Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum

OBJECTIVE: To compare the effectiveness of extracorporeal shock wave therapy (ESWT) and trigger point injection (TPI) for the treatment of myofascial pain syndrome in the quadratus lumborum. METHODS: In a retrospective study at our institute, 30 patients with myofascial pain syndrome in the quadratus lumborum were assigned to ESWT or TPI groups. We assessed ESWT and TPI treatment according to their affects on pain relief and disability improvement. The outcome measures for the pain assessment were a visual analogue scale score and pain pressure threshold. The outcome measures for the disability assessment were Oswestry Disability Index, Roles and Maudsley, and Quebec Back Pain Disability Scale scores. RESULTS: Both groups demonstrated statistically significant improvements in pain and disability measures after treatment. However, in comparing the treatments, we found ESWT to be more effective than TPI for pain relief. There were no statistically significant differences between the groups with respect to disability. CONCLUSION: Compared to TPI, ESWT showed superior results for pain relief. Thus, we consider ESWT as an effective treatment for myofascial pain syndrome in the quadratus lumborum.

Short-Term Change of Handgrip Strength After Trigger Point Injection in Women With Muscular Pain in the Upper Extremities

OBJECTIVE: To determine overall handgrip strength (HGS), we assessed the short-term change of HGS after trigger point injection (TPI) in women with muscular pain in the upper extremities by comparison with established pain scales. METHODS: The study enrolled 50 female patients (FMS with MPS group: 29 patients with combined fibromyalgia [FMS] and myofascial pain syndrome [MPS]; MPS group: 21 patients with MPS) who presented with muscular pain in the upper extremities at Konyang University Hospital. In addition, a total of 9 healthy women (control group) were prospectively enrolled in the study. We surveyed the three groups using the following established pain scales: the Fibromyalgia Impact Questionnaire (FIQ), the 36-Item Short Form Health Survey (SF-36), and the Short Form McGill Pain Questionnaire (MPQ). HGS was measured in both hands of study participants using a handgrip dynamometer. We performed TPI (0.5% lidocaine, total 10 mL, injected at the pain site of upper extremities). After 20 minutes, we remeasured the patient's HGS and MPQ score. RESULTS: ANOVA analysis was conducted among groups. Based on Tukey multiple comparison test, the majority of FIQ and SF-36 subscales, total FIQ and SF-36 scores, MPQ and HGS were significantly different between FMS with MPS and the other groups. There was no statistically significant difference between MPS and control groups. Higher HGS was positively associated with enhanced physical function, negatively associated with total FIQ and MPQ scores, and positively associated with the total SF-36 score calculated using Spearman correlation. Post-TPI MPQ decreased and HGS increased. In patient groups, a negative correlation was found between MPQ and HGS. CONCLUSION: The HGS test might potentially be a complementary tool in assessing the short-term treatment effects of women with muscular pain in the upper extremities.

Short-Term Change of Handgrip Strength After Trigger Point Injection in Women With Muscular Pain in the Upper Extremities

OBJECTIVE: To determine overall handgrip strength (HGS), we assessed the short-term change of HGS after trigger point injection (TPI) in women with muscular pain in the upper extremities by comparison with established pain scales. METHODS: The study enrolled 50 female patients (FMS with MPS group: 29 patients with combined fibromyalgia [FMS] and myofascial pain syndrome [MPS]; MPS group: 21 patients with MPS) who presented with muscular pain in the upper extremities at Konyang University Hospital. In addition, a total of 9 healthy women (control group) were prospectively enrolled in the study. We surveyed the three groups using the following established pain scales: the Fibromyalgia Impact Questionnaire (FIQ), the 36-Item Short Form Health Survey (SF-36), and the Short Form McGill Pain Questionnaire (MPQ). HGS was measured in both hands of study participants using a handgrip dynamometer. We performed TPI (0.5% lidocaine, total 10 mL, injected at the pain site of upper extremities). After 20 minutes, we remeasured the patient's HGS and MPQ score. RESULTS: ANOVA analysis was conducted among groups. Based on Tukey multiple comparison test, the majority of FIQ and SF-36 subscales, total FIQ and SF-36 scores, MPQ and HGS were significantly different between FMS with MPS and the other groups. There was no statistically significant difference between MPS and control groups. Higher HGS was positively associated with enhanced physical function, negatively associated with total FIQ and MPQ scores, and positively associated with the total SF-36 score calculated using Spearman correlation. Post-TPI MPQ decreased and HGS increased. In patient groups, a negative correlation was found between MPQ and HGS. CONCLUSION: The HGS test might potentially be a complementary tool in assessing the short-term treatment effects of women with muscular pain in the upper extremities.

