• Hariharan Shankar and Craig Cummings.
• Department of Anesthesiology, Clement Zablocki VA Medical Center & Medical College of Wisconsin, Milwaukee, Wisconsin 53295, USA. hshankar@mcw.edu
• Pain Pract. 2013 Jun 1;13(5):405-8.

AbstractTrigger points can result from a variety of inciting events including muscle overuse, trauma, mechanical overload, and psychological stress. When the myofascial trigger points occur in cervical musculature, they have been known to cause headaches. Ultrasound imaging is being increasingly used for the diagnosis and interventional management of various painful conditions. A veteran was referred to the pain clinic for management of his severe headache following a gunshot wound to the neck with shrapnel embedded in the neck muscles a few years prior to presentation. He had no other comorbid conditions. Physical examination revealed a taut band in the neck. An ultrasound imaging of the neck over the taut band revealed the deformed shrapnel located within the levator scapulae muscle along with an associated trigger point in the same muscle. Ultrasound guided trigger point injection, followed by physical therapy resolved his symptoms. This is a unique report of embedded shrapnel and coexisting myofascial pain syndrome revealed by ultrasound imaging. The association between shrapnel and myofascial pain syndrome requires further investigation.© 2012 The Authors Pain Practice © 2012 World Institute of Pain.

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