Signalment
- Age: 8 years
- Sex: female spayed
- Breed: Border Terrier
- Species: dog
Disease Notes
- Certainty: confirmed
- Final Status: resolved as of day 118 of treatment
Treatment and Outcome
Treatments
Notes:
(full case report)
Stabilizing a Canine Stifle Joint with Acupuncture
Deanna S. Bowen LVT CVT GDVACU Best Dog Ever Acupuncture LLC
Abstract:
Acupuncture successfully stabilizes a stifle joint in a canine with notable drawer and laxity in the joint. The dog presents non-weight bearing, marked swelling and pain with popping on flexion or extension. A ruptured cranial cruciate ligament is diagnosed with a secondary luxating patella. With weekly acupuncture treatments for three months the dog’s pain is gone and drawer, laxity swelling and thickness in the joint is resolved.
History:
An Eight year old spayed female Border Terrier was found limping after she darted after a squirrel in her yard. She enters the clinic non-weight bearing and quiet. The left hind leg has swelling around the knee joint and she tenderly walks on it, but mostly she carries it. Radiographs do not reveal any fractures; strict rest and Non Steroidal Anti Inflammatory medications are prescribed by the referring Veterinarian (rDVM). A diagnosis of a ruptured Cranial Cruciate Ligament is noted in the Orthopedic surgeon notes. The owner and the surgeon agree that if no improvement is seen with conservative management, surgery will be pursued to stabilize the joint.
Conventional treatments:
Standard Process Ligaplex II was given to the patient daily to increase lubrication in the joint, increase the health of the surrounding tissues and strengthen the tendons. The rDVM prescribed the patient Rimadyl 25mg at a dose of half a tablet every 12 hours for seven days. No further pain medications were needed in this case and this prescription was not refilled.
TCM history and exam:
The patient is always on high alert and more than willing to chase a rogue squirrel from the yard when needed. This over abundance of Liver energy uses a tremendous amount of recourses and Blood can become depleted over time if the Spleen is not supported in the making of Vital Substances which leaves the tendons to dry out and become brittle. I find the dog to have a lavender tongue, which is thin and has crisp edges. Her pulses are thin, weaker on the left and wiry bilaterally. Heat is appreciated over her gallbladder channel surrounding the stasis in her knee. She is painful on palpation of her hind leg gallbladder points.
TCM patterns:
She has Liver Blood deficiency (thin tongue and pulse) and Blood stasis (lavender tongue). Her Gallbladder channel is obstructed. The dog is a Wood element personality. She is showing signs of Damp heat. Trauma allowed a low Blood supply to stagnate around the knee, the stagnation is beginning to solidify to stasis and if normal blood flow is not restored to moisten the damaged tendon, it will dry out and the joint will need to be surgically stabilized.
Treatment goals:
Move stagnation and relieve stasis, build and move Blood and support the Spleen in its making of vital substances. Drain dampness (edema), resolve pain.
Treatments:
Laser acupuncture was utilized in this case for the first treatment as the patient was too painful for me to needle, she attempted to bite when palpated to locate points. After one treatment, most points could be needled freely with the exception the following, which were always lasered as the patient did not tolerate needles in these points.
Point Name: Location: Use in this case:
BL 18 Gan Shu 1.5 cun lateral to the posterior edge of the spinous process of the tenth thoracic vertebra. Liver association point promotes smooth flow of Liver Blood and Qi.
BL 20 Pi Shu 1.5 cun lateral to the posterior edge of the spinous process of the twelfth thoracic vertebra. Spleen association point, strengthen Spleen in its transformation and transportation functions.
SP 9 Yin Mound Spring On the lower edge of the medial condyle of the tibia, in a depression between the posterior edge of the tibia and the gastrocnemius muscle. Normalize Spleen function, circulatory disorders in the hind quarters, edema. Local stifle point
Acupuncture point prescription: Needles used in this case were DBCTM Spring Ten 0.16mm diameter by 15mm length.
Point name: Location: Use in this case:
GV 20 Bai Hui On the dorsal midline of the head where it intersects with a line between the rostral edges of the bases of the ears, slightly caudal to the highest point on the head 0.5 cun deep. Stimulates the Spirit, calming.
GB 27 Wu Shu Directly in front of the lower corner of the ilium, on the anterior superior iliac spine. 0.5 cun perpendicular insertion. Regulates the Girdling Vessel, transforms stagnation, Hip triangle, proximal point
GB 29 Ju Liao In front of the hip joint, one third the distance between the greater trochanter of the femur and the dorsal edge of the posterior superior iliac spine. 1 cun perpendicular insertion. Proximal point for pain in the hind leg, resolves obstruction in the channel, supports the hind leg.
BL 54 Zhi Bian Dorsal to the major trochanter at the end of the second third of a line between the coxal tuber and the ishial tuberosity. 1 cun perpendicular insertion. Master point for the hind legs, Pain in the hind legs.
GB 34 Yan Ling Quan Laterally below the knee, in a depression cranial and distal to the head of the fibula. Remove channel obstruction, hui-meeting point for the tendons, supports smooth flow of Liver Qi body wide, relaxes the tendons, Move Blood, master point for tendons, tendon pathology.
ST 35 Du Bi In the depression below the patella, lateral to the patellar ligament. 0.5 cun perpendicular insertion. Local point for knee, draws out dampness and swelling.
Xi Yan, Eye of the Knee Below the patella, bilateral in the depression next to the straight patellar ligament. 0.5 cun perpendicular insertion. Local point to knee, moves Qi stagnation, clears heat, swelling in the knee.
ST 36 Zu San Li Laterally at the height of the distal end of the tibial tuberosity, in a depression roughly in the center of he tibialis cranialis muscle. 1 cun perpendicular insertion. Nourishes Blood and Yin, calms the Spirit, knee problems.
BL 40 Wei Zhong In the middle of the popliteal fold, at the center of the transverse crevice in the popliteal fossa, between the biceps femoris and semitendinous muscle. 1.5 cun perpendicular insertion. Removes Blood stasis, relaxes the tendons, arthritis of the knee, Pain, local point for the stifle
BL 60 Kum Lun Between the lateral malleolus and the calcaneal tuberosity, on a line with the tip of the malleolus between the bone and the Achilles tendon. 0.2 cun perpendicular insertion. Relaxes the tendons, strengthens the knees, relieves swelling and pain, aspirin point. Distal point.
This point prescription was repeated weekly for 9 weeks, after which the patient was found to have complete resolution of symptoms. She was fully weight bearing on both hind legs, with no draw present, no laxity in the stifle joint and no pain swelling or thickness on palpation of stifle.
Discussion:
Acupuncture is a reasonable treatment modality for torn cruciate ligaments. It can remove pain and inflammation while allowing the body’s own natural healing properties to repair the stability of the joint without arthritic reconstruction. A weekly acupuncture treatment brought blood flow back into her knee that flushed out the inflammatory mediators by increasing the nitric oxide to the area, which brings with it increased macrophage activity and promotes neutrophil clearance while providing analgesia . Pain in Traditional Chinese Medicine can be caused by stagnation, therefore when the blood flow is restored and the inflammation is reduced; pain is naturally decreased . After three months the surgeon could find no drawer on the leg, she is no longer a surgical candidate as repair of the stifle joint is no longer necessary as a complete resolution of limping was achieved. The patient a year later has a normal gait and continues to have normal mobility in her hind legs with no further treatment.
Diet is largely canned or kibble
Acupuncture points were stimulated