Appropriate Depth of Needle Insertion During Rhomboid Major Trigger Point Block

OBJECTIVE: To investigate an appropriate depth of needle insertion during trigger point injection into the rhomboid major muscle. METHODS: Sixty-two patients who visited our department with shoulder or upper back pain participated in this study. The distance between the skin and the rhomboid major muscle (SM) and the distance between the skin and rib (SB) were measured using ultrasonography. The subjects were divided into 3 groups according to BMI: BMI less than 23 kg/m2 (underweight or normal group); 23 kg/m2 or more to less than 25 kg/m2 (overweight group); and 25 kg/m2 or more (obese group). The mean+/-standard deviation (SD) of SM and SB of each group were calculated. A range between mean+1 SD of SM and the mean-1 SD of SB was defined as a safe margin. RESULTS: The underweight or normal group's SM, SB, and the safe margin were 1.2+/-0.2, 2.1+/-0.4, and 1.4 to 1.7 cm, respectively. The overweight group's SM and SB were 1.4+/-0.2 and 2.4+/-0.9 cm, respectively. The safe margin could not be calculated for this group. The obese group's SM, SB, and the safe margin were 1.8+/-0.3, 2.7+/-0.5, and 2.1 to 2.2 cm, respectively. CONCLUSION: This study will help us to set the standard depth of safe needle insertion into the rhomboid major muscle in an effective manner without causing any complications.

Ischemic Compression After Trigger Point Injection Affect the Treatment of Myofascial Trigger Points

OBJECTIVE: To investigate the effects of trigger point injection with or without ischemic compression in treatment of myofascial trigger points in the upper trapezius muscle. METHODS: Sixty patients with active myofascial trigger points in upper trapezius muscle were randomly divided into three groups: group 1 (n=20) received only trigger point injections, group 2 (n=20) received trigger point injections with 30 seconds of ischemic compression, and group 3 (n=20) received trigger point injections with 60 seconds of ischemic compression. The visual analogue scale, pressure pain threshold, and range of motion of the neck were assessed before treatment, immediately after treatment, and 1 week after treatment. Korean Neck Disability Indexes were assessed before treatment and 1 week after treatment. RESULTS: We found a significant improvement in all assessment parameters (p<0.05) in all groups. But, receiving trigger point injections with ischemic compression group showed significant improvement as compared with the receiving only trigger point injections group. And no significant differences between receiving 30 seconds of ischemic compression group and 60 seconds of ischemic compression group. CONCLUSION: This study demonstrated the effectiveness of ischemic compression for myofascial trigger point. Trigger point injections combined with ischemic compression shows better effects on treatment of myofascial trigger points in the upper trapezius muscle than the only trigger point injections therapy. But the duration of ischemic compression did not affect treatment of myofascial trigger point.

Treatment Experience of Pulsed Radiofrequency Under Ultrasound Guided to the Trapezius Muscle at Myofascial Pain Syndrome: A Case Report

Trigger point injection treatment is an effective and widely applied treatment for myofascial pain syndrome. The trapezius muscle frequently causes myofascial pain in neck area. We herein report a case in which direct pulsed radiofrequency (RF) treatment was applied to the trapezius muscle. We observed that the RF treatment produced continuous pain relief when the effective duration of trigger point injection was temporary in myofascial pain.

