Trigger Point Examination and Injection Techniques in TMDs

Güzin Neda HASANOĞLU ERBAŞAR1,2, 

1Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Türkiye, guzinnedahasanogluerbasar@aybu.edu.tr 

2Honorary Research Professor, Department of Oral Health & Medicine,  University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland

Abstract

The assessment of muscle-related pain and selection of an appropriate therapeutic approach in myofascial temporomandibular disorders (TMDs) require a systematic clinical examination. Evaluating trigger points, recognising referred pain patterns, and relating examination findings to patients’ symptoms are important components of this process. The clinical use of trigger point injections should be considered alongside anatomical knowledge, appropriate technique, and safety principles. This workshop aims to develop participants’ knowledge and skills in trigger point examination and injection procedures. The first section will briefly introduce the trigger point concept and proposed clinical diagnostic criteria. The anatomy of the masticatory and associated cervical muscles commonly examined for trigger points in patients with TMDs will be reviewed. Demonstrations will illustrate muscle localisation, palpation methods, assessment of tender regions, and the significance of reproducing the patient’s familiar pain during examination. Local and referred pain patterns of the relevant muscles will be examined, and their relationship to clinical symptoms will be discussed. Limitations in interpreting examination findings and considerations relevant to differential assessment will be highlighted. The second section will introduce the materials, local anaesthetics, and equipment used for trigger point injections. Topics will include assessment before the procedure, patient information and informed consent, positioning, identification of anatomical landmarks, asepsis, and preparation of the injection site. Muscle-specific injection approaches and procedural steps will be explained in detail, with attention to relevant anatomical structures and safety considerations. Demonstrations will support the discussion of needle and syringe selection, target site identification, and technical aspects requiring attention during the procedure. Potential adverse effects and complications during and after injection, contributing factors, and measures to reduce risk will also be discussed. Particular attention will be given to contraindications, early recognition of complications, and the need for appropriate intervention or referral. The workshop will combine theoretical instruction, video demonstrations of injection techniques, and questions and answers. By the end of the workshop, participants should be able to describe the steps of a systematic trigger point examination, assess referred pain patterns, and identify the technical and safety requirements of injection procedures. The workshop’s principal contribution is to support an approach that interprets examination findings within the clinical context and prioritises patient safety. Participants will be encouraged to apply this knowledge to clinical assessment within their professional competence and scope of practice.

Keywords: Local anaesthetics, myofascial pain, referred pain, temporomandibular disorders, trigger point injections.