Sequential Myofascial Trigger Point Injection to Treat a Patient with Myofascial Pain Syndrome Associated with Reflex Sympathetic Dystrophy: A Case Report

以接續性肌筋膜激痛點注射來治療合併有反射性交感神經失養症之肌筋膜疼痛症候群的病患：病例報告

官大紳(Ta-Shen Kuan) ； 洪章仁(Chang-Zern Hong)

《中華民國復健醫學會雜誌》 31卷3期 (2003/09) Pp. 155-163

https://doi.org/10.6315/JRMA.200309.0155

摘要

一位右肩遭受創傷性旋轉環帶撕裂傷的患者，在其右側上肢發展出嚴重的肌筋膜疼痛症候群、合併有反射性交感神經失養症。由於整個右上肢有嚴重的觸感痛，這位患者無法接受任何型式的徒手治療與針刺療法。她大約在受傷2個月之後，來到我們的疼痛門診。她接受了肌筋膜激痛點的注射療法，從右手第一背側骨間肌的激痛點注射開始，接著再注射右側手腕與手指伸肌群、以及右側前三角肌的激痛點。此時觸感痛有顯著地降低，因此她接受了右側肩部關節與尖峰下滑囊的關節內類固醇的注射。兩個禮拜之後，她已經可以使用她的右手來從事輕度的工作。隨後她又接受了右側肩胛帶肌肉群的肌筋膜激痛點的注射，包括有三角肌、棘上肌、棘下肌和小圓肌的注射。在注射過後約3個月，她幾乎不再有疼痛的現象，並且右側肩部幾乎有完全的活動範圍。本文將討論肌筋膜激痛點的機轉，以及它與反射性交感神經失養症的相關性。

關鍵字

肌肉疼痛 ； 肌筋膜激痛點 ； 反射性交感神經失養症 ； 激痛點注射

並列摘要

A patient with traumatic rotator cuff tear of right shoulder developed severe myofascial pain syndrome with reflex sympathetic dystrophy (RSD) involving the right upper extremity. She was unable to take any type of manual therapy or needle treatment due to severe allodynia in the whole right upper limb. She visited our pain clinic about 2 months after the onset of trauma. She received myofascial trigger point (MTrP) injection beginning with injection into the MTrP of the right first dorsal interosseous muscle, followed by injecting MTrPs of the right wrist-finger extensors and right anterior deltoid muscles. The allodynia was remarkably reduced. Then she received intra-articular steroid injection into her right shoulder joint and subacromial bursa. Two weeks later, she was able to use her right hand for light activity. She received further injection of MTrPs in the right shoulder girdle muscles including deltoid, supraspinatus, infraspinatus and teres minor muscles. She had almost pain free with nearly full range of motion in her right shoulder by 3 months after injection. The mechanism of MTrPs and their association with RSD were discussed.

並列關鍵字

muscle pain ； myofascial trigger point ； reflex sympathetic dystrophy ； trigger point injection