Objective: The purpose of this study was to evaluate Thoroughbred racehorses in training using traditional oriental techniques for meridian or channel diagnosis (CD) before and after intra-articular (IA) therapy of the metacarpophalangeal joint, and to determine the incidence and significance of channel abnormality in the diagnosis of fetlock disease. Background: In traditional oriental channel diagnosis, key diagnostic acupoints are palpated and evaluated for sensitivity. Pathological sensitivity of acupoints is referred to as channel imbalance in oriental medicine, and myofascial pain syndrome (MPS) with trigger points (TrP's) in western medicine. If there is an abnormally sensitive acupoint, and the sensitivity can be changed markedly by the IA injection of a diagnostic or therapeutic medication, then the mechanism for the propagation of the observed channel imbalance must be related to an intra-articular phenomenon. Design and Patients: Three hundred twenty-seven (327) Thoroughbred racehorses were evaluated for abnormal reactivity of the specific acupoints: Large Intestine (LI) 18, Small Intestine (SI) 16, Triple Heater (TH) 15, Urinary Bladder (UB) 42, a Lung Meridian Associated Point, and Urinary Bladder (UB) 14, a Pericardium Meridian Associated Point. Acupoint reactivity was graded on a scale of I–IV, where GdI=normal sensitivity, GdII=slight sensitivity, Gd III=pain or abnormal sensitivity, and Gd IV=active evasion by the horse. Grades III and IV were considered to be pathological. The evaluations were unblinded in that pre-and post-treatment evaluations were made by the same examiner. All horses whose medical and working history and acupuncture evaluation suggested pain referable to the fetlock(s) were injected intra-articularly with either a local anesthetic or an articular therapeutic product. The horses were subsequently evaluated for a change in acupoint sensitivity, either ten minutes for the local anesthetic or twenty-four hours for the medications, after the initial injection. Results: Intra-articular medication of the fetlock joint markedly changed the pathological channel imbalance in 176 (54%) racing horses in training. The majority of these, 111 (63%) were not lame. Eighteen (10%) were frankly lame (≥ Gd II/V) and became sound with IA anesthesia of the fetlock joint. The remaining 47 (27%) were lame as a result of extra-articular or nonfetlock pain and were not made sound with IA fetlock anesthesia despite a marked change in acupoint sensitivity. The diagnoses were made with conventional regional nerve blocks. Of the 176 horses with channel imbalance, LI/LU was involved in 100%, 158 (90%) had involvement of SI/HT, 46 (26%) involved TH, and 16 (9%) involved the PC channel. Channel imbalance was defined as the presence of one or more of the described acupoints in excess, that is with a Gd III–IV sensitivity. Each point in excess reflected abnormality in either the actual channel, LI, SI, and TH, or in the case of the associated points, UB 42 and UB 14, the LU and PC channels, respectively. Concomitant sources of foreleg pain were found. Seven (4%) horses with fetlock related channel imbalance also had interphalangeal related imbalance, and 7 (4%) had carpal related imbalance as well as fetlock imbalance. Ninety-three (53%) had imbalance related to the hind legs. Five (3%) were lame due to IA fetlock pathology yet had no channel imbalance. Conclusions: Thoroughbred horses in training had a consistently high percentage of CD imbalance with TrP's that could be directly related to IA structures of the fetlock and alleviated with IA drugs. The distribution of channel imbalance suggested the site of fetlock pathology, with LI/LU (dorso-medial and medial) > SI/HT (dorso-lateral and lateral) > TH (dorsal midline) > PC (caudal midline). Extra articular fetlock pathology did not result in CD imbalance. CD is an additional method of evaluating the influence of medications, shoeing, and training regimes on most of the innervated structures of the metacarpophalangeal joint.
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