Clare Romero CNP amp 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 ID: 920335
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Slide1
Trigger Point Injections of the Back
Clare Romero, CNP & Karen
Cardon
, MD
Slide2What are Trigger Points?
Trigger points are hyperirritable areas of contracted muscle fibers that form a nodule you can palpate
Caused by:
Repetitive overuse injuriesSustained loadingPoor postureDirect InjuryPoor circulation due to prolonged contraction, remodelingPoor nerve conduction due to prolonged contraction, remodelingFibrous tissue encapsulates muscle sheath
Slide3Types of Trigger Points
Central/Primary Trigger Points:
well
established, most painful. Exist at a neuromuscular pointSatellite/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.
Slide4Primary Common Back Trigger Points
Slide5Referred Common Back Trigger Points
Slide6Pharmacologic Management of Myofascial Pain/Trigger Points
NSAIDS
Muscle Relaxants
Injections: SalineCorticosteroidsLidocaine/BupivicaineTopical TherapiesNSAIDSCapcasinAnalgesicsMethyl Salicylate/Menthol
Slide7Non-Pharm Management of Myofascial Pain/Trigger Points
Stretch/Foam Roller
Trigger Pressure
HeatTENSPosture!
Slide8Slide9Slide10NSAIDS for Myofascial Pain/Trigger Points
NSAIDS
2-4 weeks
Ibuprofen 400-600mg QIDNaproxen 220-500mg BIDContraindications- renal, GI, CV disease
Slide11Muscle Relaxers for Myofascial Pain/Trigger Points
Slide12Topical Preparations
Topical NSAIDS
Topical Analgesics
Topical CapcasinMethyl salicylate/menthol Cream
Slide13Who 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 locationPersonal History: avoid those with clotting disorders, on blood thinning medication, immunocompromised
Slide14Exam/Objective
Pt
can point with finger the exact location/locations
Palpable painful nodule often with spasm/ fasciculationPossibly decreased ROM“TTP right rhomboid, right upper trapezius, thoracic paraspinus”, etc
Slide15Informed Consent
Informed Consent- Risk of bleeding, infection, bruising, nerve pain, worsening pain, soreness, pneumothorax
Slide16Slide17Rhomboids
Suprispinatus
Slide18Trapezius Posterior Neck
Slide19Gluteus
Paraspinus
Slide20Piriformis
Slide21Mark Y
our
Patient
Slide22Set Up
Lidocaine &
Bupivicaine
or NSSterile glovesChlorhexadine27g 1.5 inch needleSet up sterile fieldHave assistant (RN, LPN, tech) help you draw up lidocaine/bupivacaine or NS Complete the time out
Slide23One Technique….
https://www.youtube.com/watch?v=ch4Otm3C_F4
Slide24Post Procedure Care
Stretch
Heat
Will be sore for 2-3 days but effects can last several days to weeksMay have some bruising
Slide25Follow up
Can complete this procedure every 2-4 weeks if using NS or Lidocaine.
Recommend not using corticosteroid.