Trigger point injections for myofascial pelvic pain

Abstract

The objectives of this video are to define myofascial pelvic pain syndrome, illustrate relevant pelvic floor anatomy and exam techniques for the assessment of pelvic floor myofascial pain, and demonstrate trigger point injections to the pelvic floor muscles in a cadaver model. Myofascial pelvic pain syndrome is characterized by contracted bands of skeletal muscles that contain discrete, painful nodules known as trigger points. Trigger points may develop as the primary source of pain or may develop as a downstream effect from other disorders within the pelvis. Myofascial pelvic pain tends to co-exist with other visceral pelvic diseases such as endometriosis or bladder pain syndrome. There is good evidence to support the use of trigger point injections for myofascial pelvic pain. Injections may consist of local anesthetics with or without a steroid. Studies have also evaluated the use of botulinum toxin injections to the pelvic floor muscles for treatment of refractory pelvic floor myofascial pain. This video demonstrates a pelvic floor muscle examination using a cadaver model in addition to performing trigger point injections to the pelvic floor muscles. In conclusion, myofascial pelvic pain syndrome is an important contributor to chronic pelvic pain; a thorough pelvic floor muscle assessment will allow identification of potential trigger points, and trigger point injections may be performed for both diagnostic and therapeutic benefit.