Levator scapulae trigger point injection is a useful diagnostic and therapeutic procedure for myofascial pain.
After informed consent is obtained, the patient is placed in a sitting or prone position. The levator scapulae muscle is palpated along the attachment at the C1 to C4 vertebrae and the superior angle of the scapulae. 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. 67-23).
FIGURE 67-23. Levator scapulae. Trigger points and referred pain patterns.
The entire body of the levator scapulae muscle should be palpated from origin to insertion and all trigger points injected.
Total injection should not exceed maximum safe dosage. The referred pain pattern for the levator scapular muscle often includes a posterior lateral neck and occipital and temporal regions. The patient should be fully familiar with the stretching program for the levator scapulae muscle and be instructed in a home program. Failure to include a home stretching program usually results in short-term relief.
Nerve root blockade may result from improper needle placement or injection of large quantities of local anesthetic in the vertebral region. Intraneural injection may result in nerve damage. Severe pain on injection suggests the possibility of an intraneural injection, and the needle should be repositioned immediately.