SlideShare une entreprise Scribd logo
1  sur  37
Télécharger pour lire hors ligne
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
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
Indications


• Indicated for patients who have
  symptomatic active trigger points that
  produce a twitch response to pressure and
  create a pattern of referred pain
Trigger point injection-
     Prerequisites
• Supine –Prone - Sitting
Explain the procedure-allay anxiety
• Sharp pain
• Muscle twitching
• Unpleasant sensation as the needle contacts the taut
  muscular band
Full aseptic precautions
Skin infiltration with 26 g ,half inch needle
• 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
Technique
• Identification of Trigger points

     • Active
     • Latent
• First the most symptomatic
• 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
• 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
Trigger point injection
• 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.
• Not more than four trigger point injections
  per year.
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.
• Trapezius stretch
• Levator scapuli stretch
• Posterior neck sretch
• Scalene stretch
Modalities
Ultrasound guided Myofacial pain trigger
            point injection
Ultrasound guided trigger point
                  injection

• Observation of needle placement in real-
  time
Ultrasound guided trigger point
                injection
• The possibility of diagnosing musculoskeletal
  pathologies
Ultrasound guided trigger point
                injection

• We can avoid injury to important structures
  around trigger points.
Ultrasound guided trigger point
                injection

• Avoidance of radiation exposure

• Reduced overall cost

• Portability of equipment within the office
  setting
Fluoroscopic guided
Complications

• Vasovagal syncope-Resuscitation
  equipment's
• Pneumothorax- Fluoroscopy guided
• Hematoma-apply 2 min pressure
• Nerve injury
• Reg Anaesth Pain Manage 2009; 13: 179–83

• Pain Phys 2008; 11: 885–9

• Arch PhysMedRehabil 2009;90: 1829–38

• Obstet Gynecol Clinic North Am 1993; 20:
  809–15
Thanks
Trigger point injection
Trigger point injection
Trigger point injection
Trigger point injection
Trigger point injection
Trigger point injection
Trigger point injection
Trigger point injection

Contenu connexe

Tendances

Dextrose Prolotherapy for Chronic Musculoskeletal Pain
Dextrose Prolotherapy for Chronic Musculoskeletal Pain Dextrose Prolotherapy for Chronic Musculoskeletal Pain
Dextrose Prolotherapy for Chronic Musculoskeletal Pain Ade Wijaya
 
Efficacy of therapeutic ultrasound in the physiotherapy management of musculo...
Efficacy of therapeutic ultrasound in the physiotherapy management of musculo...Efficacy of therapeutic ultrasound in the physiotherapy management of musculo...
Efficacy of therapeutic ultrasound in the physiotherapy management of musculo...Ayobami Ayodele
 
Interventional spine & pain management dr manish raj
Interventional spine & pain management  dr manish rajInterventional spine & pain management  dr manish raj
Interventional spine & pain management dr manish rajManish Raj
 
Pain management after joint replacement surgery
Pain management after joint replacement surgeryPain management after joint replacement surgery
Pain management after joint replacement surgeryPranav Bansal
 
complex regional pain syndrome. C.R.P.S
complex regional pain syndrome. C.R.P.Scomplex regional pain syndrome. C.R.P.S
complex regional pain syndrome. C.R.P.SDr Ravi Shankar Sharma
 
Phantom limb pain
Phantom limb painPhantom limb pain
Phantom limb painmohsen abad
 
Chronic pain assessment & management
Chronic pain assessment & management Chronic pain assessment & management
Chronic pain assessment & management Shekhar Anand
 
8 dry needling vs acupuncture
8 dry needling vs acupuncture8 dry needling vs acupuncture
8 dry needling vs acupunctureSubhanjan Das
 
Interventional pain management by dr rajeev harshe
Interventional pain management  by dr  rajeev harsheInterventional pain management  by dr  rajeev harshe
Interventional pain management by dr rajeev harsheRajeev Harshe
 
Complex regional pain syndrome Petrus Iitula
Complex regional pain syndrome   Petrus IitulaComplex regional pain syndrome   Petrus Iitula
Complex regional pain syndrome Petrus IitulaPetrus Iitula
 
Frozen shoulder 9.6.15
Frozen shoulder 9.6.15Frozen shoulder 9.6.15
Frozen shoulder 9.6.15Anubhav Verma
 
