Trigger Point Injection

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  • Presence of a trigger point that is accessible for treatment with injection
  • Trigger point not safely accessible by needle
  • Cellulitis in area overlying TrP
  • Poorly controlled psychiatric disorder
  • Poorly controlled systemic illness that may compromise healing or predispose to infection
  • Resuscitation equipment not available
  • Bleeding disorder, including anticoagulant use (relative contraindication)
  • Severe fibromyalgia or the presence of numerous TrPs (relative contraindication)
  • History of keloid formation (relative contraindication)
  • Highly anxious or needle-phobic patient (relative contraindication)
  • Alcohol wipes
  • Gloves (nonsterile)
  • Several gauze pads
  • Ballpoint pen (with retracted nib) or skin marker
  • Lidocaine (0.25%-1% without epinephrine) or bupivacaine (0.125%-0.25%). Consider adding sodium bicarbonate 1 mg per 10 mL of 1% anesthetic
  • 25- to 27-gauge needles, depending on the site to be injected
  • 3-, 5-, or 10-mL syringes
  • Resuscitation equipment (as with any injection)
  • Pillows for patient comfort (optional)
  • Vapocoolant spray such as ethyl chloride for topical anesthesia (optional)
  • Trigger points are irritable areas in a tight band of skeletal muscle.
  • Local twitch response (LTR) is elicited by palpation (while the tight muscle band or fibers are stretched) or by insertion of a needle into the trigger point.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Repeat injections as indicated.
  • Advise the patient to use cold compresses or oral anti-inflammatory medication for temporary discomfort caused by the injection itself.
  • Instruct patients to report any redness, pus, streaking, increased pain, or other concerns.
  • Consider activity modification and ergonomic retraining to avoid reinjury.
  • Vasovagal symptoms or syncope
  • Skin infection
  • Injury to nerves, vasculature, or other structures due to injection
  • Rebound pain
  • Reactions to the local anesthetic
  • Hematoma formation, bleeding, compartment syndrome
  • Pneumothorax (rare)
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