Ultrasound-guided interfascial infiltration of the upper trapezius and levator scapulae

In this case, we discuss interfascial ultrasound-guided injections of the upper trapezius and levator scapulae muscles. Both are commonly affected by pain, whether due to postural causes, overload, overuse, repetitive movements, physical exertion, or myofascial injury.

Interfascial ultrasound-guided injections aim to provide analgesia to the muscle groups causing acute or chronic pain. Fascia is understood as the connective tissue that surrounds and separates muscles. Nerves and blood vessels circulate through it. Ultrasound guidance allows us to deliver medication (local anesthetics, corticosteroids, PRP, etc.) with extreme precision, minimizing the risk of injury to neurovascular structures.

Indications for interfascial ultrasound-guided injections are reserved for a second line of treatment, when physical therapy and rehabilitation cannot control the pain. Interfascial ultrasound-guided injections are indicated for:

• Myofascial injuries: to treat trigger points and chronic muscle pain that can cause pain and loss of function.
• Chronic musculoskeletal pain: it can be useful in the treatment of pain in the back, shoulder, knee, and other joints.

The upper trapezius is the most important stabilizer of the scapula. Its involvement, in the form of hyperactivity, stiffness, overload, or fatigue, can determine the alteration of scapular muscle balance, and with this alteration, erratic scapular mobility, a common source of shoulder and cervical pain.

The levator scapulae is a stabilizing muscle of the superomedial angle of the scapula, which contributes to its elevation.

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

Patients who fail to improve with various rehabilitation treatments are candidates for interfascial ultrasound-guided injections.