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
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.
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
Trigger point injection
1. Interventions for Myofacial Pain
Dr (Maj) Pankaj N Surange
MBBS, MD (Anesthesiology), FIPP (Hungary)
Director, Interventional Pain and Spine Centre, New Delhi
Secretary, World Institute of Pain, India Chapter
www.ipscindia.com
2. Mechanism of Action of
Trigger point Injections
• Mechanical disruption of the needle going
into the trigger point is the most important
part of deactivating a trigger point
3. Indications
• Indicated for patients who have
symptomatic active trigger points that
produce a twitch response to pressure and
create a pattern of referred pain
8. • Needle selection
• 22-25 G needle
• Length depending on the location of trigger
point and body habitus
– 1.5 inch to 3.0 inch
– Never insert all the way to its hub
– inadvertently contact with bone-replace
10. • Fix the trigger point between two fingers
• Ensure adequate tension in the muscle fiber
• Advance nedle into the trigger point at an acute angle of 30 degrees to the
skin
11. • Withdraw the needle to the level of the subcutaneous
tissue, then redirected superiorly, inferiorly, laterally and
medially, repeating the needling and injection process in each
direction.
• Needle all the loci (active spots) within the primary trigger
points
13. • Medications, volume, number and doses
• 1% Lignocaine vs dry needling
• 0.2 to 0.3 ml per trigger point
• Without epinephrine..
• Botulinum toxin injection does not offer any
advantage over saline or local anaesthetic
Ferrante FM, Bearn L, Rothrock R & King L. Evidence against trigger point injection technique for the treatment of
cervicothoracic myofascial pain with botulinum toxin type A. Anesthesiology 2005; 103: 377e383.
Graboski CL, Gray DS & Burnham RS. Botulinum toxin A versus bupivacaine trigger point injections for the
treatment of myofascial pain syndrome: a randomised double blind crossover study. Pain 2005; 118: 170e175.
14. • Not more than four trigger point injections
per year.
15. Post Procedure Rehabilitation
• Injection should be followed by three repetitions of
the full range of motion of the muscle, meaning it
should be shortened or contacted fully, and then
stretched to its longest point.
• The patient should then be taught how to stretch
the muscle(s) every 60-90 minutes during waking
hours.
23. Ultrasound guided trigger point
injection
• The possibility of diagnosing musculoskeletal
pathologies
24. Ultrasound guided trigger point
injection
• We can avoid injury to important structures
around trigger points.
25. Ultrasound guided trigger point
injection
• Avoidance of radiation exposure
• Reduced overall cost
• Portability of equipment within the office
setting
Not yet clearly understood.Initially some thought that it is actually fibrositis, so injecting steroids causes relaxation. Some thought that it is ectopic firing of the nerve endings so local anesthetics causes stabilization…..but today the most acceptable theory is mechanical disruption of the muscle fibre causes deactivation of trigger points
Primarily indicated for active trigger points. Satellite trigger points are also active tps so inj in these is alos an indication. As regrds to latent tps we don’t have conclusive evidence to support to address latent tps.
Depends on the location of tps and comfort of the patient.