De quervain's
De quervain'sDe quervain's
De quervain'sLee Yew
 
Crps ppt 2017 (1)
Crps ppt 2017 (1)Crps ppt 2017 (1)
Crps ppt 2017 (1)Sami Halim
 
Cognitive Behavioral Therapy - Chronic Pain (CBT-CP)
Cognitive Behavioral Therapy - Chronic Pain (CBT-CP)Cognitive Behavioral Therapy - Chronic Pain (CBT-CP)
Cognitive Behavioral Therapy - Chronic Pain (CBT-CP)Michael Changaris
 
Complex Regional Pain Syndrome
Complex Regional Pain SyndromeComplex Regional Pain Syndrome
Complex Regional Pain SyndromeAhmed Youssef
 
Chronic pain management
Chronic pain managementChronic pain management
Chronic pain managementSubrat Nayak
 

Tendances (20)

Facet joint injection
Facet joint injection Facet joint injection
Facet joint injection
 
Sacroiliac Joint
Sacroiliac JointSacroiliac Joint
Sacroiliac Joint
 
Dextrose Prolotherapy for Chronic Musculoskeletal Pain
Dextrose Prolotherapy for Chronic Musculoskeletal Pain Dextrose Prolotherapy for Chronic Musculoskeletal Pain
Dextrose Prolotherapy for Chronic Musculoskeletal Pain
 
Efficacy of therapeutic ultrasound in the physiotherapy management of musculo...
Efficacy of therapeutic ultrasound in the physiotherapy management of musculo...Efficacy of therapeutic ultrasound in the physiotherapy management of musculo...
Efficacy of therapeutic ultrasound in the physiotherapy management of musculo...
 
Interventional spine & pain management dr manish raj
Interventional spine & pain management  dr manish rajInterventional spine & pain management  dr manish raj
Interventional spine & pain management dr manish raj
 
Pain management after joint replacement surgery
Pain management after joint replacement surgeryPain management after joint replacement surgery
Pain management after joint replacement surgery
 
Complex Regional Pain Syndrome
Complex Regional Pain SyndromeComplex Regional Pain Syndrome
Complex Regional Pain Syndrome
 
Complex regional pain syndrome
Complex regional pain syndromeComplex regional pain syndrome
Complex regional pain syndrome
 
complex regional pain syndrome. C.R.P.S
complex regional pain syndrome. C.R.P.Scomplex regional pain syndrome. C.R.P.S
complex regional pain syndrome. C.R.P.S
 
Phantom limb pain
Phantom limb painPhantom limb pain
Phantom limb pain
 
Chronic pain assessment & management
Chronic pain assessment & management Chronic pain assessment & management
Chronic pain assessment & management
 
8 dry needling vs acupuncture
8 dry needling vs acupuncture8 dry needling vs acupuncture
8 dry needling vs acupuncture
 
Interventional pain management by dr rajeev harshe
Interventional pain management  by dr  rajeev harsheInterventional pain management  by dr  rajeev harshe
Interventional pain management by dr rajeev harshe
 
Complex regional pain syndrome Petrus Iitula
Complex regional pain syndrome   Petrus IitulaComplex regional pain syndrome   Petrus Iitula
Complex regional pain syndrome Petrus Iitula
 
Frozen shoulder 9.6.15
Frozen shoulder 9.6.15Frozen shoulder 9.6.15
Frozen shoulder 9.6.15
 
De quervain's
De quervain'sDe quervain's
De quervain's
 
Crps ppt 2017 (1)
Crps ppt 2017 (1)Crps ppt 2017 (1)
Crps ppt 2017 (1)
 
Cognitive Behavioral Therapy - Chronic Pain (CBT-CP)
Cognitive Behavioral Therapy - Chronic Pain (CBT-CP)Cognitive Behavioral Therapy - Chronic Pain (CBT-CP)
Cognitive Behavioral Therapy - Chronic Pain (CBT-CP)
 
Complex Regional Pain Syndrome
Complex Regional Pain SyndromeComplex Regional Pain Syndrome
Complex Regional Pain Syndrome
 
Chronic pain management
Chronic pain managementChronic pain management
Chronic pain management
 

En vedette

En vedette (15)

PTCA
PTCAPTCA
PTCA
 
PTBD
PTBDPTBD
PTBD
 
Proton pump inhibitors
Proton pump inhibitorsProton pump inhibitors
Proton pump inhibitors
 
GEMC- EMedHome Board Review: Procedures- Resident Training
GEMC- EMedHome Board Review: Procedures- Resident TrainingGEMC- EMedHome Board Review: Procedures- Resident Training
GEMC- EMedHome Board Review: Procedures- Resident Training
 
