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Indications

Gastrocnemius injection is a useful diagnostic and therapeutic procedure for myofascial pain.

Techniques

After informed consent is obtained, the patient is placed in a supine position. The gastrocnemius and soleus muscles are palpated from the knee to the ankle. The injection sites are identified as points of maximal tenderness to deep palpation, reproducing the patient’s pain complaint. This may or may not result in referred pain. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1½-in. (4-cm), 21- to 25-gauge needle is inserted at the point of maximal tenderness and advanced to the area of the trigger point. After negative aspiration, the trigger point area is injected with 4 mL of local anesthetic (Fig. 67-33).

FIGURE 67-33. Gastrocnemius and soleus trigger points and referred pain patterns.

Comment

The patient should be fully familiar with the stretching program for the gastrocnemius muscle and be instructed in a home program. Failure to include a home stretching program usually results in short-term relief. The referred pain pattern for the gastrocnemius and soleus muscles often involves the posterior knee, calf, heel, and plantar aspect of the foot.

Complications

Significant complications are uncommon with gastrocnemius trigger point injections.

Refferences

Source: Physical Medicine and Rehabilitation - Principles and Practice

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Indications

Hip adductor muscle injection is a useful diagnostic and therapeutic procedure for myofascial pain.

Techniques

After informed consent is obtained, the patient is placed in the supine position and the affected limb flexed, adducted, and externally rotated. The adductor longus, adductor brevis, and adductor magnus are palpated along the medial aspect of the humerus and thigh. The injection sites are identified as points of maximal tenderness to deep palpation, reproducing the patient’s pain complaint. This may or may not result in referred pain. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1½-in. (4-cm), 21- to 25-gauge needle is inserted at the point of maximal tenderness and advanced to the area of the trigger point. After negative aspiration, the trigger point area is injected with 4 mL of local anesthetic (Fig. 67-32).

FIGURE 67-32. Hip adductor trigger points and referred pain patterns.

Comment

The referred pain pattern for the adductor muscles of the hip often involves the proximal hip, medial thigh, anterior thigh, and knee. The patient should be fully familiar with the stretching program for the adductor muscle and be instructed in a home program. Failure to include a home stretching program usually results in short-term relief.

Complications

Significant complications are uncommon with hip adductor trigger point injections.

Refferences

Source: Physical Medicine and Rehabilitation - Principles and Practice

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Indications

Gluteal muscle injection is a useful diagnostic and therapeutic procedure for myofascial pain.

Techniques

After informed consent is obtained, the patient is placed in the lateral position with the unaffected side down, or in the prone position. The gluteus maximus, minimus, and medius muscles are palpated. The injection sites are identified as points of maximal tenderness to deep palpation, reproducing the patient’s pain complaint. This may or may not result in referred pain. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1½-in. (4-cm), 21- to 25-gauge needle is inserted at the point of maximal tenderness and advanced to the area of the trigger point. After negative aspiration, the trigger point area is injected with 4 mL of local anesthetic (Fig. 67-30).

FIGURE 67-30. Gluteal trigger points and referred pain patterns.

Comment

The referred pain pattern for the gluteus maximus usually involves the sacroiliac joint, hip, and buttock. The referred pain pattern for the gluteus medius often involves the iliac crest, sacroiliac joint, and buttock. The referred pain pattern for the gluteus minimus muscle usually involves the buttock and lateral aspect of the lower extremity. The patient should be fully familiar with the stretching program for the gluteal muscle and be instructed in a home program. Failure to include a home stretching program usually results in short-term relief.

Complications

Significant complications are uncommon with gluteal trigger point injections; however, the anatomy of the region, including the sciatic nerve, must be carefully considered with these injections. Intraneural injection may result in nerve damage. Severe pain on injection suggests the possibility of an intraneural injection, and the needle should be immediately repositioned. Temporary lower extremity weakness is possible from regional spread of the local anesthetic.

Refferences

Source: Physical Medicine and Rehabilitation - Principles and Practice

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Indications

Piriformis muscle injection is a useful diagnostic and therapeutic procedure for myofascial pain.

Techniques

After informed consent is obtained, the patient is placed in the lateral Sims’ position. The piriformis muscle is palpated from the sacrum toward the hip. The injection sites are identified as points of maximal tenderness to deep palpation, reproducing the patient’s pain complaint. This may or may not result in referred pain. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1½-in. (4-cm), 21- to 25-gauge needle is inserted at the point of maximal tenderness and advanced to the area of the trigger point. After negative aspiration, the trigger point area is injected with 4 mL of local anesthetic (Fig. 67-31).

FIGURE 67-31. Piriformis trigger points and referred pain patterns.

Comments

The referred pain pattern for the piriformis muscle often involves the buttocks, iliosacral region, and posterior hip. The patient should be familiar with the stretching program for the piriformis muscle and be instructed in a home program. Failure to include a home stretching program usually results in short-term relief.

Complications

Attention to the anatomy of the sciatic nerve in this region will prevent intraneural injection; otherwise, significant complications are uncommon with trigger point injections. Severe pain on injection suggests the possibility of an intraneural injection, and the needle should be repositioned immediately. Temporary lower extremity weakness is possible from regional spread of the local anesthetic.

Refferences

Source: Physical Medicine and Rehabilitation - Principles and Practice

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Indications

The paraspinal muscle injection is a useful diagnostic and therapeutic procedure for myofascial pain.

Techniques

After informed consent is obtained, the patient is placed in the prone position. The appropriate thoracic and lumbar regions are palpated. The injection sites are identified as points of maximal tenderness to deep palpation, reproducing the patient’s pain complaint. This may or may not result in referred pain. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1½-in. (4-cm), 21- to 25-gauge needle is inserted at the point of maximal tenderness and advanced to the area of the trigger point. After negative aspiration, the trigger point area is injected with 4 mL of local anesthetic (Fig. 67-29).

FIGURE 67-29. Paraspinal musculature. Trigger points and referred pain patterns.

Comment

The referred pain pattern for the thoracic paraspinal muscles often involves the scapular and chest wall region, as well as the lower thoracic paraspinal muscles and abdomen region. The referred pain pattern for the lumbar paraspinal muscles often involves the buttock, iliac crest, and sacroiliac joint region. These muscles involve the erector spinae, semispinalis cervicis, longissimus capitis, longissimus cervicis, longissimus iliocostalis thoracis, iliocostalis lumborum, and semispinalis multifidus. The patient should be fully familiar with the stretching program for the affected paraspinal muscle and be instructed in a home program. Failure to include a home stretching program usually results in short-term relief.

Complications

Significant complications are uncommon with paraspinal trigger point injections.

Refferences

Source: Physical Medicine and Rehabilitation - Principles and Practice

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