trigger points injections

[powermd]

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Expensive and awesome..

 

[Pain Applicant1]

I like TPIs. I mainly use them when I want to offer the patient something other than things I don't like to prescribe or if someone has a muscle spasm. For muscle spams, I find they work great. I personally rarely have pain but one time I had a horrible spasm to the point where my spine was flexed laterally or side bent. I had a TPI done and it worked great. I could've given a rat's +$# about what studies showed what at that time and was just glad it worked. I'm sure some patients feel the same.

The patients with diffuse pain located everywhere who just happen to be allergic to everything except opioid. They ain't getting it from me so I ask for their most painful area and TPI it. If it's the Trap, I grab it, use a 27 g 1.5 inch and get deep in it. I look for the twitch and find it relaxes the muscle. I don't like using anything smaller than a 27 gauge because I don't think it works as well. I only use US when injecting into abd muscles.

A lot of patients like them and come back often for them. I get paid less than an office visit for prescribing opioid but for the most part, I'd rather TPI than prescribe opioid. If it works by placebo that's fine by me. Some patients really swear by them.

 

[powermd]

I treated another patient a few days ago with pain just inferior to the medial malleolus, anterior aspect. I injected at this exact location and saw three tendon sheaths flood open. Instant relief. Now let's see if it sticks.

I wanted to provide an update on this case. The TP turned tendon sheath injection seems to be sticking with durable relief for foot pain at two week follow up. Her exact words were, "my foot feels great! Now if you could just do the same thing for my back."

Today she got some trap injections. I injected the superficial and deep trap fascia in the upper thoracic region.

 

[bedrock]

nice work, powermd!

 

[No Pain All gain]

Totally agree...if you are going to do trigger points with a 30g 1/2inch needle - it is totally worthless.

To get meaningful results, you need to hit the facial planes, and the deep ones - it is a very targeted and specific injection. My bias is that since I have been targeting specific structures (deep facial planes - and serratus muscle), the effectiveness has improved.

To answer your question, 2inch is for ease of ultrasound.

To see the needle effectively (using an in-plane approach), one needs to make sure the angle between the ultrasound beam and needle is less than 30 - 40 deg. To accomplish this, you need to enter the skin farther away from the probe. The payoff is you get to see the needle very well. The cost is you need a longer needle.

I can't say that they always work, but it is definitely satisfying to the patient when they feel you "got the spot". In my personal practice, I use ultrasound to actually ensure I am in the muscle belly. Usually a 25ga or 27ga 1.5" to 2" needle using in-plane technique.

Frequently perform TPIs for a number of indications, and have been using Botox to scalenes, traps, levator, supraspinatus in patients with TOS.