Indications of proton pump inhibitors
Indications of proton pump inhibitorsIndications of proton pump inhibitors
Indications of proton pump inhibitors
 
Proton Pump Inhibitors
Proton Pump InhibitorsProton Pump Inhibitors
Proton Pump Inhibitors
 
PTBD Percutaneous transhepatic biliary drainage
PTBD Percutaneous transhepatic biliary drainagePTBD Percutaneous transhepatic biliary drainage
PTBD Percutaneous transhepatic biliary drainage
 
Coronary angiogram
Coronary angiogramCoronary angiogram
Coronary angiogram
 
Renal Arteriogram
Renal ArteriogramRenal Arteriogram
Renal Arteriogram
 
proton pump inhibitors
 proton pump inhibitors proton pump inhibitors
proton pump inhibitors
 
Coronary angiography
Coronary angiography Coronary angiography
Coronary angiography
 
Coronary angiogram
Coronary angiogramCoronary angiogram
Coronary angiogram
 
Proton pump inhibitor
Proton pump inhibitorProton pump inhibitor
Proton pump inhibitor
 
proton pump inhibitors PPT
proton pump inhibitors PPTproton pump inhibitors PPT
proton pump inhibitors PPT
 
PERICARDIOCENTESIS
PERICARDIOCENTESISPERICARDIOCENTESIS
PERICARDIOCENTESIS
 

Similaire à Trigger point injection

Shockwave [Read-Only].pptx
Shockwave [Read-Only].pptxShockwave [Read-Only].pptx
Shockwave [Read-Only].pptxPaiMin7
 
Ppt for cims con 2017 chronic pain algorythm
Ppt for cims con 2017 chronic pain algorythm Ppt for cims con 2017 chronic pain algorythm
Ppt for cims con 2017 chronic pain algorythm drdipakdesai
 
15. Presentation15.pptx
15. Presentation15.pptx15. Presentation15.pptx
15. Presentation15.pptxv c
 
Acupuncture for hysterectomy
Acupuncture for hysterectomyAcupuncture for hysterectomy
Acupuncture for hysterectomymohamed abuelnaga
 
Arthrocentesis and Injection of Joints.pptx
Arthrocentesis and Injection of Joints.pptxArthrocentesis and Injection of Joints.pptx
Arthrocentesis and Injection of Joints.pptxnugraha65
 
Gpacon 2018 dry needling
Gpacon 2018 dry needlingGpacon 2018 dry needling
Gpacon 2018 dry needlingDeepak Kumar
 
Role of radiofrequency ablation in pain management
Role of radiofrequency ablation in pain managementRole of radiofrequency ablation in pain management
Role of radiofrequency ablation in pain managementDr. Kaustav Basu Thakur
 
Pocket comp periph nerve blocks.pdf
Pocket comp periph nerve blocks.pdfPocket comp periph nerve blocks.pdf
Pocket comp periph nerve blocks.pdfdalialamasbonita1093
 
Pain management
Pain managementPain management
Pain managementSpinePlus
 
MANAGEMENT OF COMMON PAIN SYNDROME.pptx
MANAGEMENT OF COMMON PAIN SYNDROME.pptxMANAGEMENT OF COMMON PAIN SYNDROME.pptx
MANAGEMENT OF COMMON PAIN SYNDROME.pptxGiEm3
 
Local anaesthesia in dentistry
Local anaesthesia in dentistryLocal anaesthesia in dentistry
Local anaesthesia in dentistryKirtiRanka1
 
Intervention Pain Management on Treating Postherpetic Neuralgia- dr. Rivan Da...
Intervention Pain Management on Treating Postherpetic Neuralgia- dr. Rivan Da...Intervention Pain Management on Treating Postherpetic Neuralgia- dr. Rivan Da...
Intervention Pain Management on Treating Postherpetic Neuralgia- dr. Rivan Da...ssusere7af1e
 
Joint and soft tissue injections
Joint and soft tissue injectionsJoint and soft tissue injections
Joint and soft tissue injectionsRVTEZ
 
Myofascial Pain.pptx
Myofascial Pain.pptxMyofascial Pain.pptx
Myofascial Pain.pptxssuserfd3caf
 
Intra articular injection by dr. ahmed shedeed
Intra articular injection by dr. ahmed shedeedIntra articular injection by dr. ahmed shedeed
Intra articular injection by dr. ahmed shedeedAhmed-shedeed
 
