Laser acupuncture treatment of infected arthritis and tendosynovitis in horses
Dr. med. vet. Uwe Petermann, E-mail: DrUwePetermannMelle@t-online.de
Laser acupuncture treatment is not yet standard at universities, although it can be used throughout the entire spectrum of medicine. 7 equine patients were given acupuncture treatment for infected arthritis and tendosynovitis after standard medical treatments had been exhausted; the potential restorative benefits of laser acupuncture treatment are presented here.
Key words: laser acupuncture, horse, infected synovitis
Patient evidence and methodology
The patients were seven horses suffering from either an infected arthritis or tendosynovitis. Three infections were the result of pitchfork wounds; one infection (in the shoulder joint) was caused by a sharp wooden post which had broken through. A postoperative infected tarsitis followed a chip operation (a clinically completely healthy horse), and a postoperative infection of the digital synovial sheath of the fetlock resulted following an operation on the palmar annular ligament of the fetlock. A purulent podarthritis resulted from a hock joint injection in a patient with an apparent disease of the podotrochlea. Prior to the start of laser acupuncture treatment, all of the patients had exhausted all conventional medical therapies over a longer period of time, some of them in several clinics; the prognosis in each case was either unfavorable or it had been suggested that the animal be put to sleep. With one exception, all of the animals were given anywhere from 9 to 20 local treatments for individually selected acupuncture points with an impulse laser (60 watts and 90 watts pulse peak power, 200 nsec pulse width, from Reimers und Janssen, Berlin). Following completion of therapy, it was possible to work again with six of the horses. One horse finally had to be put to sleep following a long period of treatment. I would like to present 3 patient histories in greater detail.
Case study 1: A chip in the right ankle joint was noticed during a preventive X-ray examination of a two-year-old crossbred stallion. Following an endoscopic removal of the fragment, an infectious tarsitis developed. This was first treated by the clinic where the operation had taken place; intensive treatment followed at three other clinics. 6 months after the operation, I examined the horse. The horse did not set the diseased limb down and only with great effort could it move forward with three legs. The circumference of the joint was 61 cm (a normal tarsal joint measures 42 cm). (Picture Thieb. 1 + 2). After fourteen days or seven treatments, the circumference of the joint had been reduced to 47 cm, and the horse could be walked and also be exercised at a trot (Picture Thieb. 3 + 4).for about 5 minutes. After trotting for approximately one minute, the horse was able to move without a limp. After the third day of exercise, a new feverish inflammation of the joint appeared spontaneously, with over 41°C body temperature and pronounced swelling of the joint. During the acute phase, the inflammation was treated with antibiotics (parenteral and not intra-articular). After approximately four weeks with twelve additional treatments, the patient was released and gradually began training to full capacity at home.
Case study 2: Following a coffin joint injection, a twenty-year-old crossbred stallion developed an infectious arthritis. The patient did not stand on that foot and was clearly in great pain; the entire hoof area was swollen significantly. Following consultation with the clinic, I administered an acupuncture examination to the horse (thus avoiding the need of transportation) and the owner and/or clinic personnel gave the horse daily acupuncture treatments at the acupuncture points I had marked. After three days, the horse could be walked almost without limping. One week later ? I am not aware of the precise cause ? (the horse was apparently again given an intra-articular injection), its condition deteriorated considerably. Now, despite the horse's condition, it was transferred to another clinic and there it was punctured and cleansed several times and finally drained. It was then agreed that euthanasia was the only solution, as its condition continued to worsen despite all the efforts made, including continued laser acupuncture by the owner and clinic personnel.
Case study 3: Following a routine endoscopy of the digital synovial sheath of the fetlock in a six-year-old crossbred gelding, which took place within the scope of an operation on the palmar annular ligament of the fetlock, the healing of the wound was disturbed by a continuous discharge of synovia. Despite intensive therapy by the clinic where the operation had been performed, there was at first an infection of the tendon sheath and a necrotizing inflammation in the area where the operation took place. Six weeks after the operation, the clinic decided to suggest euthanasia to the owner, as continued deterioration of the horse's condition seemed definite and the infection of the tendon sheath could not be controlled. However, the owner decided to try acupuncture treatment for the horse, a decision which was strongly opposed by the clinic. These were the findings: approx. two 5 DM coin-sized wounds with escaping synovia and a necrotic center. (Picture 5). A brisk walk was indeed possible, but only with a high degree of lameness. The foot was set down only at the tip of the toe. Due to the adhesions of the tendon sheath, it was not possible to use the fetlock joint to press down. The circumference of the fetlock joint was 49 cm (a healthy joint measures 43 cm). After two treatments (two days, see Picture 6), no further secretion from the tendon sheath could be determined). A marked necrotic area of approx. the size of a 1 pfennig coin was considerably reduced (circumference still 46 cm). After five days (five treatments), the wound was completely dry and had shrunk to half its original size. After ten days the wound had almost completely closed (Picture 7); there was now only a slight lameness when walking, which gradually disappeared. Even in trotting, only a slight to medium limp was noted. After a total of fourteen days of treatment, the patient was released, where it is currently receiving additional treatment from its owner; the horse is gradually increasing its walking and trotting in order to further loosen the adhesions and to continue reducing the tendon's contracture.
Discussion: In all the patients, it could be seen that laser acupuncture had a rapid influence on demarcation and inflammation. On the other hand, restitution of the degenerative consequences of the inflammation, including adhesions, defects in the cartilage and similar problems presented considerably greater difficulty and required far more time. Nonetheless, healing was eventually achieved in all cases but one. These cases clearly demonstrate how it is possible to expand the limits of therapy with the help of laser acupuncture, and I do not wish to exclude the possibility that in the case of the patient with podarthritis, healing might have been possible with immediate and continuing laser acupuncture without the irritation caused by puncture, cleansing and drainage. Still, one must keep in mind ? particularly when discussing acupuncture, which has not yet been fully integrated scientifically ? that one cannot refuse an owner's wish to combine acupuncture with conventional medical therapy. This can be a significant factor in case the therapy fails; otherwise one may well be held responsible for the failure. I have therefore reached the conclusion that, in a similar case, I would not attempt an additional laser acupuncture treatment.
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