Rheumatology Book

Intra-Articular Disorders

Myofascial Pain

http://www.fpnotebook.com/

Spray and StretchAka: Stretch and Spray, Fluori-Methane, Vapocoolant Spray

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  1. Indications
    1. Myofascial Pain Syndrome
  2. Mechanism
    1. Anesthetic spray distracts patient
    2. Clinician passively stretches Trigger Point muscle
  3. Equipment: Vapocoolant Spray
    1. Fluori-Methane Spray (by Gebauer Co. in Cleveland)
    2. Contents of Vapocoolant Spray
      1. Dichlorodifluoromethane 15%
      2. Trichloromonofluoromethane 85%
    3. Spray kept at 10 to 12 degrees celsius
  4. Technique
    1. Patient positioned comfortably
    2. Fluori-Methane sprayed over involved muscle
      1. Direct spray at 30 to 60 degree angle
        1. Sweep spray parallel to muscle fibers
        2. Sweep spray toward Trigger Point
      2. Spray 2-3 times, each covering 10 cm/sec
    3. Muscle involving Trigger Point is stretched
    4. After Stretch and Spray
      1. Apply moist heat to involved muscle for 10-20 min
      2. Full active range of motion of involved muscle
    5. Repeat up to daily for 1-2 weeks
    6. Suspend treatments for 2-3 days if soreness develops
  5. Precautions
    1. Hyperirritable Trigger Points may be exacerbated
    2. Fluori-Methane is potential biohazard for ozone loss
      1. Safer alternative than ethyl chloride (explosive)
  6. References
    1. Sola in Roberts (1998) Procedures, Saunders, p. 890-901
    2. Alvarez (2002) Am Fam Physician 65(4):653
    3. Fomby (1997) Phys Sportsmed 25(2):67

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