Facet Injection to Control the Recurrent Myofascial Trigger Points : A Case Report

經由小面關節注射來控制復發性肌膜引痛點：病例報告

李佩俽(Pei-Hsin Lee) ； 林伯威(Poi-Wei Lin) ； 謝霖芬(Lin-Fen Hsieh) ； 洪章仁(Chang-Zern Hong)

《中華民國復健醫學會雜誌》 26卷1期 (1998/03) Pp. 41-45

摘要

復發性肌膜引痛點（ MTrP ）可能與不易辨識的慢性軟組織病變有關，甚至可能由它所引起。本文將報告一個上背部復發性肌膜引痛點，經由小面關節（ facet or zygapophysial joint ）注射而成功控制疼痛的病例。這是一位40歲男性病人，因持續6個月漸進性左側上背部疼痛、麻木及頸部僵硬至復健科求診。臨床上發現在左側提肩胛肌（ levator scapulae ）、大小菱形肌（ rhomboid major and minor ）、上斜方肌（ upper trapezius ）及上後鋸肌（ serratus posterior superior ）有活動性肌膜引痛點。肌電圖檢查發現有雙側慢性第六及第七頸神經根病變，而磁振造影證實在左側第五/六和第六/七頸椎間有輕微椎間盤凸出。經兩個多月頸椎牽引、局部引痛點注射及針灸治療，症狀無明顯改善。進一步檢查發現左側第五/六頸椎小面關節有壓痛點，並引發左上背肌膜引痛點之疼痛，故在第五/六小面關節施以4毫克 betamethasone 加 1% lidocaine 0.5cc 局部注射。注射後症狀立刻緩解。兩個月後複診檢查，病人已無疼痛現象。一年半後再以電話追蹤，背痛完全緩解且無復發現象。由以上可知，當病人有上背部復發肌膜引痛點時，可能也要檢查頸椎小面關節是否有與引痛點相關之病灶，而適當的局部小面關節注射，對復發性肌膜引痛點控制可能有極大的幫助。

關鍵字

頸部疼痛 ； 小面關節 ； 小面關節注射 ； 肌膜引痛點

並列摘要

Recurrent myofascial trigger points (MTrPs) may be caused by or associated with chronic soft tissue lesion(s) which can not be easily identified. We hereby report a case of recurrent myofascial trigger points in the upper back muscles, which were successfully controlled after one treatment of cervical facet injection.
This patient was a 40-year-old man who had suffered from chronic left upper back pain and soreness with tingling sensation and back stiffness for six months. He had active MTrPs in the left levator scapulae, left rhomboid major and minor, left upper trapezius, and left serratus posterior superior muscles. Spurling sign was negative. Neurological examination was within normal limits. Electromyographic examination revealed evidence of chronic C6 and C7 radiculopathies in both sides. MRI of the cervical spine showed mild disc bulging at C5-6 and C6-7 levels. He was firstly treated conservatively with physical therapy including heat therapy and cervical traction. He also received acupuncture and lidocaine injection to the active MTrPs, which showed only temporary effect. Further examination revealed severe tenderness in the left C5-6 facet joint, which was correlated with finding of CT scan. MTrPs pain in the left upper back could be reproduced during compression of the facet joint. Therefore, injection with betamethasone 4 mg plus 1% lidocain 0.5 cc was performed to the left C5-6 facet. Immediately after injection, all the MTrPs became inactive (pain free) . In a follow-up examination 2 months later, no active MTrPs could be identified. No recurrence of symptoms was reported in a follow up phone call 15 months later. It is suggested that when a patient has recurrent MTrPs in the upper back, careful examination for facet joints to find possible association of facet lesion and MTrPs and to offer appropriate local injection may be very helpful to control the recurrent MTrPs.

並列關鍵字

neck pain ； facet joint ； facet injection ； myofascial trigger point