Case Series of Mycobacterium Abscessus Infections Associated with a Trigger Point Injection and Epidural Block at a Rural Clinic / 한국역학회지

OBJECTIVES: The aim of this report is to investigate Mycobacterium abscessus infections at a rural clinic and carry out a surveillance program to determine the extent and source of these infections. METHODS: The authors conducted an active surveillance investigation of 36 patients who had visited the clinic since 1 July 2008. Clinical specimens were collected from the patients and an envirnmental investigation. Pulsed-field gel elctrophoresis (PFGE) was performed for comparing with M. abscessus isolates from the patients. RESULTS: Six specimens were obtained from the 6 patients respectively and 22 environmental samples were obtained. M. abscessus was isolated from the wounds of two patients, and various nosocomial pathogens, but not M. abscessus, were isolated from the surrounding environment. Two strains of M. abscessus from patients were identical as a result of PFGE. CONCLUSION: Infection control education including proper hand hygiene should be emphasized for physicians performing invasive procedures. There also needs to be more attention for invasive procedures management, including trigger point injection and epidural block in rural clinics.

Myositis Ossificans of the Elbow after a Trigger Point Injection

Trigger point injection is a simple procedure that is widely performed for relieving pain. Even though there are several complications of trigger point injection, myositis ossificans has not been documented as one of its complications. We treated a patient who suffered from painful limitation of elbow motion and this was caused by myositis ossificans between the insertions of brachialis and supinator muscles after a trigger point injection containing lidocaine mixed with saline, and we also review the relevant medical literature.

Posterior auricular pain caused by the trigger points in the sternocleidomastoid muscle aggravated by psychological factors: A case report / 대한마취과학회지

Psychological factors play a significant role in the pain mechanism, and psychological approaches may be useful complements to traditional medical and surgical treatments in pain management. The authors report a case of recurrent severe posterior auricular pain caused by trigger points in the right sternocleidomastoid muscle and influenced by stressful psychological situations (e.g., family affairs, job loss) in a 50-year-old man.

Chest Pain Caused by the Trigger Points in the Scalenus Muscle: A case report / 대한마취과학회지

Myofascial pain syndrome is very common disease but cause symptoms that are easily misdiagnosed as other conditions. The authors report a case of chest pain caused by the trigger points in the scalenus muscle. A 43 year-old man had chest pain without any history of trauma or infection. And, there were not any abnormal findings by cardiology and pulmonary evaluation. On physical examination, the scalenus muscle had the trigger points, and the chest pain was successfully treated by trigger point injections.

Epidural and Psoas Abscesses Recognized after Paravertebral Trigger Point Injection: A case report / 대한통증학회지

The trigger point injection technique is widely used in pain clinics for the treatment of acute and chronic pain. Yet it has a variety of complications such asvasovagal syncope, total spinal anesthesia, paralysis, root block, pneumothorax, needle breakage, skin infection, and hematoma formation. Among them, the simultaneous occurrence of psoas and epidural abscesses is extremely rare. We report here on a patient who was diagnosed with epidural and psoas abscesses after paravertebral trigger point injection.

A Case of Hypokalemic Paralysis Provoked after Trigger Point Injection with Dexamethasone and Lidocaine

Acute hypokalemic paralysis is characterized by acute systemic weakness and low serum potassium. Trigger point injection (TPI) is frequently performed for myofacial pain relief with rare complications. 34-year-old male was admitted with quadriparesis after TPI with dexamethasone and lidocaine before 24 hours. Hypokalemia was found with compatible findings on nerve conduction studies and electromyography. Hypokalemia and weakness were fully recovered after potassium replacement. Steroid and lidocaine can provoke iatrogenic hypokalemic paralysis, therefore, TPI with these medications should be cautiously performed.

Iatrogenic Iliopsoas Abscess after Trigger Point Injection : A case report

After slip down, a 64 years old female had pain on the left buttock and the back without weakness or sensory change. Physical examination revealed tender points on left buttock and quadratus lumborum muscle. Straight leg raising test was 40degrees/20degrees. After trigger point injection on tender points, her symptoms were improved. Magnetic resonance imaging showed central extruded disc at L3-S1. After systemic steroid therapy was started, fever was developed about 39.3degrees C and laboratory evaluation showed inflammatory sign. Systemic steroid injection was stopped. Physical examination revealed a palpable and painful mass on the left lower quadrant of the abdomen. Ultrasonography and computerized tomography of abdomen and pelvis showed a large (7x5 cm) irregular shaped cystic mass along left iliopsoas muscle. Percutaneous catheter was inserted for drainage. Thick turbid yellow-greenish pus (300 cc) was drained. Intravenous antibiotics were administered and the patient's symptoms gradually improved. Culture of the pus revealed Streptococcus agalactiae.

