Injection in the Cervical Facet Joint for Shoulder Pain With Myofascial Trigger Points in the Upper Trapezius Muscle

Abstract

The goal of this double-blinded, randomized, controlled study was to confirm the effectiveness of the cervical facet joint injection in treating shoulder pain with the myofascial trigger point in the upper trapezius muscle secondary to cervical facet lesion. Eighty-nine patients with chronic unilateral shoulder pain due to myofascial trigger points in the upper trapezius muscle received an injection to the C4-5 facet joint in the experimental group and to the corresponding unilateral multifidi muscle in the control group. Subjective pain intensity and pressure pain threshold of the myofascial trigger point were assessed, and the prevalence of endplate noise in the myofascial trigger point region was measured in 28 patients before, immediately after, and 1 month after the injection. Half of the patients in the experimental group, but none of the control patients, reported being completely pain free 1 month after the injection. Both the decrease in the pain intensity and the increase in pressure pain threshold were significantly more in the experimental group than in the control group either immediately or 1 month after the injection. There was no significant difference in the change of endplate noise prevalence between the 2 groups. This study demonstrates that intra-articular or peri-articular injection into the cervical facet joint region can effectively inactivate the upper trapezius myofascial trigger point secondary to the facet lesion.

Percutaneous Soft Tissue Release for Treating Chronic Recurrent Myofascial Pain Associated with Lateral Epicondylitis: 6 Case Studies

“…Chiropractic adjustment [31] or local injection [32] of cervical facet joint could inactivate the MTrPs in the upper trapezius muscles. Bogduk and Simons [30] have suggested the possible connection between facet nociceptors and MTrP nociceptors in the spinal cord and a common use of nociceptive pathway to the higher center from these two kinds of nociceptors.…”

New Trends in the Treatment and Management of Myofascial Pain Syndrome

“…Pain-relieving injections into painful C5/C6 cervical articular facet joints reduced both the pain intensity and pain threshold of myofascial trigger points in the upper trapezius muscle (C3/C4) immediately and at the 1-month follow-up when compared with controls [35].…”

The local twitch response during trigger point dry needling: Is it necessary for successful outcomes?

“…L-MTrPs are only painful with compression or palpation (Bron et al, 2011), however, they may predispose patients to altered movement patterns (Ge et al, 2012Ibarra et al, 2011;Lucas et al, 2010;Sergienko and Kalichman, 2015) and/or be converted to A-MTrPs when perpetuating factors are present . Importantly, MTrPs are prevalent in patients with musculoskeletal pain (Alburquerque-García et al, 2015;Arendt-Nielsen, 2015;Bron et al, 2011;Castaldo et al, 2014;Fernandez-Carnero et al, 2007;Fern andez-de-las-Peñas et al, 2005;Sergienko and Kalichman, 2015) and a multitude of causes for MTrP development have been suggested (Campa-Moran et al, 2015;Huang et al, 2014;Itoh et al, 2004;Lin et al, 2011;Ruiz-Saez et al, 2007;Treaster et al, 2006;Tsai et al, 2009). MTrP injection and trigger point dry needling (TrPDN) are commonly applied interventions for MTrP pain (Kuan, 2009).…”