Manipulation Under Anesthesia

Is a multidisciplinary and manual therapy treatment system, which is used to improve articular and soft tissue movement using specifically controlled release, myofascial manipulation, and mobilization techniques while the patient is under moderate to deep IV sedation using monitored anesthesia care (MAC).

This procedure is used by specially trained chiropractors as a means of breaking up scar-tissue around a joint without complete ROM (range of motion).

In cases of post-operative total knee replacement, for example, if a patient is having difficulty regaining their flexibility after a 6-8 week period, the practitioner may elect to bring the patient back to the operating room, place them under anesthesia and perform a manipulation under anesthesia. The procedure takes a relatively short period of time (15- 20 min) and the surgeon can gain improved range of motion for the patient. This can also be performed for other musculoskeletal limitations, as indicated. Knee manipulation under anesthesia (MUA) is indicated for total knee arthroplasty (TKA) patients who have not obtained at least 90° of flexion by the 6th postoperative week.

Conditions Treated by Manipulation Under Anesthesia:

  • Failure to respond to conservative chiropractic or manual therapy care in the office setting after a minimum of six to eight weeks of continuous conservative care.
  • Chronic or recurrent pain.
  • Pain so severe that narcotic analgesic is of little benefit.
  • Chronic peripheral, muscular, fibrotic adhesion formation (adhesions and scar tissues will begin to develop 6-12 hours after an initial injury) Myositis.
  • Chronic Fibrositis – peripheral, can be muscular or articular: related to fibrotic adhesion buildup over short or long periods of time (i.e.- facet joint encapsulation or encapsulitis with associated restriction of motion).
  • Nerve Entrapment – peripheral (i.e. – facet syndrome or inflammation or disc pathology).
  • Disc Pathology – Disc protrusions, bulging discs, protrusions (spontaneous or from traumatic origin) documented by CT, MRI or Myelography.
  • Traumatically induced restriction of range of motion (i.e. torticollis).
  • Lumbarization associated with acute/chronic pain – peripheral in nature, causing muscle splinting, fibrotic adhesions, and/or chronic spasm.
  • Sacralization associated with acute/chronic pain – peripheral causing chronic muscle splinting contracture, spasm fibrotic adhesion formation (relating to degenerative changes).
  • Chronic disc changes – associated with fibrotic adhesions due to degenerative changes.
  • Traumatic torticollis – peripheral in nature, causing severe muscle splinting and/or contracture, vertebral subluxation due to trauma (intractable pain from hyperflexion/hyperextension injury).
  • Failed spinal surgery.
  • Headaches – non-organic origin.
  • Post-surgical fibrosis

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