scholarly journals Ultrasound-Guided Trigger Point Injections in the Cervicothoracic Musculature: A New and Unreported Technique

2008 ◽  
Vol 6;11 (12;6) ◽  
pp. 885-889 ◽  
Author(s):  
Kenneth P. Botwin
Keyword(s):  
Ultrasound Guidance ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Trigger Points ◽  
Target Tissue ◽  
Obese Patients ◽  
Needle Placement ◽  
Ultrasound Guided ◽  
Myofascial Trigger Points ◽  
Point Injection

Background: Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The myofascial pain syndrome is one of the largest groups of under diagnosed and under treated medical problems encountered in clinical practice. Trigger points are commonly seen in patients with myofascial pain which is responsible for localized pain in the affected muscles as well as referred pain patterns. Correct needle placement in a myofascial trigger point is vital to prevent complications and improve efficacy of the trigger point injection to help reduce or relieve myofascial pain. In obese patients, these injections may not reach the target tissue. In the cervicothoracic spine, a misguided or misplaced injection can result in a pneumothorax. Here, we describe an ultrasound-guided trigger point injection technique to avoid this potential pitfall. Office based ultrasound-guided injection techniques for musculoskeletal disorders have been described in the literature with regard to tendon, bursa, cystic, and joint pathologies. For the interventionalist, utilizing ultrasound yields multiple advantages technically and practically, including observation of needle placement in real-time, ability to perform dynamic studies, the possibility of diagnosing musculoskeletal pathologies, avoidance of radiation exposure, reduced overall cost, and portability of equipment within the office setting. To our knowledge, the use of ultrasound guidance in performing trigger point injection in the cervicothoracic area, particularly in obese patients, has not been previously reported. Methods: A palpable trigger point in the cervicothoracic musculature was localized and marked by indenting the skin with the tip of a plastic needle cover. The skin was then sterile prepped. Then, using an ultrasound machine with sterile coupling gel and a sterile latex free transducer cover, the musculature in the cervicothoracic spine where the palpable trigger point was detected was visualized. Then utilizing direct live ultrasound guidance, a 25-gauge 1.5 inch needle connected to a 3 mL syringe was placed into the muscle at the exact location of the presumed trigger point. This guidance helps confirm needle placement in muscle tissue and not in an adipose tissue or any other non-musculature structure. Results: The technique is simple to be performed by a pain management specialist who has ultrasound system training. Conclusion: Ultrasound-guided trigger point injections may help confirm proper needle placement within the cervicothoracic musculature. The use of ultrasound-guided trigger point injections in the cervicothoracic musculature may also reduce the potential for a pneumothorax by an improperly placed injection. Key words: Trigger point injection, myofascial pain, ultrasound

scholarly journals Electromyographically Guided Trigger Point Injections in the Cervicothoracic Musculature of Obese Patients: A New and Unreported Technique

2007 ◽  
Vol 6;10 (6;11) ◽  
pp. 753-756
Author(s):  
Kenneth P. Botwin
Keyword(s):  
Myofascial Pain ◽  
Trigger Point ◽  
Trigger Points ◽  
Injection Technique ◽  
Target Tissue ◽  
Obese Patients ◽  
Needle Placement ◽  
Hypodermic Injection ◽  
Myofascial Trigger Points ◽  
Point Injection

