Norman Marcus, MD - Years of pain relief in neck and shoulder with muscle injections
Years of pain relief in neck and shoulder with muscle injections, when the correct muscle(s) is injected properly.
A patient was seen in 2002 with years of neck pain that radiated into the back of the head and the upper part of the arm. He had failed at attempts of physical therapy. An MRI had shown that there were signs of arthritis in his neck and narrowing of the holes through which the nerves in his neck travelled as they left the spinal cord.
Although nerve block injections are frequently given for neck and shoulder pain, his symptoms and physical exam weren’t convincing to support getting epidural steroids or facet joint injections. When I evaluated him I found the following muscles were painful with the MPDD: left Trapezius, Infraspinatus, Teres Major, Levator Sacpula, Supraspinatus, Rhomboids, and Splenius Capitus
After injecting all of the muscles (one muscle per day, 2 muscles a week, with PT specifically for injected muscles for 3 days following each muscle injected) all of his pain was gone and he had regained normal motion in his neck. He remained pain free for seven years. He had a minor sports injury and had recurrence of his pain. This time only two muscles (Left Levator Scapula and Supraspinatus) were found to be the cause of his pain and when they were injected and he received the after injection PT, his pain was once again gone and remains that way now (2011).
Nerve injections and Trigger Point muscle injections done for neck pain will frequently achieve transient partial relief. Since muscles are frequently the reason for the pain, nerve injections such as ESIs will not have significant lasting effects. If muscles were suspected it may be difficult to decide which muscle in a region of the body actually is causing the pain and not just experiencing pain (muscles can confusingly cause pain in adjacent muscles). Even if the correct muscle was identified, injecting the belly of the muscle and not the areas where the muscle attaches to tendons and bone, will miss the major pain generators in that muscle, and the chance for lasting relief.