Manipulation under anesthesia
Encyclopedia
Manipulation Under Anesthesia (MUA) is multidisciplinary 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 monitorized anesthesia care (MAC)
This procedure is used by specially trained chiropractors and orthopedic surgeons as a means of breaking up scar tissue
around a joint without complete range of motion
. In cases of post operative total knee replacement
, for example, if a patient is having difficulty achieving their flexibility after a 6-8 week period, the surgeon 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 orthopedic musculoskeletal limitations, as indicated. Knee manipulation under anesthesia (MUA) is indicated for total knee arthroplasty (TKA) patients who have not obtained at least 90º of flexion by the 6th postoperative week.
and organizations and malpractice carriers to recognize appropriate training programs. Towards that end, specific criteria have been adopted to establish credible certification course offerings. Standards and protocol establishing credible certification training programs are recognized by the National MUA Academy of Physicians and the International Academy of MUA Physicians and are subscribed to by the accredited academic institutions offering post graduate certification in Manipulation Under Anesthesia.
In addition, for over 30 years now, the collection of MUA procedures (including hip, pelvis, spine, and back among other body regions), has been listed as a Category I CPT code in the AMA Codebook of Reimbursable Procedures.. The introduction of that book notes that in order to qualify as a Category I code, "the clinical efficacy of the service/procedure is well established and documented in the United States per review literature." This was later reaffirmed by the AMA, where they noted that simply by having a Category I code, a procedure, by definition is not experimental and has a well established clinical efficacy.
and due to the type of nonspecific manipulation procedures used. It was modified and revived in the 1990s, primarily by chiropractor
s, and also by osteopaths; this was likely due to safer anesthesia used for conscious sedation
, along with increased interest in SM.
Manual therapy
Manual therapy, manipulative therapy, or manual & manipulative therapy is a physical treatment primarily used by physiotherapists, chiropractors, osteopaths to treat musculoskeletal pain and disability; it most commonly includes massage therapy, joint mobilization and joint...
treatment system which is used to improve articular and soft tissue
Soft tissue
In anatomy, the term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes , and muscles, nerves and blood vessels .It is sometimes...
movement using specifically controlled release, myofascial manipulation, and mobilization techniques while the patient is under moderate to deep IV sedation using monitorized anesthesia care (MAC)
This procedure is used by specially trained chiropractors and orthopedic surgeons as a means of breaking up scar tissue
Scar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...
around a joint without complete range of motion
Range of motion
Range of motion , is the distance that a movable object may normally travel while properly attached to another object. It is also called range of travel, particularly when talking about mechanical devices and in mechanical engineering fields...
. In cases of post operative total knee replacement
Knee replacement
Knee replacement, or knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis...
, for example, if a patient is having difficulty achieving their flexibility after a 6-8 week period, the surgeon may elect to bring the patient back to the operating room
Operating theatre
An operating theater was a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery...
, 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 orthopedic musculoskeletal limitations, as indicated. Knee manipulation under anesthesia (MUA) is indicated for total knee arthroplasty (TKA) patients who have not obtained at least 90º of flexion by the 6th postoperative week.
Training
Currently MUA certification courses offered through accredited chiropractic college post graduate departments are recognized by malpractice carriers for inclusive coverage. It has been important to regulatory agencies, academic institutions, professional associationsProfessional body
A professional association is usually a nonprofit organization seeking to further a particular profession, the interests of individuals engaged in that profession, and the public interest.The roles of these professional associations have been variously defined: "A group of people in a...
and organizations and malpractice carriers to recognize appropriate training programs. Towards that end, specific criteria have been adopted to establish credible certification course offerings. Standards and protocol establishing credible certification training programs are recognized by the National MUA Academy of Physicians and the International Academy of MUA Physicians and are subscribed to by the accredited academic institutions offering post graduate certification in Manipulation Under Anesthesia.
Evidence basis
- “In a first study by Siehl ad Bradford published in 1952, 33 percent of the patients … demonstrated good (symptom-free) results.” Page 294
- “Siehl’s followup study … 96 percent reported successful (good or fair) outcomes.”
- “In Chrisman’s study 83 percent of the subjects reported good or excellent result after a 3-year follow-up.” Page 294
- “In Morey’s 1973 review … treating physician reported excellent or good results in 85 percent of the cases.” Page 294
- “In a study published in 1986 by Krumhansel and Nowacek … outcomes were reported as 25 percent ‘cured’, 50 percent ‘much improved’, and 20 percent ‘better, but’. Page 294
- “In a 1990 article by Mennell … 30 percent with symptoms cured, 35 percent with marked improvement, 29 percent with moderate improvement…” Page 294
- “In a recent case series by West et al … VAS scores improved 4.6 points for cervical pain and 4.31 points for lumbar pain. Decrease in time off work and less use of prescription pain medicationAnalgesicAn analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
were also reported.” Page 294 - “We have been unable to find any report of complications using more modern osteopathic and chiropractic techniques or as a result of the use of anesthesia.” Page 297
In addition, for over 30 years now, the collection of MUA procedures (including hip, pelvis, spine, and back among other body regions), has been listed as a Category I CPT code in the AMA Codebook of Reimbursable Procedures.. The introduction of that book notes that in order to qualify as a Category I code, "the clinical efficacy of the service/procedure is well established and documented in the United States per review literature." This was later reaffirmed by the AMA, where they noted that simply by having a Category I code, a procedure, by definition is not experimental and has a well established clinical efficacy.
History
MAM has been used since then 1930s, and MUA was practiced by osteopaths and orthopedic surgeons in the 1940s and 1950s. It was largely abandoned due to complications from general anesthesiaGeneral anaesthesia
General anaesthesia is a state of unconsciousness and loss of protective reflexes resulting from the administration of one or more general anaesthetic agents...
and due to the type of nonspecific manipulation procedures used. It was modified and revived in the 1990s, primarily by chiropractor
Chiropractor
A Chiropractor, according to the Association of Chiropractic Colleges , "focuses on the relationship between the body's main structures – the skeleton, the muscles and the nerves – and the patient's health. Chiropractors believe that health can be improved and preserved by making adjustments to...
s, and also by osteopaths; this was likely due to safer anesthesia used for conscious sedation
Sedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure...
, along with increased interest in SM.
External links
- Manipulation Under Anesthesia: A Report of Four Cases. Cremata, et al. J Manipulative Physiol Ther. 2005 Sep;28(7):526-33