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Trigger Point Injections of the Back

Trigger Point Injections of the Back. Clare Romero, CNP & Karen Cardon , MD. What are Trigger Points?. Trigger points are hyperirritable areas of contracted muscle fibers that form a nodule you can palpate Caused by: Repetitive overuse injuries Sustained loading Poor posture

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Trigger Point Injections of the Back

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  1. Trigger Point Injections of the Back Clare Romero, CNP & Karen Cardon, MD

  2. What are Trigger Points? • Trigger points are hyperirritable areas of contracted muscle fibers that form a nodule you can palpate • Caused by: • Repetitive overuse injuries • Sustained loading • Poor posture • Direct Injury • Poor circulation due to prolonged contraction, remodeling • Poor nerve conduction due to prolonged contraction, remodeling • Fibrous tissue encapsulates muscle sheath

  3. Types of Trigger Points • Central/Primary Trigger Points: • well established, most painful. Exist at a neuromuscular point • Satellite/Secondary Trigger Points: • Referred pain zone. • Active Trigger Points: • Applies to central & satellite trigger points. TTP, elicits pain pattern, limits ROM. Activated by some type of stimulus or activity. • Latent Trigger Points: • Feels like a lump or nodule, is not painful nor does it illicit referred pain. Can be activated by stimulus or activity.

  4. Primary Common Back Trigger Points

  5. Referred Common Back Trigger Points

  6. Pharmacologic Management of Myofascial Pain/Trigger Points • NSAIDS • Muscle Relaxants • Injections: • Saline • Corticosteroids • Lidocaine/Bupivicaine • Topical Therapies • NSAIDS • Capcasin • Analgesics • Methyl Salicylate/Menthol

  7. Non-Pharm Management of Myofascial Pain/Trigger Points • Stretch/Foam Roller • Trigger Pressure • Heat • TENS • Posture!

  8. NSAIDS for Myofascial Pain/Trigger Points • NSAIDS • 2-4 weeks • Ibuprofen 400-600mg QID • Naproxen 220-500mg BID • Contraindications- renal, GI, CV disease

  9. Muscle Relaxers for Myofascial Pain/Trigger Points

  10. Topical Preparations • Topical NSAIDS • Topical Analgesics • Topical Capcasin • Methyl salicylate/menthol Cream

  11. Who is a candidate for TPI? • Subjective Complaint: Pts with acute or chronic myofascial pain symptoms. • Described as spasm, tight, ache, throbbing, sharp and shooting, often with radiating pain. • Sometimes will have decreased ROM due to spasm, pain. • Usually history of aggravating event, injury, stress, etc. • Pinpoint location • Personal History: avoid those with clotting disorders, on blood thinning medication, immunocompromised

  12. Exam/Objective • Pt can point with finger the exact location/locations • Palpable painful nodule often with spasm/ fasciculation • Possibly decreased ROM • “TTP right rhomboid, right upper trapezius, thoracic paraspinus”, etc

  13. Informed Consent • Informed Consent- Risk of bleeding, infection, bruising, nerve pain, worsening pain, soreness, pneumothorax

  14. Rhomboids Suprispinatus

  15. Trapezius Posterior Neck

  16. Gluteus Paraspinus

  17. Piriformis

  18. Mark Your Patient

  19. Set Up • Lidocaine & Bupivicaine or NS • Sterile gloves • Chlorhexadine • 27g 1.5 inch needle • Set up sterile field • Have assistant (RN, LPN, tech) help you draw up lidocaine/bupivacaine or NS • Complete the time out

  20. One Technique…. https://www.youtube.com/watch?v=ch4Otm3C_F4

  21. Post Procedure Care • Stretch • Heat • Will be sore for 2-3 days but effects can last several days to weeks • May have some bruising

  22. Follow up • Can complete this procedure every 2-4 weeks if using NS or Lidocaine. • Recommend not using corticosteroid.

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