 12, gall bladder (GB) 21.

Outcomes, Discussions and References:

The patient was quite sensitive to needle placement along the topline whether on the GV or BL line and so different combinations were attempted and fewer points selected in attempt to address the patient’s needs.  Lumbar pain resolved after two treatments with the second including electro-acupuncture.  On the third treatment, GV 20 was able to be placed for the first time.  This was a significant improvement over previous failed attempts at any points in that area.  A recheck was done two weeks after initial exam and no excess sensitivity was found on MF exam and digital palpation of the poll area was tolerated.  Videos were taken of poll exams.

References:

Xie, Huisheng “Evaluation of electro-acupuncture treatment of horses with signs of chronic thoracolumbar pain.” J Am Vet Med Association July 2005; 227(2): 281-6.