Ultrasound-guided 3-in-1 trigger point injection for treating myofascial pain syndrome in muscles of the lateral scapular area: a case report

Abstract

Background: Myofascial pain syndrome (MPS) is a common cause of musculoskeletal pain.MPS in the muscles of the lateral scapula frequently develops due to poor sitting posture (rounded shoulders and cervical kyphosis) in the office as well as long working hours. Herein, we introduce the use of the trigger point injection (TPI) technique in three muscles (i.e., the deltoid, infraspinatus, and teres major muscles) with the same sonographic view for the purpose of treating MPS in the lateral scapular area.Case Description: A 48-year-old woman presented to our hospital complaining of dull pain in the right lateral scapular area that had persisted for 4 months. The numeric rating scale (NRS) pain score was 5.After confirming taut bands and tenderness in the muscles of the right lateral scapular area, we diagnosed the patient with MPS within the deltoid, infraspinatus, and teres major muscles. Under ultrasound (US) guidance, a mixed solution of 1 mL of 2% lidocaine and 2 mL of normal saline was injected layer by layer into the three muscles within the same sonographic view. At the 1-month follow-up (F/U) visit, the patient reported only slight initial pain (NRS score, 1).Conclusions: Thus, we recommend our US-guided 3-in-1 technique for performing TPI to treat MPS in the muscles of the lateral scapular area.

Trigger points in medical practice - current therapeutic directions

“…In recent years, injection of MTrPs under ultrasound guidance has become a common technique. This allows for safer injections, reducing the risk of complications like pneumothorax, hematomas, and damage to structures such as vessels and nerves [18]. Moreover, ultrasound control allows the administration of a smaller amount of local anesthetic, reducing the risk of systemic anesthetic toxicity [19].…”