Trigger Point Injection

A trigger point is a taut band of painful muscle. Palpating a trigger point will induce referred pain or be the point of maximal tenderness. 

Trigger point injections have been shown to be effective, but it’s unclear if there’s a benefit to injecting local anesthetic vs. sterile water or saline or just dry needling. In this video, we are using lidocaine.

Have the patient identify the site of maximal tenderness and then mark the site. Prep the skin. Use a 27 gauge needle and 3 mL of lidocaine. Pinch and stabilize the site with your non-dominant hand and enter at a shallow angle, about 30°. This keeps the needle in muscle and away from lung to avoid causing a pneumothorax. Inject about half an mL of lidocaine, withdraw the needle, and fan into a different direction, repeating the injection. Once again, withdraw and re-enter at a different angle, injecting half a milliliter. Repeat this motion multiple times. This is essentially needling the myofascial bundle. 

Using a 27 gauge needle, inject about 1 ml into the trigger point. The needle tip should be just under the skin, in the muscle. This is muscular pain, so inject the muscle. You can use ultrasound to measure depth if you have concerns about being near a lung or other vulnerable structures. 

Remember, don’t go too deep. Better to be too superficial and massage it in. And don’t go midline. This is not meant to be an epidural.

You can repeat this 3-5 times to address other painful trigger points.

Peer reviewed by Sean Nordt, MD and Jessie Werner, MD.