Definition & Overview

Stiffness of the joints in any part of the body could be quite painful and in some cases, debilitating. This condition can be brought about by muscle spasms, joint misalignment, inflammation, injury, or as a result of major surgery like total joint replacement.

Joint manipulation under anaesthesia is a procedure used to improve the movement of stiff joints in the body. Usually done under general anaesthesia, with the patient asleep and unable to feel any pain or discomfort, the joints are stretched and made to perform passive movements. However, there are also instances when local or regional anaesthesia is used to keep the patient awake though the joint being manipulated is kept numb. Anaesthesia is used to reduce spasm and reflex muscle guarding, as well as prevent patient’s anxiety and discomfort. The choice of anaesthesia to use usually depends on the type and severity of the condition.

Manipulation under anaesthetic is typically considered when patients no longer benefit from other rehabilitative efforts to relieve joint pain and stiffness. This procedure can help restore close-to-normal range of motion for affected joints and provide patients with longer lasting pain relief. It is also considered safe with low risk for infection since it is noninvasive.

Who Should Undergo and Expected Results

Joint manipulation under anaesthesia is recommended for:

  • Patients suffering from chronic pain and stiffness of the neck, back, elbow, knees, shoulders, and pelvis
  • Patients who underwent total joint replacement and unable to move the affected limb postoperatively without a great deal of pain
  • Patients diagnosed with acute muscle spasms and fibromyalgia
  • Patients suffering from persistent pain due to pinched or entrapped nerves
  • Patients experiencing failed back surgery syndrome and chronic disc conditions
  • Patients with carpal tunnel syndrome, curvature of the spine, joint capsulation, and gait abnormality

However, not all conditions leading to joint stiffness and pain can be addressed by manipulation under anaesthesia. Those with acute inflammatory arthritis and gout, severe osteoporosis, and older patients whose bones are too frail and brittle are discouraged from undergoing this procedure.

The procedure is known for producing generally positive outcomes with patients gaining back mobility of the affected joint and experiencing significant long-term pain reduction. Depending on the severity of the condition, patients may need to undergo several sessions to achieve optimal results. They are also advised to undergo physical therapy for several weeks following the procedure to prevent the regrowth of fibrous scar tissue that was broken down during manipulation. Stretching and flexibility exercises are also recommended to regain strength and maintain easy movements.

How is the Procedure Performed?

This procedure is performed in a hospital setting with the attendance of an anaesthesiologist whose tasks include monitoring the patient's vital signs during the procedure to avoid possible complications. Once the anaesthesia is applied, the doctor will employ one or more manipulation techniques, varying from one patient to another. To decrease muscle spasms, procedures that involve the soft tissues, such as lateral and line stretching and separation of muscle origin and insertion are performed on the affected joint. The doctor could also use articulatory procedures such as putting the affected joint through full range of motion to gradually move the restrictive barrier and resume normal elasticity and feel. Specific joint mobilization techniques also aim to increase the range of motion as well as decrease muscle tension and stretch fibrous connective tissue that may have shortened due to an injury or disease.

The procedure usually takes about 15 to 20 minutes and the patient is typically discharged after a short monitoring period.

Possible Risks and Complications

Joint manipulation under anaesthetic is linked to the following risks and complications:

  • Adverse reactions to the anaesthetic used
  • Extensive pain immediately following the procedure, which is often addressed by the administration of painkillers
  • Swelling and soreness of the affected joint, which may last for a few weeks
  • Cortisone flare, if cortisone is administered to reduce inflammation
  • Soft tissue damage
  • Injury to the ligament or tendon
  • Broken or fractured bone
  • Injury to the muscle due to inappropriate or excessive application of force

References:

  • Keating JC Jr (2003). "Several pathways in the evolution of chiropractic manipulation". J Manipulative Physiol Ther26 (5): 300–21.

  • Eder M, Tilscher H. Chiropractic therapy: diagnosis and treatment (English translation). Rockville, Md: Aspen Publishers,

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