Trigger Point Injections

Trigger points are localized, very sensitive areas in skeletal muscle that contain palpable, taut bands of muscle. This is felt as a rope-like thickening. Trigger point pain is sometimes called myofascial pain. Myofascial refers to muscle and connective tissue. Trigger points are painful to the touch and are associated with referred pain. Referred pain is discomfort that is felt at a point away from the actual source of pain. For example, trigger points in certain shoulder muscles can refer pain to your arm or even to your hand. Thus, other conditions—such as arthritis, bursitis, nerve impingement, and pain from internal organs—can mimic myofascial pain.

Trigger points are divided into active and latent groups. Active trigger points cause constant pain and inhibit movement. This leads to a reduction in the use of the muscle group, which causes a further decrease in muscle tone and strength, which itself can cause a loss of range of motion. Latent trigger points do not cause constant pain. They are formed by injuries or microtrauma and may be present for years after the inciting event. Latent trigger points do not manifest themselves or become active until movement in the involved joint is extended beyond the usual range.

To treat myofascial pain, our physicians search and eliminate the trigger points that perpetuate the pain cycle, prevent normal range of motion, and shorten the active length of the involved muscle. Trigger point injections are very safe and effective in decreasing or eliminating myofascial pain. After identifying the involved muscle, an injection of local anesthetic is made into the trigger point. In certain circumstances, Botox® may be used to lengthen the duration of pain relief.

Complications are extremely rare and involve the risks of the needle placement (infection, bleeding, or local tissue injury) and the local anesthetic injection. A series of trigger point injections is most likely to be effective when added to an ongoing program of physical therapy, followed by home stretching exercises.

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