This case involves a male patient who had been involved in a work-related accident. After his accident, he continued to suffer from consistent back pain. He had a consultation at a comprehensive spine center roughly 2 months after the accident. Radiography revealed no significant osseous injuries. The physician’s plan included moving forward with trigger point injections to his lumbar musculature. The procedure notes indicate the patient tolerated the injection well with no complications. The patient was instructed to follow up at the clinic in two weeks, and also received oral medications and ice. The patient returned to the clinic one week later with complaints of left-sided lumbar back pain and left hip pain. In addition, he was suffering from significant muscle spasms and jerking sensations in the back lumbar region.
Question(s) For Expert Witness
- 1. How often do you perform these types of injections?
- 2. Have you ever lectured or published on trigger point injections?
Expert Witness Response E-049238
I am a board certified physical medicine and rehabilitation physician and also completed a fellowship in pain management. I conduct trigger point injections on a regular basis (typically weekly). My initial thoughts are it is unusual for a trigger point injection to cause those symptoms. It is also unusual for a right piriformis injection to cause left sided symptoms. Ultrasound is indicated for piriformis injections but it’s not below standard to not use it (it’s how we did it prior to ultrasound being mainstream). Nerve injury is a risk with all injections and it would be difficult to assert this was below standard of care if they were properly consented. If consent was improper, there might be something there.
Expert Witness Response E-006028
I am board certified in physical medicine and rehabilitation and trained under a pain fellowship at a major university. I am extremely familiar with spinal procedures and am currently an active physician in a pain management practice. I perform trigger point injections at least weekly. Ultrasound use during these injections is not necessarily required, however it could indicate if there was indeed a breach in the standard of care.