Background: Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The myofascial pain syndrome is one of the largest groups of under-diagnosed and under-treated medical problems encountered in clinical practice. Trigger points are commonly seen in patients with myofascial pain that can be responsible for localized pain in the affected muscles as well as referred pain patterns. Correct needle placement in a myofascial trigger point is vital to prevent complications and improve efficacy of the trigger point injection to help reduce or relieve myofascial pain. In the obese patients, these injections may not reach the target tissue. In the cervicothoracic spine, a misguided or misplaced injection can result in a pneumothorax. Here, we review an electromyographically guided trigger point injection technique to avoid this potential pitfall. Methods: Using a disposable Teflon coated hypodermic injection needle attached to an electromyography (EMG) machine, a trigger point injection can be performed utilizing electromyographic guidance. This guidance by observing motor unit action potentials (MUAPs) on the EMG screen helps confirm the needle placement to be within the muscle tissue and not in an adipose tissue or any other non-musculature structure. Results: The technique is simple when performed by a pain management specialist who has electromyographic training. Conclusion: This technique helps confirm proper needle placement within the cervicothoracic musculature in an obese patient in whom the musculature is not readily palpated. This, thus, reduces the potential for a pneumothorax by an improperly placed injection. Key words: Trigger point injection, myofascial pain, electromyography

scholarly journals Myofascial Pain Syndrome: A Concise Update on Clinical, Diagnostic and Integrative and Alternative Therapeutic Perspectives

2019 ◽  
pp. 1-14 ◽  
Author(s):  
Naseem A. Qureshi ◽  
Hamoud A. Alsubaie ◽  
Gazzaffi I. M. Ali
Keyword(s):  
Myofascial Pain ◽  
Trigger Point ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Muscle Twitch ◽  
Myofascial Trigger Points ◽  
Pain Syndromes ◽  
Clinical Diagnostic ◽  
Regional Pain Syndromes

Background: Myofascial pain syndrome is a common multifactorial condition that presents with key manifestations and comorbid with many systemic diseases and regional pain syndromes. Objective: This study aims to concisely review clinical, diagnostic and integrative therapeutic aspects of myofascial pain syndrome. Methods: E-searches (2000-2019) using keywords and Boolean operators were made and using exclusion and inclusion criteria, 50 full articles that focused on myofascial pain syndrome were retained for this review. Results: Myofascial pain syndrome is a multidimensional musculoskeletal disorder with ill-understood etiopathogenesis and pathophysiology and characterized by tender taut muscle with myofascial trigger points, muscle twitch response, specific pattern of referred pain and autonomic symptoms. A variety of pharmacological and nonpharmacological therapies with variable efficacy are used in myofascial pain syndrome, the latter modalities such as education, stretching and exercises, moist hot and cold packs, dry needling and myofascial massage or myofascial trigger point massage are used as first line options. Conclusion: Myofascial pain syndrome and trigger points initiated by repeated strains and injuries co-occur with diverse physical diseases and regional pain syndromes, which need comprehensive diagnostic evaluation using multiple methods. Several interventions are used in patients with myofascial pain syndrome who effectively respond to myofascial massage. This study calls for exploring etiopathogenesis and basic pathophysiological mechanisms underlying myofascial pain syndrome in future.

scholarly journals Myofascial Pain in Patients Waitlisted for Total Knee Arthroplasty

2012 ◽  
Vol 17 (5) ◽  
pp. 321-327 ◽  
Author(s):  
Richard Henry ◽  
Catherine M Cahill ◽  
Gavin Wood ◽  
Jennifer Hroch ◽  
Rosemary Wilson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Short Form ◽  
Trigger Points ◽  
Mcgill Pain Questionnaire ◽  
Myofascial Trigger Points ◽  
Total Knee

BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA) in patients with osteoarthritis (OA).OBJECTIVES: To determine the presence of myofascial pain in OA patients waitlisted for TKA and to determine whether their knee pain may be alleviated by trigger point injections.METHODS: Following ethics approval, 25 participants were recruited from the wait list for elective unilateral primary TKA at the study centre. After providing informed consent, all participants were examined for the presence of active trigger points in the muscles surrounding the knee and received trigger point injections of bupivacaine. Assessments and trigger point injections were implemented on the first visit and at subsequent visits on weeks 1, 2, 4 and 8. Outcome measures included the Timed Up and Go test, Brief Pain Inventory, Centre for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory and Short-Form McGill Pain Questionnaire.RESULTS: Myofascial trigger points were identified in all participants. Trigger point injections significantly reduced pain intensity and pain interference, and improved mobility. All participants had trigger points identified in medial muscles, most commonly in the head of the gastrocnemius muscle. An acute reduction in pain and improved functionality was observed immediately following intervention, and persisted over the eight-week course of the investigation.CONCLUSION: All patients had trigger points in the vastus and gastrocnemius muscles, and 92% of patients experienced significant pain relief with trigger point injections at the first visit, indicating that a significant proportion of the OA knee pain was myofascial in origin. Further investigation is warranted to determine the prevalence of myofascial pain and whether treatment delays or prevents TKA.

