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trigger point injection
Indications:
- pain relief
Contraindications:
1) absolute
- localized abscess or cellulitis at site of injection
- active Herpes simplex virus (HSV) or tuberculosis infection
- previous hypersensitivity to injectable anesthetic
2) relative
- bleeding diathesis
- anticoagulant therapy
- bacteremia
- partial tendon rupture at site of injection
Procedure:
Preparation:
1) obtain informed consent
2) identify landmarks
3) wide-field skin cleaning
4) sterile glove
5) sterile drape may be indicated
Precautions:
1) withdraw needle to subcutaneous tissue prior to redirecting needle
2) avoid removing the needle completely when redirecting
Glucocorticoids for trigger point injection:
1) triamcinolone acetonide or hexacetonide (Kenalog) 10 mg/mL
2) 0.2 mL (2 mg) plus normal saline (0.8-5 mL)
Complications:
1) localized cutaneous depigmentation & atrophy from leaking of injectable steroids onto skin
2) subcutaneous swelling & pain after procedure:
- ice may attenuate
3) post procedural infection
Related
myofascial trigger point
General
injection