Full Transcript Shoulder Girdle Trigger Point Overview 0:00 This is a very common location. A lot of 0:02 patients will be needing treatment 0:03 [music] in the shoulder girdle. For the 0:06 two rotator cuff muscles that are the 0:08 most commonly needed [music] to be 0:09 treated for trigger points, the easiest 0:11 access is right here in the V and 0:15 [music] that is the supraspinatus. 0:17 If you are a beginner and you feel more 0:19 comfortable, [music] have the patient 0:21 take a deep breath in and blow it out 0:23 and tell them ahead of time when they 0:25 blow out the breath to hold their 0:26 breath. 0:27 >> [music] 0:27 >> That way the lungs are deflated when 0:29 you're inserting the needle into the 0:31 lung field. So, you can feel the scapula 0:33 coming out and [music] coming down here 0:36 and I'll put my finger on the outer edge 0:38 of the scapula [music] and I'm going to 0:40 rotate her head and I can feel it 0:43 underneath my skin when I do a 0:46 opposite rotation of her [music] head. 0:49 Right here where my finger is is the 0:51 attachment onto the bone. So, that is 0:55 the injection entry point. 1:00 >> [music] 1:00 >> Shoulder girdle trigger point
Upper Trapezius Injection Technique 1:02 injections. This is a very common 1:04 location. A lot of patients will be 1:06 needing treatment in the shoulder 1:07 girdle. Where I see patients needing 1:10 treatment the most is the 1:12 >> [music] 1:12 >> upper trapezius, the levator scapula, 1:16 which is on the border of the scapula 1:18 attachment, rhomboid major, which is 1:21 just on the medial aspect of the 1:24 scapula, and then for the two rotator 1:27 cuff muscles that are the most commonly 1:29 needed to be treated for trigger points, 1:31 the easiest access is right here 1:34 >> [music] 1:34 >> in the V and that is the supraspinatus. 1:38 That's a big [music] one. You will be 1:39 doing this one frequently. And then 1:41 finally, the infraspinatus [music] comes 1:44 around this direction. The biggest 1:46 trigger point tends to be right here, 1:48 dead center in the middle of that 1:50 infraspinatus. [music] 1:51 So, those are the most common trigger 1:54 point locations for the um 1:57 shoulder girdle. So, first [music] I'm 1:59 going to start with the uh upper 2:02 trapezius, a very common location. Um 2:05 once I've cleaned the skin, well, once I 2:07 palpate, I like to mark. And the easiest 2:10 way to mark this is actually the lid. It 2:13 creates a beautiful little bull's-eye 2:15 for me. 2:16 All right. So, since we are in a lung 2:18 field, she's very slender. If you are a 2:21 beginner and you feel more comfortable, 2:23 have the patient take a deep breath in
Levator Scapula and Rhomboid Major 2:25 and blow it out. And tell them ahead of 2:27 time when they blow out the breath to 2:28 hold their breath. [music] That way the 2:30 lungs are deflated when you're inserting 2:33 the needle into the lung field. Little 2:35 pearl on that. Okay, here we go. A 2:37 little pinch. 1 2 3. So, you can see 2:40 I've penetrated in. I am tapping, 2:42 injecting, and deploying. And that 2:45 muscle, that skin did not lift at all. 2:47 [music] It's nice and flat. I could 2:49 actually feel what Dr. Travell calls 2:52 LTR, local twitch response. That upper 2:56 trapezius was just quivering on the 2:58 needle and deployment of [music] the 3:00 fluid, which is normal and that's 3:02 actually what to document a local twitch 3:04 response or an LTR in the upper 3:06 trapezius. Okay, next is the levator 3:10 scapula. I'm going to show you a really 3:12 cool trick. [music] 3:13 So, you can feel the scapula coming out 3:16 and coming down here. And I'll put my 3:18 finger on the outer edge of the scapula 3:21 and I'm going to rotate her head and I 3:24 can feel it underneath my skin [music] 3:26 when I do a um opposite rotation of her 3:30 head. Right here where my finger is is 3:32 the attachment [music] onto the bone. 3:34 So, that is the injection entry point 3:39 for the levator scapula. Here we go. A 3:41 little pinch. 3:42 You can go in at 90 or I'm going at a 3:44 slight [music] angle towards the 3:46 scapula. 3:48 It did bubble up just a little bit, but 3:50 that's okay. She's very slender, [music] 3:52 so I'm making sure I'm not going too 3:53 deep on anything. Next is the rhomboid 3:56 major. 3:57 The rhomboid major comes all the way 3:59 down next to the scapula border, and you 4:01 can do this one in upright seated
Supraspinatus and Infraspinatus Injections 4:03 position, or you could do it prone as 4:05 their arm is out, and that opens up this 4:08 shoulder girdle right in through here. 4:09 Ooh, she's got a great big one. It's 4:11 actually snapping. 4:13 I don't know if you can see that on 4:15 camera, but it is snapping on that 4:17 shoulder girdle. 4:18 So, rhomboid major, very, very common 4:21 location for a trigger point. 4:23 Here we go. I've marked it. I've cleaned 4:25 it. 90° in, little [music] pinch, 1 2 3. 4:28 And you can see I'm doing the star 4:30 technique. 4:32 It is not bubbling up, and I've [music] 4:34 deployed. Normally, I deploy 1 cc per 4:38 site from C7 down, and it's um about a 4:42 quarter to a half a cc from C6 and up 4:46 [music] in majority of the muscles. It's 4:48 kind of a good general rule of thumb. 4:50 Next, I'm going to do the two most 4:52 common uh rotator cuffs. So, this first 4:55 one, there's a V-shape right here of the 4:57 scapula, and when you go into that V, it 5:00 drops straight down. That's an easy 5:03 access right into the supraspinatus. 5:07 And with supraspinatus, you'll remember 5:09 its empty can is your orthopedic test, 5:12 um and there's frequently impingement 5:14 [music] um of that supraspinatus. 90° 5:17 straight down, 1 2 3 pinch. 5:20 And I'm doing [music] a pepper as well 5:21 as a little bit of a modified star 5:23 technique. And finally, last one is the 5:26 infraspinatus. 5:28 This is again a very common uh location 5:31 for a trigger point. 5:34 Here we go. Little pinch, 1 2 3.
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