Rhomboid major muscle ultrasound-guided trigger point injection: a case report and technique description

Abstract

Introduction: Myofascial pain syndrome is an acute and chronic painful musculoskeletal condition that involves muscle and surrounding connective tissue. Trigger point injection is a common treatment for this condition providing long-term relief. The procedure is generally safe; however some side effects have been reported including pain, nerve injury, bleeding, infection, and pneumothorax. Objective: To report a case of a patient with myofascial pain syndrome successfully treated by Ultra Sound-guided infiltration of a myofascial trigger point in the rhomboid major muscle. Case description: A 39-year-old presented with cervical and dorsal pain of 4 months of evolution. She had physical and occupational therapy, with partial improvement of cervical pain but persistence of dorsal pain. No abnormal finding was noted on the neurological examination. On palpation, the patient had a myofascial trigger point in the left rhomboid major muscle. Given the persistence of the myofascial trigger point after physical therapy, it was considered the patient might benefit from Ultra Sound-guided infiltration. No adverse events were reported. At the end of the procedure, the patient reported a 70% reduction in pain. The patient returned for a follow-up visit one month after the procedure, reporting pain relief of 80%. Conclusions: The use of an Ultra Sound-guided technique for trigger point injection decreases the risk of iatrogenic complications. The blind method may result in poor localization of the point. Further studies are required to develop Ultra Sound based criteria to determine its clinical use.