scholarly journals The relative effectiveness of chiropractic manipulation to the level of main segmental nerve supply as opposed to dry needling in the treatment of muscles with myofascial trigger points

2000 ◽  
Author(s):  
◽  
Hayden Clyde Pooke
Keyword(s):  
Myofascial Pain ◽  
Trigger Point ◽  
Relative Effectiveness ◽  
Trigger Points ◽  
Nerve Supply ◽  
Dry Needling ◽  
Chiropractic Manipulation ◽  
Myofascial Trigger Points ◽  
Medical Disorders ◽  
Segmental Nerve

Myofascial trigger points are a common problem for patients as weJl as physicians. According to some authors Myofascial Pain Syndromes encompass the largest group of unrecognised and under-treated medical disorders. At present, needling techniques seem to be most effective in treating myofascial trigger points, however, many chiropractors claim that manipulation alone is sufficient for trigger point amelioration. The aim of this study was to determine the effectiveness of chiropractic manipulation to the level of main segmental nerve supply versus dry needling in the treatment of selected muscles with myofascial trigger points.

Concomitant Sympathetically Mediated Pain and Myofascial Trigger Point Pain

1994 ◽  
Vol 12 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Peter Baldry
Keyword(s):  
Myofascial Pain ◽  
Trigger Point ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Myofascial Trigger Point ◽  
Sympathetically Maintained Pain ◽  
Myofascial Trigger Points ◽  
Release Of Noradrenaline ◽  
Genetically Determined

It is not sufficiently well recognised that the reflex sympathetic dystrophy syndrome (RSDS) and the myofascial pain syndrome (MPS) may develop concomitantly. This happens because they have similar aetiological factors, with trauma being by far the commonest. Everyone is liable to develop nociceptor pain as a result of trauma-induced activation and sensitisation of C afferent skin and Group IV muscle nociceptors; also A-β mediated pain as a result of the sensory afferent barrage produced by these nociceptors giving rise to sensitisation of dorsal horn transmission neurones. With most people these neural changes lead only to the development of MPS. In a minority of people, possibly those with a genetically determined predisposition, this sensory afferent barrage also causes changes to take place in the sympathetic nervous system, with the development of a characteristic burning type of sympathetically mediated pain. This may develop alone or in association with myofascial trigger point pain. There is much controversy concerning the mechanisms for development of RSDS pain. One theory is that the pain develops as a result of the nociceptor-induced sensory afferent barrage setting up aberrant sympathetic efferent activity. This results in the release of noradrenaline which binds to α-1 adrenoreceptors in the walls of the nociceptors, exciting them further. Much research, however, still has to be done before the development of sympathetically maintained pain can be adequately explained. It is stressed that for the successful treatment of RSDS early diagnosis is essential. Treatment involves sympathetic blockade either by the injection of local anaesthetic into a sympathetic ganglion, or by the regional infusion of a catecholamine depleting drug. Sympathetically maintained pain is morphine resistant and is therefore unlikely to be relieved by acupuncture, the analgesic effect of which is mediated by opioid peptides. The main place for acupuncture is in the treatment of concomitant myofascial trigger point pain. It is emphasised that in all cases of RSDS it is essential to search for myofascial trigger points and, when present, to deactivate these by means of acupuncture stimulation of A-δ nerve fibres present in the skin and subcutaneous tissues at the trigger point sites.

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