• Journal of Korean Physical Therapy Science
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• v.2 no.1
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• pp.413-422
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• 1995

The trigger point phenomenon is an extremely common syndrome in physical therapy room. The symptoms created by these syndromes may be interpreted as originating in discogneic disease, nerve entrapment syndromes, viscerosomatic pain, and certain myalgic pain of unknown etiology. Injuries, viral or bacterial infections, immobilization, psychogenic stress, and other environment factors can preciptate and perpetuate these syndromes, which may occur in any of the voluntary muscles of the human body and thus lead to a multitude of myofascial pain syndromes. Obviously symptomatic treatment can meet with only partial success. Knowledge of the trigger point phenomenon will aid the diagnostician in understanding otherwise in explicable symptom. The trigger point are $2{\sim}5mm$ in diameter, hyperirritable palpable taut in a tissue, when compressed, is locally tender, if sufficiently hypersensitive, give rise to referred pain and tenderness, and sometimes to referred automatic phenomena and distortion of proprioception. The treatment of myofascial trigger point pain syndrome is not difficult once the source of the problem has been determined. Where as many modalities may be used, two of the most effective are spray-and stretch and TP injection. These can be followed by deep massage, specific, manual resistive exercise, and an exercise program which the patient can follow at home. The goal of management is to inactivate the TPs and to restore shortened and stretch resistent muscles to their full range of motion. The purpose of this case study was to know about the pathophysiologic mechanism of the trigger point and will enable to physical therapist to direct his treatment to the real source of trouble.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.105-108
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• 1996

Localized or radiating pain in the arm and shoulder joint may result after faulty alignment causing compression or tension on nerves, blood vessels, or supporting soft tissues. The critical site of faulty alignment is the quadrangular space in the axilla bounded by the teres major, teres minor, long head of triceps, and humerus. The axillary nerve emerges through this space to supply the deltoid and teres minor. The activity of the trigger point on teres minor compressing the axillary nerve causes pain to develop through the area of sensory distribution of cutaneous branch of the axillary nerve. Relieving compression on the axillary nerve and suprascapular nerve is the key point to relieving the pain. Spasm of the supraspinatus and infraspinatus compressing the suprascapular nerve caused pain to develop in the shoulder joint and scapular area. We treated those patients experiencing such pain with local anesthetic infiltration or I-R laser stimulation on the identified trigger points.

• The Korean Journal of Pain
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• v.6 no.2
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• pp.224-230
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• 1993

Most patients who have suffered from pain and muscle weakness on femoral nerve distributing area show no definite pathologic finding on X-ray or laboratory examinations. Therefore proper diagnosis is difficult to determine for the proper treatment of the symptoms. Based on my clinical experiences and anatomical studies, I have found most of these symptoms are a result of femoral nerve compression on trigger point of psoas major muscle. Accordingly, releasing the compression of femoral nerve by Laser stimulation and local anesthetic injection to the identified trigger point of psoas major muscle was found to be an effective treatment for femoral neuralgic pain.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.109-113
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• 1996

Even in the absence of any specific abnormal pathologic findings of the gastrointestinal tract, many patients still suffer from : fullness, anorexia and postprandial abdominal pain. As these symptoms are similar to visceral origin pain, many physicians focus on the discovery of pathologic abnormality of the gastrointestinal tract. At our Yoido Pain Clinic, after diagnosing myofascial pain syndrome, we treated 64 patients by trigger point injection and physical therapy on abnormal abdominal muscle, from June 1993 to April 1995. Most patients' conditions improved after these treatments.

• The Korean Journal of Pain
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• v.3 no.2
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• pp.150-159
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• 1990

The patient with muscle contraction headache usually have one or more specific trigger points. These trigger points have been treated with various treatment modalities including "stretch and spray" and regional infiltration with local anesthetics with or without corticosteroids. I treated 36 patients with muscle contraction headache with regional infiltration of local anesthetics and steroid into trigger points and the results were as follows 1) The diagnosis of muscle contraction headache was possible by confirming specific trigger points by palpation. 2) Patients relieved rapidly from headache by regional infiltration of local anesthetics and steroid into the tender point. 3) Single injection was effective in relieving headache. But the curability of the single injection could not be assessed because of difficulty in follow-up study. 4) Active trigger points could be occasionally inactive, which also made difficult in assessing the effectiveness of the treatment.

