Interfascial ultrasound-guided infiltration of the middle trapezius and rhomboids

As we have seen in previous articles, the objective of ultrasound-guided injections at the interfascial level is to treat chronic pain of myofascial origin in cases where rehabilitation treatment is ineffective, or in combination with physical therapy.

Ultrasound-guided interfascial injections at the middle trapezius-rhomboid level can reduce inflammation and pain, improve muscle function, and indirectly improve mobility of the scapula and shoulder.

We recall the importance of the connective tissue that lines and separates the muscles (fascia), through which nerves and blood vessels circulate. Ultrasound imaging allows us to administer medications (local anesthetics, corticosteroids, PRP, etc.) with great precision, reducing the risk of injury to neurovascular structures. We see in Figures 1 and 2 that the trigger points of the middle trapezius and rhomboids can be very similar, with pain referred to the same location between the thoracic spine and the inner border of the scapula. In the case of the middle trapezius, it can also cause referred pain to the back of the shoulder and a tingling sensation in the arm.

Figure 1 - Trigger points and referred pain of the middle trapezius muscle

Figure 2 - Trigger points and referred pain of the rhomboid muscle

Interfascial ultrasound-guided injections of the middle trapezius and rhomboid muscles are indicated for:

• Myofascial pain: to treat trigger points and chronic muscle pain that may be the cause of pain along the medial border of the scapula and loss of scapular function.
• Chronic pain in both muscles can be due to postural causes, overload, overuse, repetitive movements, physical exertion, or myofascial injury.

Figure 3: Needle access to the interfascial space between the middle trapezius and rhomboid muscles (white line) or to the thickness of the rhomboid muscle (yellow line).

The middle trapezius is an important stabilizer of the medial border and slightly assists in the superior rotation of the scapula. The rhomboid major and minor are important stabilizers of the medial border of the scapula. Their functional alteration causes scapular dyskinesis and shoulder pain secondarily.

Both muscles are common sources of acute and chronic pain in daily clinical practice. The first line of treatment is physical therapy with stretches associated with myofascial release techniques, deep gliding massage with friction, etc.

Patients who do not improve with various rehabilitation treatments are candidates for interfascial ultrasound-guided injections.