Article Figures & Data
Figures
- Figure 1.
A: Locations of myofascial trigger points (TrPs) in the gastrocnemius muscle, where we identified myofascial TrPs in patients with nocturnal calf cramps in this study. B: Flat palpation, which compresses the muscle against the underlying bone to identify taut bands that harbor myofascial TrPs. C: Injection technique. The TrP is positioned between 2 fingers to prevent the TrP from sliding during injection. The fingers are pressed downward and apart to maintain pressure and ensure hemostasis. A 25-gauge, 1.5-inch needle is inserted between the fingers that have located the TrP. The needle penetrates the skin 1 to 2 cm away from the TrP so that the needle can approach it at an acute angle (30°) to the skin. The syringe, filled with 0.25% lidocaine, may be held between fingers of the injecting hand and thumb pressure used against the plunger. Ensure that the needle tip is positioned on the TrP, and then inject 1–2 mL of lidocaine.
- Figure 2.
Prevalence of clinical insomnia determined by a cutoff score of 15 on the Insomnia Severity Index (ISI) at each time point during treatment with myofascial trigger point injection(s) for patients with nocturnal calf cramps. T0, baseline; T1, 1 week after the first injection; T2, 2 weeks after the first injection; T3, 4 weeks after the first injection. *P < .05 vs T0.
Tables
- Table 1. Patient Characteristics, Calf Cramps Profile at Baseline, and Clinical Presentations During the Study Period
Patient No. Sex Age (Years) Side Duration (Months) T0 T2 History of spine surgery Current medications NRS ISI FC TrPs B and D, Lt TrPs A and C, Lt TrPs A and C, Rt TrPs B and D, Rt TrPs (n) TPI TrPs B and D, Lt TrPs A and C, Lt TrPs A and C, Rt TrPs B and D, Rt TrPs (n) TPI 1 F 52 Both 36 4 24 1 X O O X 6 Yes X X O X 3 Yes None – O O O O X O O X 2 F 70 Both 48 9 18 14 X O O X 6 Yes X X X X 4 Yes None – O O O O O O O O 3 F 70 Both 48 7 22 2 X O O O 6 Yes X X O X 2 Yes None – X O O O X X O X 4 F 80 Both 12 7 25 3 O O O O 6 Yes X X O X 3 Yes None Phenytoin 100 mg daily X O O X X O O X 5 M 69 Both 36 8 7 3 X O O X 4 Yes X X X X 2 Yes None Neurontin 900 mg daily X O O X X O O X 6 F 52 Right 36 8 21 3 X X O O 3 Yes X X X X 0 No None – X X O X X X X X 7 F 58 Right 36 7 15 7 X X X O 3 Yes X X X X 0 No PLIF L4/5/S1 – X X O O X X X X 8 F 56 Both 60 7 19 14 X O O X 6 Yes X O O X 6 No PLIF L3/4/5 – O O O O O O O O 9 F 68 Right 36 5 15 4 X X X X 2 Yes X X X X 2 No PLIF L4/5 – X X O O X X O O 10 M 47 Right 36 5 14 2 X X X O 2 Yes X X X O 2 Yes Laminectomy L5/S1 – X X X O X X X O 11 M 74 Both 36 10 17 14 X O O X 5 Yes X X X X 0 No None – X O O O X X X X 12 F 61 Both 12 6 16 21 O O O O 6 Yes O O O O 6 Yes PLIF L2/3 – X O O X X O O X O indicates the existence of a trigger point. X indicates no existence of a trigger point.
F, female; FC, frequency of nocturnal calf cramps; ISI, Insomnia Severity Index; Lt, left; M, male; NRS, numerical rating scale pain score; PLIF, posterior lumbar interbody fusion; Rt, right; T0, baseline; T2, 2 weeks after the first injection; TPI, trigger point injection; TrP, trigger point (shown in Figure 1A).
- Table 2. Changes in Numerical Rating Scale Pain Score, Insomnia Severity Index, and Frequency of Nocturnal Calf Cramps During Treatment With Myofascial Trigger Point Injection(s)
T0 T1 T2 T3 NRS 6.9 ± 1.7 4.8 ± 2.0* 2.4 ± 2.6* 2.2 ± 2.2* FC 3.5 (1–20) 1.0 (0–7)† 0.0 (0–7)† 0.5 (0–2)† ISI 17.8 ± 5.0 12.8 ± 4.6* 10.8 ± 4.4* 8.9 ± 3.7* Data are presented as mean ± standard deviation or median (range).
↵* P < .01 vs baseline (T0) using repeated measures analysis of variance.
↵† P < .01 vs T0 using Wilcoxon signed rank test.
FC, frequency of nocturnal calf cramps; ISI, Insomnia Severity Index; NRS, numerical rating scale pain score; T1, 1 week after the first injection; T2, 2 weeks after the first injection; T3, 4 weeks after the first injection.