• Clinical Pain
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• v.20 no.2
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• pp.141-144
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• 2021

There are some cases of myofascial pain syndrome (MPS) with chronic upper back pain that does not respond to dry needling or trigger point injection, well-known treatments for MPS. A 67-year-old female developed a stabbing upper back pain with trigger point at left T7~8 levels 10 years ago. She complained of the pain with Numeral Rating Scale (NRS) 8 points. Myofascial release technique and trigger point injection had no effect. Under ultrasound guidance 20 ml of 1% lidocaine was injected into thoracic paravertebral space. Immediately, the pain was reduced to NRS 4 points. One week later, the second block was performed in the same way as the first, and the pain was reduced to NRS 2 points. The stabbing pain disappeared, and oral opioids were discontinued. Ultrasound guided thoracic paravertebral space block is an effective and safe treatment for refractory MPS with chronic upper back pain.

• Journal of Oral Medicine and Pain
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• v.30 no.3
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• pp.345-351
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• 2005

The purpose of this double-blind study was to evaluate clinical effects of botulinum toxin type A (BTX-A) injection on myofascial pain syndrome (MPS) involving upper trapezius and compare with those of lidocaine injection. 21 patients presenting with active TrP1 and/or TrP2 in the upper trapezius over 6 months were selected for this study. The subjects were randomly divided into two groups; one group injected with BTX-A (15 unit of $Botox^{(R)}$ / 0.3 ml per trigger point (TrP)) and the other group injected with 0.5% lidocaine (0.3 ml /TrP). The clinical effects were evaluated by VAS and PPT at baseline, 2, 4, 6 and 8 weeks after treatment. BTX-A group showed persistent decrease of VAS values and increase of PPT values following treatment. While there was no significant difference in VAS values between BTX-A and lidocaine groups (p=0.347), there was significant difference in PPT values after treatment between two groups (p=0.000). The subjects received BTX-A showed noticeable improvement in PPT values after treatment, suggesting more reliable effect of BTX-A injection compared with lidocaine injection. The results of this study support that the direct injection of BTX-A to a TrP is an effective and safe treatment for MPS involving upper trapezius.

• Clinical Pain
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• v.19 no.1
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• pp.49-53
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• 2020

Piriformis muscle syndrome is a condition that causes direct muscle pain around piriformis muscle or sciatica from irritated sciatic nerve and the diagnosis remains debatable. The main treatment is symptomatic relief from conservative therapy such as medication and piriformis stretching exercise, and various therapeutic injections including local anesthetic, corticosteroid, botulinum toxin can be considered for diagnostic and therapeutic purposes. In this case, a 54-year-old male who had sciatica and gait disturbance showed piriformis muscle hypertrophy in the pelvis MRI. From imaging studies, electrodiagnostic study and physical examination, he was diagnosed with piriformis muscle syndrome. He underwent trigger point injection and botulinum toxin injection into the piriformis muscle, and pain and gait disturbance significantly improved. This case reports a case of piriformis muscle syndrome with clinical symptom of gait disturbance, which was improved by botulinum toxin injection.

• The Korean Journal of Pain
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• v.5 no.1
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• pp.63-68
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• 1992

One hundred and four patients who complained of chest pain or back pain in the region between scapular were studied. In most cases, anatomical location of pain was in the rhomboid or serratus anterior muscle. Hyperactivity of dorsal scapular nerve or long thoracic nerve which innervate those muscles was thought to be responsible for the pain. The hyperactivity of the nerves may be due to the spasm of the scalenus medius muscle which the nerves meet during their course to the rhomboid or serratus anterior muscles. Therefore, spasmolytic treatment including trigger point injection, physical therapy, laser therapy, or NSAIDs may be effective for the treatment of chest pain or back pain.

• The Journal of the Society of Korean Medicine Diagnostics
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• v.14 no.1
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• pp.101-110
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• 2010

Objective : A case of idiopathic spasmodic torticollis rapidly improved after Oriental Medical treatments and supplementary trigger point injection is reported. Methods & Results : The oriental medical treatment for spasmodic torticollis including acupuncture, bee-venum therapy, herb medication, taping therapy, chuna therapy and physical therapy was performed for pain alleviation, and trigger point steroid injections were also performed. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Tsui Score were used for outcome measure of the spasmodic torticollis. After treatment for 15 days, the TWSTRS showed a decrease from 56 to 22.3 and the Tsui score also decreased from 13 to 5. Conclusions : We concluded that the oriental medical treatment including acupuncture, bee-venum therapy and taping therapy rapidly induced spasmodic torticollis to remission.