Quadriparesis after intramuscular trigger point
injections for
myofascial pain syndrome has been rarely reported in the literature. A 37-year-old male patient presented with
myofascial pain syndrome and was given trigger point
injections in trapezius muscles under ultrasound guidance. The patient noticed weakness in all the 4 limbs at approximately 12 hours after the procedure, which gradually progressed to functional
quadriplegia at the time of presentation to the emergency department. On examination, he had
quadriparesis with no sensory involvement and superficial reflexes were normal. MRI screening of the whole spine was unremarkable, and MRI brain suggested an incidental
granuloma, which could not explain his symptoms. Blood tests revealed severe
hypokalemia (2.2 mEq/L) and deranged thyroid function tests. Immediate
potassium correction with intravenous and oral
potassium chloride was initiated, and the patient showed improvement within 6 hours of initiating correction. Stress of the procedure, use of
steroids with
mineralocorticoid effects such as
methylprednisolone, or deranged thyroid function tests may have acted as triggers to precipitate hypokalemic
paralysis in the patient. Knowledge of this complication is essential as prompt diagnosis and timely management of
hypokalemia can result in complete resolution of the symptoms.