Otalgia Caused by a Trigger Point in the Sternocleidomastoid Muscle: A case report / 대한마취과학회지

Myofascial pain syndrome is defined as the sensory, motor and autonomic symptoms caused by the myofascial trigger points. The sternocleidomastoid muscle is a complex muscle that frequently contains multiple trigger points. These trigger points cause symptoms that are easily misdiagnosed as other conditions. Earache of unexplained origin is likely to be caused by trigger points in the clavicular division of the sternocleidomastiod muscle. The authors report a case of earache caused by a trigger point in the sternocleidomastoid muscle. A 34 year-old woman had earache without any history of trauma or infection. The patient did not have any abnormal finding by otolaryngologic testing, except for an earache, which had not subsided. On physical examination, trigger points in the clavicular division of the sternocleidomastiod muscle were found, and the earache was successfully treated by trigger point injections.

Clinical Characteristics and Effects of Pain Trigger Point Injection on Myo-fascial Pain Syndrome Patients Visiting the Emergency Room

PURPOSE: Myofascial pain syndrome (MPS) is thought to be, the least understood and most frequently misdiagnosed disease. With appropriate diagnosis, pain trigger point injection has been proven its effectiveness, so I investigated the usefulness of pain trigger point injection for the treatment of MPS. METHODS: Twelve patients with clinical MPS were evaluated. Pain trigger points were identified by using the positive jump response to the operator's finger pressure. After the pain trigger points had been identified, 2 ml of lidocaine (Travel's technique) were injected. RESULTS: Of the total of 12 patients investigated, include self-diagnosis, 6 (50%) were misdiagnosed mainly as neurosis. These 12 patients had 33 pain trigger points. The pain trigger points were distributed mainly in the chest, 8 patients (66%), and 25 points (76%). As to the duration of pain, in 10 patients, the pain dramatically disappeared within 5 minutes. In the remaining two patients improved symptoms were noted within 20 minutes after injection. CONCLUSIONS: The proper diagnosis of MPS, which is frequently misdiagnosed as neurosis, or some other physiologic and psychologic diseases was the first step and the mainstay in the treatment of MPS. This study suggests that in the diagnosis of MPS, the most practically useful method in the emergency room is to confirm the positive jump response, including tout band and referred pain, by using finger pressure. Pain trigger point injection therapy was dramatically effective, so hopefully it will be available allow clinicians as a possible treatment to better care for patients suffering from MPS.

Comparison on Treatment Effects of Dextrose Water, Saline, and Lidocaine for Trigger Point Injection

Myofascial trigger point(TP) is characterized as an impaired energy metabolism. We hypothesized that the use of dextrose as an energy supplement for TP injection would be more effective than saline or lidocaine. Sixty four typical myofascial pain patients were treated with TP injections. Among them 23 were injected with 5% dextrose water(D/W Group), 20 with normal saline (N/S Group), and 21 with 0.5% lidocaine (Lidocaine Group). Visual analogue scale(VAS) and pressure threshold algometer(kg/cm2) were used as measuring tools before, immediately after, and 7 days after the injection therapies. Mean VAS scores were 6.78 before, 5.19 immediately after, and 3.39 seven days after the injections, and the treatment effects were greater after the second and third injections. Mean differences of pressure threshold were 0.37 before and immediately after injections, and 0.42 before and 7 days after injections. Significant elevation of threshold was noted after the second and third injections. Mean VAS were not significantly different in three groups before and immediately after injections. But after 7 days, only D/W Group showed significantly lower score of 2.39, compared to 3.85 in N/S Group and 4.05 in Lidocaine Group(P<0.01). Mean pressure threshold before and immediately after injections was not different in each group. After seven days D/W Group also showed significantly higher value of 2.49, compared to 1.91 in N/S Group and 2.07 in Lidocaine Group(P<0.05). We have concluded that 5% dextrose water would be the preferable choice for TP injection.