MYOFACIAL PAIN DYSFUNCTION SYNDROME.pptx
MYOFACIAL PAIN DYSFUNCTION SYNDROME.pptxMYOFACIAL PAIN DYSFUNCTION SYNDROME.pptx
MYOFACIAL PAIN DYSFUNCTION SYNDROME.pptxDR DAVIS NADAKKAVUKARAN
 
Inguinodynia by Prof. Ajay Khanna, IMS, BHU, Varanasi, India
Inguinodynia  by Prof. Ajay Khanna, IMS, BHU, Varanasi, India Inguinodynia  by Prof. Ajay Khanna, IMS, BHU, Varanasi, India
Inguinodynia by Prof. Ajay Khanna, IMS, BHU, Varanasi, India Divya Khanna
 

Similaire à Trigger point injection (20)

Shockwave [Read-Only].pptx
Shockwave [Read-Only].pptxShockwave [Read-Only].pptx
Shockwave [Read-Only].pptx
 
Ppt for cims con 2017 chronic pain algorythm
Ppt for cims con 2017 chronic pain algorythm Ppt for cims con 2017 chronic pain algorythm
Ppt for cims con 2017 chronic pain algorythm
 
15. Presentation15.pptx
15. Presentation15.pptx15. Presentation15.pptx
15. Presentation15.pptx
 
Acupuncture for hysterectomy
Acupuncture for hysterectomyAcupuncture for hysterectomy
Acupuncture for hysterectomy
 
Arthrocentesis and Injection of Joints.pptx
Arthrocentesis and Injection of Joints.pptxArthrocentesis and Injection of Joints.pptx
Arthrocentesis and Injection of Joints.pptx
 
Gpacon 2018 dry needling
Gpacon 2018 dry needlingGpacon 2018 dry needling
Gpacon 2018 dry needling
 
Role of radiofrequency ablation in pain management
Role of radiofrequency ablation in pain managementRole of radiofrequency ablation in pain management
Role of radiofrequency ablation in pain management
 
Pocket comp periph nerve blocks.pdf
Pocket comp periph nerve blocks.pdfPocket comp periph nerve blocks.pdf
Pocket comp periph nerve blocks.pdf
 
Pain management
Pain managementPain management
Pain management
 
MANAGEMENT OF COMMON PAIN SYNDROME.pptx
MANAGEMENT OF COMMON PAIN SYNDROME.pptxMANAGEMENT OF COMMON PAIN SYNDROME.pptx
MANAGEMENT OF COMMON PAIN SYNDROME.pptx
 
Local anaesthesia in dentistry
Local anaesthesia in dentistryLocal anaesthesia in dentistry
Local anaesthesia in dentistry
 
Intervention Pain Management on Treating Postherpetic Neuralgia- dr. Rivan Da...
Intervention Pain Management on Treating Postherpetic Neuralgia- dr. Rivan Da...Intervention Pain Management on Treating Postherpetic Neuralgia- dr. Rivan Da...
Intervention Pain Management on Treating Postherpetic Neuralgia- dr. Rivan Da...
 
De quervain’s
De quervain’sDe quervain’s
De quervain’s
 
Joint and soft tissue injections
Joint and soft tissue injectionsJoint and soft tissue injections
Joint and soft tissue injections
 
Myofascial Pain.pptx
Myofascial Pain.pptxMyofascial Pain.pptx
Myofascial Pain.pptx
 
spinal injections.pptx
spinal injections.pptxspinal injections.pptx
spinal injections.pptx
 
Intra articular injection by dr. ahmed shedeed
Intra articular injection by dr. ahmed shedeedIntra articular injection by dr. ahmed shedeed
Intra articular injection by dr. ahmed shedeed
 
MYOFACIAL PAIN DYSFUNCTION SYNDROME.pptx
MYOFACIAL PAIN DYSFUNCTION SYNDROME.pptxMYOFACIAL PAIN DYSFUNCTION SYNDROME.pptx
MYOFACIAL PAIN DYSFUNCTION SYNDROME.pptx
 
Peripheral blocks
Peripheral blocksPeripheral blocks
Peripheral blocks
 
Inguinodynia by Prof. Ajay Khanna, IMS, BHU, Varanasi, India
Inguinodynia  by Prof. Ajay Khanna, IMS, BHU, Varanasi, India Inguinodynia  by Prof. Ajay Khanna, IMS, BHU, Varanasi, India
Inguinodynia by Prof. Ajay Khanna, IMS, BHU, Varanasi, India
 

