Trigger Point Injection – Technique and Overview

Name of Procedure

Trigger Point Injection

Sample Opnote


To administer medications to a trigger point


Trigger point related pain


  • Local skin infection, inflammation, trauma or burns.
  • Coagulopathy or anticoagulant use (relative contraindication)
  • Common contraindications



  • Alcohol prep pad
  • 25g x 1.5” hypodermic needle
    • Usually this is sufficient but consider that deeper muscles or obese patients may require a longer needle.
    • In this case consider a 25g still so that you don’t have to anesthetize the skin.
  • 5-10cc syringe with desired injectate (ie, 0.25% bupivacaine with 40mg triamcinolone)

Landmarks and Patient Positioning

This will vary greatly based on the injection site. Generally just have the patient in a comfortable position with the target muscle well exposed.

Most often trigger points occur in the thoracic and cervical levels so the patient can usually be sitting on the side of an exam table.


  1. Identify exact targets
    1. Palpate around the area that the patient reports pain to find the specific location of trigger points
      1. Keep in mind that trigger point pain is often referred and the location of pain may not be exactly where the trigger points are
    2. You will be looking for tight bands of muscle:
      1. There might be more than one trigger point
      2. Distinguish from feeling bone
      3. Look to elicit the patient’s normal pain with pressure on the trigger point
    3. The targets are often slightly mobile and you’re targeting them blindly so it’s helpful to make a small mark on the skin to remember the exact location.
  2. Insert your 25g x 1.5” hypodermic needle right on top of the trigger point and advance straight into the trigger point
    1. You may sometimes see muscle twitching.
  3. Inject desired medication
    1. In addition to the main target, you usually want broad coverage to ensure that you’ll fully cover the trigger point
    2. Move your needle in a cone like fashion, injecting medication evenly throughout
    3. Since you are “fanning” your injection your needle is moving locations a lot and so you probably don’t need to aspirate for blood


  1. These injections are generally simple and low risk so keep in mind situations where you are most likely to have issues:
    1. Obese patients have a lot of adipose tissue before reaching muscle
    2. For thoracic and cervical area trigger points (very common) pneumothorax is theoretically possible, although generally uncommon:
      1. 25g needles can reduce the risk of a clinically significant pneumothorax
      2. If doing bilateral procedures be especially cognizant as a bilateral pneumothorax is critical.
      3. Consider all this especially important for thin patients.
  2. See various references regarding injectate options and efficacy which is beyond the scope of this article.