travell and simons pain emg of transverse abdominis

Ultrasound scanning revealed visible changes in the underlying muscle containing the palpable trigger points in all the patients (Fig.

There were four male and six female patients. The patients were followed up by telephone at 12 weeks by a specialist pain nurse. If no changes were visible in the underlying muscle over the marked area on the skin, the palpable trigger point was injected with 5 ml of levobupivacaine 0.5% using ultrasound to guide needle placement into the underlying muscle. If the needling of the suspected visible area reproduced the pain normally experienced by the patient (needle sign), it was injected with 5 ml of levobupivacaine 0.5%. After anaesthetizing the skin with 1% lidocaine, we inserted a 22 G 50 mm needle (Stimuplex, B Braun Melsungen AG, Melsungen, Germany) in real time using an in-plane approach. We noted the presence of any changes in the muscle underlying the spot marked on the skin. We scanned the palpable trigger point in both longitudinal and transverse planes using a high-resolution (7–12 MHz) linear array transducer (S Nerve, Sonosite, USA). We palpated the trigger point and the skin over the tender point was marked. Ten patients with trigger points in the anterior abdominal muscles and a positive Carnett's sign undergoing TPIs were included in this series. 1 We provide the first description of the changes visualized in trigger points located in skeletal muscle in patients undergoing ultrasound-guided TPI. Recently, TPI under real-time ultrasound guidance has been described as a technique for reducing complications and enhancing needle visualization. Traditionally, TPIs have been performed by blindly needling or injecting a palpable trigger point. Editor-Trigger point injection (TPI) is a recognized treatment for regional myofascial pain syndrome.

Travell and simons pain emg of transverse abdominis