What is the recommended needle size for trigger point (myofascial trigger point) injection?

From the Guidelines

Trigger point injection typically requires a 27-30 gauge, 1-2 inch needle to minimize discomfort and local trauma while allowing for effective injection of local anesthetics or saline solution to help relax the muscle and relieve pain 1. This size needle is small enough to reduce the risk of complications and is suitable for injecting 1% lidocaine with a dose of 0.1-0.5 mL per trigger point. The procedure may be repeated as needed, up to 3-4 times, with at least 1-2 weeks between sessions. It's essential to note that the specific medication and dosage may vary depending on the individual patient's needs and the practitioner's professional judgment.

• Key considerations for trigger point injection include:
  • Using a small-gauge needle to minimize discomfort and local trauma
  • Injecting local anesthetics or saline solution to help relax the muscle and relieve pain
  • Repeating the procedure as needed, with adequate time between sessions
  • Monitoring patient response and adjusting treatment accordingly
• The evidence suggests that a 27-30 gauge needle is a suitable size for trigger point injection, as it balances the need for effective injection with the need to minimize discomfort and complications 1. However, it's crucial to consider individual patient factors and adjust treatment accordingly.

From the Research

Needle Size for Trigger Point Injection

• The recommended needle size for trigger point injection is not explicitly stated in all studies, but some studies provide information on the needle sizes used:
  • A study published in 1992 used a 21-gauge hypodermic needle for percutaneous release of the trigger finger 2.
  • A study published in 2012 used a 14-gauge needle for percutaneous surgical technique in the treatment of trigger finger 3.
  • A study published in 2009 compared the use of 21-, 23-, and 25-gauge needles for trigger point injection in myofascial pain syndrome and found no significant difference in terms of pain intensity during injection, but injections with 21- or 23-gauge needles were found to be more effective in terms of health-related quality of life 4.
  • A study published in 2021 used a specially designed needle (0.8×100 mm) with a planus tip for percutaneous trigger thumb release 5.
  • A study published in 2010 used miniscalpel-needle release, but the specific needle size was not mentioned 6.

Comparison of Needle Sizes

• The study published in 2009 compared the use of different needle sizes (21-, 23-, and 25-gauge) and found that injections with 21- or 23-gauge needles were more effective in terms of health-related quality of life 4.
• However, the same study found no significant difference in terms of pain intensity during injection between the three needle sizes 4.

Safety and Efficacy

• The studies suggest that percutaneous needle release techniques are effective and safe for treating trigger finger and thumb, with low complication rates 2, 3, 5.
• The study published in 2009 found that trigger point injections with 21-, 23-, or 25-gauge needles were effective in reducing pain and improving health-related quality of life, with no significant difference in terms of pain intensity during injection 4.