Quadratus lumborum injection is a useful diagnostic and therapeutic procedure for myofascial pain.
After informed consent is obtained, the patient is placed in a prone position. The quadratus lumborum muscle is palpated from the 12th rib to the iliac crest and from vertebral attachments L1 to L4 to its lateral border. 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. 67-28).
FIGURE 67-28. Quadratus lumborum. Trigger points and referred pain patterns.
The referred pain pattern for the quadratus lumborum muscle usually involves the iliac crest, hip, and buttock. The patient should be fully familiar with the stretching program for the quadratus lumborum muscle and be instructed in a home program. Failure to include a home stretching program usually results in short-term relief.
Significant complications are uncommon with quadratus lumborum trigger point injections.