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Trigger Points
Daewoong Lee, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          TERMINOLOGY

          • Abbreviations

            • Trigger point (TP)
            • Trigger point injection (TPI)
          • Definitions

            • TP: Discrete, focal, hyperirritable spots located in taut band of skeletal muscle
            • Active TP: Associated with tenderness at rest, taut band of muscle, local twitch response, and reproducible referred pain from palpation
            • Latent TP: More common and not associated with spontaneous pain

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Findings and Reporting

                        POST PROCEDURE

                        • Expected Outcome

                          • Things To Do

                            • Things To Avoid

                              OUTCOMES

                              • Complications

                                Selected References

                                1. Tang TY et al: Ultrasound-guided 5-in-1 injection: trigger point injections and nerve hydrodissections for nonspecific upper back pain. Am J Phys Med Rehabil. 98(6):e55-6, 2019
                                2. Calvo-Lobo C et al: Dry needling on the infraspinatus latent and active myofascial trigger points in older adults with nonspecific shoulder pain: a randomized clinical trial. J Geriatr Phys Ther. 41(1):1-13, 2018
                                3. Gandolfi M et al: Does myofascial and trigger point treatment reduce pain and analgesic intake in patients undergoing onabotulinumtoxinA injection due to chronic intractable migraine? Eur J Phys Rehabil Med. 54(1):1-12, 2018
                                4. Unverzagt C et al: DRY needling for myofascial trigger point pain: a clinical commenTARY. Int J Sports Phys Ther. 10(3):402-18, 2015
                                5. Wong CS et al: A new look at trigger point injections. Anesthesiol Res Pract. 2012:492452, 2012
                                6. Scott NA et al: Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med. 10(1):54-69, 2009
                                7. Sikdar S et al: Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil. 90(11):1829-38, 2009
                                8. Alvarez DJ et al: Trigger points: diagnosis and management. Am Fam Physician. 65(4):653-60, 2002
                                9. Rachlin ES, Rachlin I. Myofascial Pain and Fibromyalgia: Trigger Point Management. 2nd ed. St Louis: Mosby, 2002
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Preprocedure

                                    • Procedure

                                      • Post Procedure

                                        TERMINOLOGY

                                        • Abbreviations

                                          • Trigger point (TP)
                                          • Trigger point injection (TPI)
                                        • Definitions

                                          • TP: Discrete, focal, hyperirritable spots located in taut band of skeletal muscle
                                          • Active TP: Associated with tenderness at rest, taut band of muscle, local twitch response, and reproducible referred pain from palpation
                                          • Latent TP: More common and not associated with spontaneous pain

                                        PREPROCEDURE

                                        • Indications

                                          • Contraindications

                                            • Preprocedure Imaging

                                              • Getting Started

                                                PROCEDURE

                                                • Patient Position/Location

                                                  • Procedure Steps

                                                    • Findings and Reporting

                                                      POST PROCEDURE

                                                      • Expected Outcome

                                                        • Things To Do

                                                          • Things To Avoid

                                                            OUTCOMES

                                                            • Complications

                                                              Selected References

                                                              1. Tang TY et al: Ultrasound-guided 5-in-1 injection: trigger point injections and nerve hydrodissections for nonspecific upper back pain. Am J Phys Med Rehabil. 98(6):e55-6, 2019
                                                              2. Calvo-Lobo C et al: Dry needling on the infraspinatus latent and active myofascial trigger points in older adults with nonspecific shoulder pain: a randomized clinical trial. J Geriatr Phys Ther. 41(1):1-13, 2018
                                                              3. Gandolfi M et al: Does myofascial and trigger point treatment reduce pain and analgesic intake in patients undergoing onabotulinumtoxinA injection due to chronic intractable migraine? Eur J Phys Rehabil Med. 54(1):1-12, 2018
                                                              4. Unverzagt C et al: DRY needling for myofascial trigger point pain: a clinical commenTARY. Int J Sports Phys Ther. 10(3):402-18, 2015
                                                              5. Wong CS et al: A new look at trigger point injections. Anesthesiol Res Pract. 2012:492452, 2012
                                                              6. Scott NA et al: Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med. 10(1):54-69, 2009
                                                              7. Sikdar S et al: Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil. 90(11):1829-38, 2009
                                                              8. Alvarez DJ et al: Trigger points: diagnosis and management. Am Fam Physician. 65(4):653-60, 2002
                                                              9. Rachlin ES, Rachlin I. Myofascial Pain and Fibromyalgia: Trigger Point Management. 2nd ed. St Louis: Mosby, 2002