Palpation of Channels and acupoints is part of the equine traditional Chinese veterinary medicine examination. Sensitivity of acupoints and acupoint combinations have been used to localize disease to certain regions and structures in horses. The objective of this clinical observational study was to scan and record sensitive acupoints of horses presented for lameness, poor performance or pre-purchase examinations and then evaluate the anatomic sites previously suggested for problems, using ultrasound, radiography or nerve blocks. Between January and April 2007, 259 horses, presented for examination, had sensitive acupoints and were evaluated for lesions. Of these, 139/259 (53.7%) horses were presented for lameness and pain, 91/259 (35.1%) horses were presented for general complaints about poor performance and 29/259 (11.2%) horses were presented for pre-purchase examinations. Sensitive acupoints were associated with disorders of tendons (12.9%), ligaments (19.4%), muscles (5.8%), bone (1.4%), joints (23%), hooves (7.2%) and sciatic nerves (10.8%), as well as back pain (13.7%), metacarpal and metatarsal fractures (1.4%) and general poor performance issues (5.81%). Diagnosis was confirmed with ultrasonography (44%), radiography (40%) and/or nerve blocks (16%). In this group of 259 horses, there was 100% correlation with acupoint sensitivity and lesion location reported elsewhere. Integration of palpation of acupoints into the routine conventional examination can be useful to localized lesions in horses with musculoskeletal and performance problems and detect potential problems during pre-purchase examinations.