Trunk injection is a targeted delivery of pesticides, insecticides, nutrients, or other plant protection materials into the stem or trunk of woody plants as an alternative to spraying or soil drenching. Trunk injection has historically been used for disease and pest management of high-value forest tree species or ornamental plants when aerial applications are problematic due to spatial problems and health-related concerns. An interest in using the injection technique for protection of agricultural crops in commercial production systems has emerged more recently, where foliar applications and soil drenches have proven ineffective or pose environmental hazards. This review provides an overview of the basic principles of trunk injection and the plant physiological implications, its current use in commercial agriculture and other plant systems, and associated risks.