CONSENT AGREEMENT BETWEEN - State Medical Board of Ohio ...

Matter of Kyle Elliott Hoogendoorn, D.P.M. Page 21
rhomboid muscles, and/or the intraspinous ligament, and/or greater trochanter,
and/or gluteal area, and/or zygapophyseal joint of Patients 1-5, 7-9, 11, 14, 17,
20-22. 6
(St. Ex. 54B)
Procedures Performed by Dr. Hoogendoorn – Trigger Point Injections
49. Dr. Chelimsky testified that a trigger point is a place on the body that, if pressed, triggers
pain that is felt in a different area than that being pressed. For example, a trigger point in
the shoulder, if pressed, can cause pain that travels into the elbow and finger.
Dr. Chelimsky testified that a trigger point injection is an injection of anesthetic, and
possibly a steroid or other anti-inflammatory agent, into a trigger point. Dr. Chelimsky
further testified that a physician needs to perform a physical examination to find trigger
points. The physician palpates areas that are likely to have trigger points, which includes
the shoulder areas, over the shoulder blades, along the mid-portion of the spine, and the hip
and buttock regions. The physician can distinguish between trigger points and tender
points by asking the patient if the pain travels. Further, Dr. Chelimsky testified that a
trigger point “will usually have a little bit of an indurated feel to it.” (Tr. at 1572-1574)
Dr. Chelimsky testified that trigger points are different from tender points. Tender points
are areas of localized pain that, if pressed, do not produce pain in other areas of the body.
Dr. Chelimsky believes that many of the procedures documented as trigger point injections
in the patient records were actually tender point injections. (Tr. at 1573, 1618-1619)
Testimony of Dr. Bressi
50. The testimony of Dr. Bressi concerning the issue of trigger points versus tender points was
largely consistent with that of Dr. Chelimsky. Dr. Bressi also testified that trigger points
are typically near the places where muscles insert onto bone. (Tr. at 2250-2251)
Dr. Bressi testified that tender points are more often felt in the belly of a muscle rather than
near an insertion point. Dr. Bressi noted that tender points are characteristic of
fibromyalgia, which is a syndrome that “is still very controversial in the medical field.”
Dr. Bressi stated that the techniques for performing trigger point and tender point injections
are essentially the same. (Tr. at 2318-2319, 2440-2441)
6 The notice letters issued to Dr. Leak, Dr. Griffin, and Dr. Hoogendoorn were based upon different patient keys.
Dr. Leak’s patient key named 24 patients, numbered 1 through 24; Dr. Griffin’s named 23 patients, numbered 1
through 23, and Dr. Hoogendoorn’s named 19 patients, numbered 1 through 19. Dr. Griffin’s patient key was a
subset of Dr. Leak’s, and Dr. Hoogendoorn’s patient key was a subset of Dr. Leak’s and Dr. Griffin’s. Prior to the
hearing, the Hearing Examiner ordered that Dr. Leak’s patient key be used as a master patient key, and that all
patients in the consolidated hearing be referenced using the patient number from the master patient key. In this
report, all patient references in the Summary of the Evidence refer to the master patient key. (See State’s Exhibit 26
and Board Exhibit I)