Botwin Kenneth P, Patel Bharat C
Deuk Spine Institute, Titusville, FL, USA.
Pain Physician. 2007 Nov;10(6):753-6.
Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The myofascial pain syndrome is one of the largest groups of under-diagnosed and under-treated medical problems encountered in clinical practice. Trigger points are commonly seen in patients with myofascial pain that can be responsible for localized pain in the affected muscles as well as referred pain patterns. Correct needle placement in a myofascial trigger point is vital to prevent complications and improve efficacy of the trigger point injection to help reduce or relieve myofascial pain. In the obese patients, these injections may not reach the target tissue. In the cervicothoracic spine, a misguided or misplaced injection can result in a pneumothorax. Here, we review an electromyographically guided trigger point injection technique to avoid this potential pitfall.
Using a disposable Teflon coated hypodermic injection needle attached to an electromyography (EMG) machine, a trigger point injection can be performed utilizing electromyographic guidance. This guidance by observing motor unit action potentials (MUAPs) on the EMG screen helps confirm the needle placement to be within the muscle tissue and not in an adipose tissue or any other non-musculature structure.
The technique is simple when performed by a pain management specialist who has electromyographic training.
This technique helps confirm proper needle placement within the cervicothoracic musculature in an obese patient in whom the musculature is not readily palpated. This, thus, reduces the potential for a pneumothorax by an improperly placed injection.
肌筋膜疼痛被定义为源自骨骼肌中肌筋膜触发点的疼痛。它在局部肌肉骨骼疼痛综合征中很常见，可单独出现或与其他疼痛源合并存在。肌筋膜疼痛综合征是临床实践中遇到的诊断不足和治疗不足的最大医学问题群体之一。触发点在肌筋膜疼痛患者中很常见，可导致受影响肌肉的局部疼痛以及牵涉痛模式。在肌筋膜触发点正确放置针头对于预防并发症和提高触发点注射的疗效以帮助减轻或缓解肌筋膜疼痛至关重要。在肥胖患者中，这些注射可能无法到达目标组织。在颈胸椎部位，注射方向错误或位置不当可能导致气胸。在此，我们回顾一种肌电图引导的触发点注射技术以避免这一潜在陷阱。
使用连接到肌电图（EMG）机器的一次性涂有特氟龙的皮下注射针，可利用肌电图引导进行触发点注射。通过在EMG屏幕上观察运动单位动作电位（MUAPs）进行这种引导有助于确认针头放置在肌肉组织内，而不是在脂肪组织或任何其他非肌肉结构中。
由接受过肌电图培训的疼痛管理专家进行操作时，该技术很简单。
对于肥胖患者，该技术有助于确认针头在颈胸肌组织内的正确放置，因为这些患者的肌肉组织不易触及。因此，这减少了因注射位置不当导致气胸的可能性。
