Injection Course – Trigger Points, Ligament Insertions and Ganglions
1. A Review of Anatomy and physiology
– The anatomy of internal derangements review
– The key role of ligament insertion injuries in orofacial pain and joint dysfunction
2. Diagnosis including history taking.
– The goals of history taking (more than gathering information)
– How to accomplish those goals
– The role of imaging
– A close look at migraine and other headache patterns
– Peripheral and Central Sensitization considerations
PPTTN
CRPS
– The clinical examination — the “true” goals and the “truth” about muscle palpation
3. Occlusion vs. Occluding — The key role of parafunction in orofacial pain patterns and joint dysfunction
– The dental concept of OCCLUSION
– Parafunctional control — splint therapy design considerations — (Hands on demonstration)
– Occlusal Dysesthesia – definition/Prevention/Treatment
4. Injection therapy — More Than Trigger Points
– The theory behind trigger point injections and why they can be helpful; and also over rated
– Ligament insertion injections
– Ganglion injections (including a direct, pain free, relatively untoward effect free SPG injection technique)The vast majority of the third day of the course will be HAND ON injections. All materials will be provided.NOTE: The course can be a two or three day course. In the three day course we review the entire model including history taking and parafunctional control with splint therapy. – ————————————————————————————————————————-
In the past, our two day injection course has been held in Costa Rica and in Allentown, and the fee for the specialized course was over four thousand dollars in each case. Excellent planning by several of those that took our last course helped us control costs to less than half of that total!
ANY INTEREST? PLEASE email to: DrBGlass@gmail.com
Our last course in Temecula, California was hosted by Dr. Robert Cadalso. We had eight attending. It was a three day course that not only included injection therapy but also splint therapy, occlusion, and parafunctional control appliances. The course was a total review of what has been referred to as “The Allentown Model.” This model is based on comprehensive histories with emphasis on diagnostically driven therapy recognizing the importance of ligament insertion injuries as well as the role of injection therapy and parafunctional control in trigeminally mediated disorders.
To allow you to begin therapy immediately upon their return from the course, attendees are given start-up kits, as well as product lists with contacts for their purchases.
Note: This group is truly limited in terms of attendance to a maximum of 16, depending in part on the venue.
NOTE: This course is now given per request. Please contact Dr. Glassman DIRECTLY at DrBGlass@gmail.com to express interest.
Injection Course – Trigger Points, Ligament Insertions and Ganglions
Allentown, PA
FINALLY — the course that many have heard about but have not been able to experience is being offered in Allentown For a number of years, until logistics made it impossible to continue in our chosen facility there, this course was given in Costa Rica. Since then, many dentists who recognize the tremendous advantage of mastering ligament insertion injections, ganglion injections, and trigger point injections in the treatment of pain have been asking that this course be offered again. Note: This group is limited to ten dentists!
Injection therapy can play a major role in helping to resolve many of the painful orofacial conditions we treat. These injections can be divided into three categories:
- Trigger Point Injections
- Ligament Insertion Injections
- Ganglion Injections
The model taught in the Level 1 and 2 courses emphasizes both peripheral and central injuries. Peripheral injuries can lead to both peripheral and central sensitization, a major player in non site specific chronic pain conditions. Injections to reduce local injury, as well as reduce afferent nociceptive signaling, can be very effective in treating both acute and chronic pain. Dr. Glassman’s work has been instrumental in making ligament insertion and ganglion injection in the treatment of chronic orofacial pain and headache more well accepted internationally. The sphenopalatine injection technique, long taught in this course as crucial to the treatment of orofacial pain and headache, is only now receiving extensive attention in the literature. The ligament insertion injections, now recognized in the lit, are described exactly as they have been taught for years. Add a valuable tool to your armamentarium, a tool that will help you resolve much of the orofacial pain with which your patients present. Unlike other injection courses, the emphasis will NOT be on trigger point injections. Sure, we teach trigger point injections and review the trigger point referral patterns as taught by Travell. And we will teach the use of non-injection therapy for trigger point therapy as well. But the real emphasis is on ligament insertion and ganglion injections. The enthesis is the weak point of the musculoskeltal system, and resolving these injuries and breaking the cycle of pain in these patients is key to resolving chronic orofacial pain patterns. These injections can be given nearly painlessly and are extremely effective in treating cervicogenic headaches, migraine headaches, referred otalgia, and many orofacial pain syndromes. MOST INJECTION COURSES EMPHASIZE TRIGGER POINT INJECTIONS; ENTHESIS INJECTIONS ARE MORE EFFECTIVE. Although trigger point injections are indeed taught, we have learned that ligament insertion injections in the stylomandibular ligament, the temporal tendon, and the insertions at the infranucal and supranuchal lines are more critical and more effective in terms of predictable symptomatic improvements. LEARN THE BLUME INJECTION and its key role in headache therapy. In a recent study here at the Lehigh Valley Hospital Headache Center, the SPENOPALTINE INJECTION has been demonstrated to be extremely effective in migraine and chronic daily headache management. It can also play a major role in the treatment of atypical trigeminal neuralgia. The course is a Friday/Saturday course. On Friday we will review the injection concepts, pharmacology, and anatomy. Case presentations will be reviewed as the diagnosis, and indications for each injection will be discussed separately. Videos of each injection will aid in visualization. Saturday (or the second day) is the hands-on portion. The mechanics of preparing syringes will be reviewed in detail. Each injection will be demonstrated followed by hands-on injection therapy with your partner. You will leave with experience and be prepared to begin incorporating injection therapy immediately.
Course Objectives:
Review craniofacial pain diagnostic concepts and examination
Identify trigger points
Learn pathophysiology of ligament insertion injuries
Learn the role of the sphenopalatine, otic, and submandibular ganglions in chronic orofacial pain patterns and autonomic dysautonomia.
Develop office protocols for handling of injection materials (syringes and multi dose vials)
Develop injection techniques for relatively painless injections of trigger points, ligament insertions, and ganglion injection
Understand potential untoward responses and be prepared for appropriate action
Understand joint anatomy and indications and procedures for injection techniques
Review iontophoresis and its role in ligament insertion injuries
Understand the various medicaments used in injection therapy including Marcaine, Ropivacaine, Lidocaine, Prolotherapy, and the use of steroids.
Injections To Be Reviewed and Performed:
- Anterior, Middle, and Posterior Temporalis
- Trapezius Trigger Point
- SCM Trigger Point
- Masseter Trigger Point
- Masseter Insertion
- Temporal Tendon
- Stylomandibular Ligament
- Blume (Infranuchal line deep cervical)
- Trapezius Insertion
- Mastoid Process
- Spenopalatine Ganglion
- Otic ganglion
- Submandibular Ganglion
- Auriculotemporal
- Greater Occipital Nerve
- Lesser Occipital Nerve
To allow you to begin therapy immediately upon your return from the course, attendees are given start-up kits, as well as product lists with contacts for their purchases.