Trigger Point Excision - New Treatment

Below you will find a new (or well forgotten old) treatment of trigger points.  Most of my pain management and spine surgeon colleagues never heard of it.  Do not be surprised if you never did either.  Please read below.

Management of trigger points is a challenging problem. There is limited research on etiology of trigger points.  The treatment is usually limited to attempts to reduce stress, overuse, anti-inflammatory medications, muscle relaxants, antidepressants, neuroleptics, acupuncture, osteopathic manipulations, massage, heat and cold applications, ultrasound, nerve stimulators, dry needling and trigger point injections with local anesthetic or steroids.   The goal of all therapies is to disrupt the taut band within the fascia or the muscle itself.  Some patients end up having spinal surgeries in attempt to reduce pain. 

Having so many treatment options for a single condition tells you that none of them produce great and reliable results. 

The basic anatomic cause of trigger point is a scar or scar-like tissue formation that creates thickening of the fascia on top of the muscle or inside of it.  There are many reasons why that is happening, but the final anatomic structure or abnormality is the same – tight scar lake band or knot.

Our approach adds additional minimally invasive way to manage trigger points - by excising diseased fascia through a small, about 1 inch, incision.  It was originally pioneered by a retired Texas plastic surgeon over 30 years ago, who performed over 2000 procedures with internal success rate of 98% but it never became mainstream.

The procedure is elegant and simple.  The trigger point is identified with manual examination and ultrasound and is tagged and internally marked.   Through a small incision diseased fascia and muscle are gently removed and then muscle defect is repaired / reconstructed.  

The procedure is usually performed in the surgery center or hospital on outpatient basis under local anesthesia and mild sedation and takes about an hour. In most cases general anesthesia and overnight stay are not required.

Most patients experience significant improvement of trigger point symptoms.  The trigger point pain is temporarily replaced with usual postsurgical pain, which is much different then trigger point pain.  Recovery from surgery takes about 1-3 weeks depending on complexity, amount of fascia removed and other factors.

Procedure can be performed on any body part with palpable trigger point location.

If you had 2 or more unsuccessful trigger point injections and failed other non-surgical methods, or if you do not want to continue taking numerous medications for the rest of your life or have spinal surgery, give our office a call to schedule your evaluation to see if you are a candidate for minimally invasive trigger point excision procedure.

Below you will find some additional information on trigger points.

Trigger points are local, tender, and hyperirritable spots located next to or within the skeletal muscle.  They not only produce pain locally, but also can produce referred pain to the other parts of the body. Trigger points are commonly associated with acute trauma, such as Motor Vehicle accidents, or chronic musculoskeletal conditions.

Trigger points can be active or latent.  Active trigger point has pain at rest, tender to palpation, can have referred or radiating pain to other parts of the body.  Latent trigger points usually restrict the motion or result in muscle weakness.  The patient does not have pain at rest but will complain of pain if the pressure is applied directly to trigger point location.

Traditionally trigger points are separate from tender points associated with conditions such as fibromyalgia. Trigger points are located over muscle belly. Tender points also have local tenderness, but they are not located over the belly of the muscle, do not cause referred pain, but commonly cause body hypersensitivity.

Trigger points are commonly associated with local twitch response. Local twitch response is a palpable or visible muscle contraction when the pressure on the trigger point is applied.

Causes of trigger points.

1                     acute trauma, especially caused by repetitive stress (tennis elbow, golf shoulder etc)

2                     repetitive microtrauma

3                     lack of exercise

4                     prolonged poor posture

5                     vitamin deficiency

6                     sleep deficiency

7                     repetitive occupational or recreational activity

8                     surgical scars

9                     tissues placed under tension due to surgery (after spinal or hip surgery)