Abnormal Thought Patterns - Manipulation Under Anesthesia: The Ultimate Guide for Prog Metal Fans (3

Manipulation under anesthesia involves a controlled and forced, end range positioning of the humerus relative to the glenoid in physiologic planes of motion (flexion, abduction, rotation) in patients with an anesthetic block to the brachial plexus. The block allows the shoulder muscles to completely relax so that the force may actually reach the capsuloligamentous structures.[5]Traditionally, long lever arms were used, but now short lever arm techniques are utilized to minimize potential risks.[5][8] Although success rates are high, ranging from 75-100%,[5] manipulations are considered a last resort and are not indicated unless symptoms persist in spite of adequate conservative treatment for six months.[1][5][18][36] This is due to the numerous risks and complications such as: dislocation, glenoid, scapular, or humeral fracture, nerve palsy, rotator cuff tear, hemarthrosis, labral tears, and traction injuries of the brachial plexus or a peripheral nerve.[1][5][18][36] However, it has been shown that manipulations are the most reliable way to improve range of motion and reduce pain and disability in patients resistant to physical therapy[1][18] and these complications can be minimized with proper techniques and precautions. A good prognosis is often indicated if an audible and palpable release of the tissue occurs during the manipulation.[5]

Contraindications to manipulation under anesthesia include: history of fracture or dislocations, moderate bone loss, or an inability to follow through with post procedure care.[5] Although manipulation under anesthesia has been shown to be effective in improving function and motion in patients with frozen shoulder, more randomized controlled trials comparing this treatment to competing treatments before widespread use are needed.[8]

Abnormal Thought Patterns - Manipulation Under Anesthesia (2013) 320k

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An alternative to traditional MUA is translation mobilization under anesthesia, which has been identified in an attempt to avoid the complications associated with the traditional approach. This procedure involves the use of gliding techniques with static end range capsular stress with a short amplitude high velocity thrust, if needed, as opposed to the angular stretching forces in manipulation under anesthesia.[5][8]2 to 3 30 second sets of low velocity, oscillatory mobilizations (Maitland Grade IV-IV+) are performed initially in the same directions as traditional manipulation under anesthesia (anteriorly, posteriorly, and inferiorly). If an immediate increase in passive range of motion is not seen, a high velocity, low amplitude manipulation may be performed. This technique appears to be a safe and efficacious alternative for treatment of patients resistant to conservative treatment, however, higher level studies are needed for verification.[5]

According to a Cochrane review by Green et al,[29] there is little evidence to support or refute the use of any of the common interventions listed for Adhesive Capsulitis. There are also no studies with objective data supporting the timing of when to switch to invasive treatments such as manipulation under anesthesia or arthroscopic release, which are not usually performed until 6 months of conservative treatment have been unsuccessful. Unfortunately this exposes more than 40% of patients with Adhesive Capsulitis to a long period of disability and pain.[18]

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