Trigger Point Injection of Bupivacaine Hydrochloride for Chronic Nonvisceral Pelvic Pain in Women / 대한비뇨기과학회지

Enigmatic chronic pelvic pain is the persistence of unexplained pain in the low abdomen and pelvic lesions without evidence of active disease. One of the most frequent causes is the nonvisceral pain such as myofascial and postsurgical incisional origin. We evaluated the trigger point injection of bupivacaine hydrochloride as a treatment option for chronic nonvisceral pelvic pain. From March, 1995 to May, 1996, 35 female patients (16 to 68 years old, mean 43.7 years ) with localized chronic pelvic pain for 6 months to 10 years were managed by trigger point injection. After confirming the absence of intraabdominal pathology by physical examination and Carnett`s test, 3 to 5 ml of 0.25% bupivacaine hydrochloride was injected to the most hyperpathic foci with 22 gauge, one and half inch needle percutaneously. The mean followup time was 9.7 months. The results were assessed by Visual Analogue Scale(VAS) and subjective symptoms. Twenty six patients had nonincisional pain and 9 had incisional pain. Twenty two patients were treated by only one session while others needed two or more sessions(maximum 4 sessions). The sites of pain were hypogastrium, suprapubic area and iliac fossa in the order of frequency. The mean VAS value at the time of last followup was reduced to 1.7 cm(0 - 5.7 cm) from 6.7 cm(4.9 - 9.1 cm). The improvement of pain occurred mostly within 1 week after treatment and was maintained thereafter. Eighty percent of patients expressed more than 50% reduction of pain by VAS. Sixteen patients(45.7%) responded ""pain free"", 10(28.6%) ""occasional"", 6(17.1%)"" present but better"", and 3(8.6%) ""no change"". The successful responses were noted in 74.3%. No significant complications were identified. These results demonstrated that the trigger point injection is an easy, safe and effective treatment option for chronic nonvisceral pelvic pain.

Trigger Point Injection of Bupivacaine Hydrochloride for Chronic Nonvisceral Pelvic Pain in Women / 대한비뇨기과학회지

Enigmatic chronic pelvic pain is the persistence of unexplained pain in the low abdomen and pelvic lesions without evidence of active disease. One of the most frequent causes is the nonvisceral pain such as myofascial and postsurgical incisional origin. We evaluated the trigger point injection of bupivacaine hydrochloride as a treatment option for chronic nonvisceral pelvic pain. From March, 1995 to May, 1996, 35 female patients (16 to 68 years old, mean 43.7 years ) with localized chronic pelvic pain for 6 months to 10 years were managed by trigger point injection. After confirming the absence of intraabdominal pathology by physical examination and Carnett`s test, 3 to 5 ml of 0.25% bupivacaine hydrochloride was injected to the most hyperpathic foci with 22 gauge, one and half inch needle percutaneously. The mean followup time was 9.7 months. The results were assessed by Visual Analogue Scale(VAS) and subjective symptoms. Twenty six patients had nonincisional pain and 9 had incisional pain. Twenty two patients were treated by only one session while others needed two or more sessions(maximum 4 sessions). The sites of pain were hypogastrium, suprapubic area and iliac fossa in the order of frequency. The mean VAS value at the time of last followup was reduced to 1.7 cm(0 - 5.7 cm) from 6.7 cm(4.9 - 9.1 cm). The improvement of pain occurred mostly within 1 week after treatment and was maintained thereafter. Eighty percent of patients expressed more than 50% reduction of pain by VAS. Sixteen patients(45.7%) responded ""pain free"", 10(28.6%) ""occasional"", 6(17.1%)"" present but better"", and 3(8.6%) ""no change"". The successful responses were noted in 74.3%. No significant complications were identified. These results demonstrated that the trigger point injection is an easy, safe and effective treatment option for chronic nonvisceral pelvic pain.