trigger point injection

Indications

• pain relief

Contraindications

• absolute
  • localized abscess or cellulitis at site of injection
  • active Herpes simplex virus (HSV) or tuberculosis infection
  • previous hypersensitivity to injectable anesthetic
• relative
  • bleeding diathesis
  • anticoagulant therapy
  • bacteremia
  • partial tendon rupture at site of injection

Procedure

Preparation:

• obtain informed consent
• identify landmarks
• wide-field skin cleaning
• sterile glove
• sterile drape may be indicated

Precautions:

• withdraw needle to subcutaneous tissue prior to redirecting needle
• avoid removing the needle completely when redirecting

Glucocorticoids for trigger point injection:

• triamcinolone acetonide or hexacetonide (Kenalog) 10 mg/mL
• 0.2 mL (2 mg) plus normal saline (0.8-5 mL)

Complications

• localized cutaneous depigmentation & atrophy from leaking of injectable steroids onto skin
• subcutaneous swelling & pain after procedure:
  • ice may attenuate
• post procedural infection

More general terms

• injection

Additional terms

• myofascial trigger point