Trigger Injections In Scottsdale

Overview

A trigger point injection consists of a saline, local anesthetic [1] and occasionally an anti-inflammatory.    While a variety of mixtures is possible and dependent upon the healthcare provider and patient, the most common is a mixture of lidocaine and Marcaine. [2]

The mixed solution is administered directly into the trigger point of the skeletal muscle via a small needle.    The anesthetic blocks pain receptors in the muscles and nerves so the brain does not receive the pain signal.    If an anti-inflammatory is used, swelling and inflammation in the area is reduced which helps reduce pain.

Myofascial “trigger points” are areas in the muscle that are easily irritated.    Trigger points usually feel like a taut band or palpable “knot,” [3] and can be a source of local pain, regional pain or decreased range of motion. [4] Trigger points form from an acute injury or can originate from a muscle that is constantly stressed (i.e., poor posture or repetitive motion) [5] .

In the 1950s, Dr. Janet Travell and Seymour Rinzler coined the term “trigger point” [6] to describe their findings:

  • Pain related to a localized tender point within a nodule found in a taut band of muscle fibers. [3]
  • The point of pain elicits a local twitch response with snapping palpation. [3]
  • Palpation of the point reproduces the complaint and causes a referred pain pattern. [3]
  • Contraction of the muscle is painful and has limited range of motion. [3]
  • Muscles containing trigger points fatigue faster and cause weakness. The degree of weakness will vary with each muscle and with each subject. [3]

What do trigger point injections do?

These myofascial trigger point “knots” are a common a source of musculoskeletal pain.    In the current trigger point model, pressure on these points will cause a localized twitch response, pain, and pain that radiates to broader areas.    Trigger points also produce specific referral patterns. [7]

Patients commonly seek trigger point injections for:

  • Fibromyalgia
  • Myofascial pain syndromes
  • Tension headaches and Migraines
  • Jaw pain
  • Shoulder pain
  • Arm pain
  • Wrist pain
  • Hand pain
  • Hip pain
  • Knee pain
  • Ankle pain
  • Foot pain

Risks and Complications of Trigger injections

Risks associated with trigger point injections are low but include:

Common. (typically last up to 4 days)

  • Post-injection pain or numbness
  • Soreness
  • Minor bruising
  • Feeling lightheaded or dizzy
  • Rare.
  • Infection
  • Bleeding
  • Myonecrosis (usually heals within 3-4 weeks) [8]

If you experience any side effects that do not resolve within a few weeks, follow up with your doctor.

How you prepare

Trigger point injections are an outpatient procedure; so, you won’t need to stay overnight.

Patients should shower the morning of and come dressed in loose/comfortable clothes.

4 hours before getting trigger point injections, avoid solid foods (liquids are allowed up to 2 hours before).

Be sure to let your physician know any prescription or over-the-counter medications you are currently taking.    Blood thinners may need to be stopped but make sure to consult with your physician first.    Small adjustments made need to be made with Diabetic medications.

Let your physician know if you are having any symptoms of such as fever, chills or if you are pregnant.

How trigger point injections are administered

The physician will locate trigger points through examination and by feeling different areas of the muscle to locate the area of pain.

While the patient is either sitting or lying down, the healthcare provider inserts a small needle into the affected area and the mixed solution is injected.

Patients often ask, “how bad do trigger point injections hurt?” and while every patient is different, most patients report minimal or no discomfort from the injection itself.

Since the procedure only takes a few minutes, multiple points can be injected during one visit.

After receiving trigger injections

Patients are monitored in office for up to 20 minutes after the procedure in order to make sure there are no reactions to the medicine or the injection.

Patients can resume normal activities after getting trigger point injections; however, if the patient feels faint or confused, they should not drive home.

Trigger point injection success rates

For many patients, trigger point injections provide significant benefits [9] such as: immediate relief and increased range of motion; however, not everyone responds the same.    Results can last for several days or months.

Research shows trigger point injections can relieve muscle pain in the low back. [10]

For optimal results, trigger point injections can be combined with heat, ice, stretching, and massage. [11]

References

1. Raab D: Craniomandibular disorders simulating odontalgia and Eustachian tube -disorders – a case report. [Durch craniomandibuläre Dysfunktionen vorgetäuschte Zahnschmerzen und Tubenfunktionsstörungen – ein Fallbericht.] Wehrmedizinische Monatsschrift 2015: 59(12); 396-401. http://www.wehrmed.de/article/2738-durch-craniomandibulaere-dysfunktionen-vorgetaeuschte-zahnschmerzen-tubenfunktionsstoerungen-ein-fallbericht.html
2. "Trigger point injection". Non-Surgical Orthopaedic & Spine Center. October 2006. Archived from the original on 2006-10-26. Retrieved 2007-04-07.
3. Travell, Janet; Simons David; Simons Lois (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual (2 vol. set, 2nd Ed.). USA: Lippincott Williams & Williams. ISBN 9780683083637.
4. Jafri, M. S. (2014). Mechanisms of Myofascial Pain. International Scholarly Research Notices, 2014, 1–16. https://doi.org/10.1155/2014/523924
5. Md, W. F. R., PhD, Md, J. S. K., & Jr., T. R. D., MD. (2018). Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation (4th ed.). Elsevier.
6. Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V., Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM & R : the journal of injury, function, and rehabilitation, 7(7), 746–761. https://doi.org/10.1016/j.pmrj.2015.01.024
7. Tough EA, White AR, Richards S, Campbell J (March–April 2007). "Variability of criteria used to diagnose myofascial trigger point pain syndrome—evidence from a review of the literature". Clin J Pain. 23 (3): 278–86. doi:10.1097/AJP.0b013e31802fda7c. PMID 17314589. S2CID 30891217.
8. ZINK, W. (2004). Local anesthetic myotoxicity. Regional Anesthesia and Pain Medicine, 29(4), 333–340. https://doi.org/10.1016/j.rapm.2004.02.008
9. Mishra, G., Parthasarathy, S., & Sundar, S. (2019). Assessment of predisposing factors in myofascial pain syndrome and the analgesic effect of trigger point injections - A primary therapeutic interventional clinical trial. Indian Journal of Anaesthesia, 63(4), 300. https://doi.org/10.4103/ija.ija_6_19
10. Wong, C. S. M., & Wong, S. H. S. (2012). A New Look at Trigger Point Injections. Anesthesiology Research and Practice, 2012, 1–5. https://doi.org/10.1155/2012/492452
11. Gary Ruoff, MD. (2003). Trigger Point Injections [White paper]. Patient Care. https://www.patientcareonline.com/view/covid-19-updates-us-vaccinations-and-global-cases-and-deaths-as-of-june-29-2021

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