TRIGGER POINTS INJECTIONS

Indications

Various modalities for the treatment of trigger points include spray and stretch, ultrasound, manipulative therapy, and trigger point injections. Not all trigger points require injection or needling. Many active trigger points will respond to physical therapy, especially in the early stages of trigger point formation. However, for chronic trigger points, trigger point injection and needling is an effective treatment.

Trigger point injections are indicated for patients who have symptoms and examination findings consistent with active trigger points. Latent trigger points are clinically asymptomatic and do not require treatment. Trigger points should be limited in number and should be appropriate for injection.

Conditions involving widespread pain complaints, such as fibromyalgia or endocrine disorder, are not suitable for injections. Treatment is indicated for endocrine diagnoses or fibromyalgia before considering trigger point injections. Also, the finding of tenderness alone is not an indication for trigger point injection because patients with fibromyalgia may also have myofascial pain trigger points.

What to expect

Trigger point injections are done as an outpatient in-office procedure. Once access to the affected site is obtained, the skin aseptically cleaned, all after proper identification of the trigger point site the injection will proceed. Sometimes the procedure is done with ultrasound guidance to avoid complications of injection too deep or puncture of the plural (lung) lining. Small amounts of local anesthesia or steroid mix are injected into the trigger point area to help break up the hard fibrous area. This may be seen with ultrasound use as well. Multiple areas can be done during the same session.