Plus de Interventional pain and spine Centre

Plus de Interventional pain and spine Centre (20)

Setting up of Pain management facility .pptx
Setting up of Pain management facility .pptxSetting up of Pain management facility .pptx
Setting up of Pain management facility .pptx
 
Stem cell treatment- IPSC Pain and Spine Hospitals Protocol.pdf
Stem cell treatment- IPSC Pain and Spine Hospitals Protocol.pdfStem cell treatment- IPSC Pain and Spine Hospitals Protocol.pdf
Stem cell treatment- IPSC Pain and Spine Hospitals Protocol.pdf
 
IPSC Varsity: Best training centre in India for Pain Medicine
IPSC Varsity: Best training centre in India for Pain Medicine IPSC Varsity: Best training centre in India for Pain Medicine
IPSC Varsity: Best training centre in India for Pain Medicine
 
Drug scheduling in india
Drug scheduling in indiaDrug scheduling in india
Drug scheduling in india
 
1. introduction to Interventional Pain Management
1. introduction to Interventional Pain Management 1. introduction to Interventional Pain Management
1. introduction to Interventional Pain Management
 
Ankylosing spond dr pankaj
Ankylosing spond dr pankajAnkylosing spond dr pankaj
Ankylosing spond dr pankaj
 
Interventional pain and spine center, new delhi, india
Interventional pain and spine center, new delhi, india Interventional pain and spine center, new delhi, india
Interventional pain and spine center, new delhi, india
 
Interventional approach to back pain Management
Interventional approach to  back pain ManagementInterventional approach to  back pain Management
Interventional approach to back pain Management
 
Management of chronic knee pain
Management of chronic knee painManagement of chronic knee pain
Management of chronic knee pain
 
Surange Mediclinic , Dwarka, New Delhi
Surange Mediclinic , Dwarka, New DelhiSurange Mediclinic , Dwarka, New Delhi
Surange Mediclinic , Dwarka, New Delhi
 
Interventional pain and spine courses
Interventional pain and spine coursesInterventional pain and spine courses
Interventional pain and spine courses
 
Interventional pain and spine centre
Interventional pain and spine centreInterventional pain and spine centre
Interventional pain and spine centre
 
ICIPM 2012, WIP-INDIA at AIIMS, New Delhi
ICIPM 2012, WIP-INDIA at AIIMS, New DelhiICIPM 2012, WIP-INDIA at AIIMS, New Delhi
ICIPM 2012, WIP-INDIA at AIIMS, New Delhi
 
Intradiscal procedures current evidence
Intradiscal procedures  current evidenceIntradiscal procedures  current evidence
Intradiscal procedures current evidence
 
icipm 2012 welcome
icipm 2012 welcomeicipm 2012 welcome
icipm 2012 welcome
 
Final brochure
Final brochureFinal brochure
Final brochure
 
Ipscindia.com
Ipscindia.comIpscindia.com
Ipscindia.com
 
Cardiac patient for non cardiac surgery
Cardiac patient for non cardiac surgeryCardiac patient for non cardiac surgery
Cardiac patient for non cardiac surgery
 
Anatomy of spine
Anatomy of spineAnatomy of spine
Anatomy of spine
 
Airway management
Airway managementAirway management
Airway management
 

Dernier

power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...Ganesan Yogananthem
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?Ryan Addison
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 

Dernier (20)

power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
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
  • 4. Trigger point injection- Prerequisites • Supine –Prone - Sitting
  • 5. Explain the procedure-allay anxiety • Sharp pain • Muscle twitching • Unpleasant sensation as the needle contacts the taut muscular band
  • 7. Skin infiltration with 26 g ,half inch needle
  • 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
  • 9. Technique • Identification of Trigger points • Active • Latent • First the most symptomatic
  • 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.
  • 21. Ultrasound guided Myofacial pain trigger point injection
  • 22. Ultrasound guided trigger point injection • Observation of needle placement in real- time
  • 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
  • 27. Complications • Vasovagal syncope-Resuscitation equipment's • Pneumothorax- Fluoroscopy guided • Hematoma-apply 2 min pressure • Nerve injury
  • 28. • Reg Anaesth Pain Manage 2009; 13: 179–83 • Pain Phys 2008; 11: 885–9 • Arch PhysMedRehabil 2009;90: 1829–38 • Obstet Gynecol Clinic North Am 1993; 20: 809–15

Notes de l'éditeur

  1. 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
  2. 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.
  3. Depends on the location of tps and comfort of the patient.