Candidates for manipulation under anesthesia (MUA) are selected after undergoing a detailed exam that includes an adequate history, thorough physical, and the appropriate diagnostic imaging and laboratory procedures necessary for an accurate diagnosis of the underlying condition.
Patient History and Physical Exam for Manipulation
The burden of proof for medical necessity rests with the treating doctor of chiropractic or other medical professional. In order for manipulation under anesthesia to be applicable to the patient, the following should be substantially documented in the patient’s history and physical exam, with specific emphasis on:
- The failure to respond to conservative (nonsurgical) means in the history
- Indication of fibrosis and/or myofibrosis in the physical examination
- Any supportive diagnostic testing as indicated and warranted by medical necessity of the patient’s condition.
A complete chiropractic exam is performed, paying special attention to motion palpation of the spine and a visual inspection and palpation of the skin (manifestation of sympathetic nervous system changes including edema, tissue texture, increase or decrease of moisture, temperature changes, etc).
Additionally, digital palpation identifies increased or decreased changes in muscle and fascia tone that lead to altered biomechanics.
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Laboratory Exam for Manipulation under Anesthesia
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Laboratory examinations should be performed to further evaluate the patient's health. These exams for manipulation under anesthesia not only contribute to differential diagnosis but help the medical staff assess patient health prior to going under anesthesia.
Females of child bearing years should be evaluated for pregnancy. A male past 40 years of age should also have the following test done: serum alkaline and acid phosphatase. After completion of the preliminary work, other laboratory procedures may be indicated.
Radiographic Exam for Manipulation under Anesthesia
Anterior-posterior (front/back) and lateral (side) radiographs of the involved joints should be taken. Additionally, extension and lateral bending views may be of benefit in visualizing loss of function.
Many times one may want a detailed view of the joints that are to be manipulated under anesthesia. Motion studies on fluoroscopy may also be helpful.
Studies should be repeated after serial manipulation under anesthesia to see what changes have been affected by the procedure. When warranted, a CT scan and/or MRI scan of the spine should be employed to rule out or confirm suspected pathology.
Electrodiagnostic Tests before Manipulation
Electrodiagnostic studies of the appropriate spinal outflows should be performed to rule out specific neurological dysfunction. These tests confirm or differentiate diagnosis of neuropathy, radiculopathy or plexopathy. They show the presence or lack of nerve compression and localize and assess the degree of injury along the course of a nerve.
Ultrasound Studies and Manipulation under Anesthesia
Musculoskeletal diagnostic ultrasound is a test used to visualize soft tissue structures and identify signs of inflammation and scar tissue (adhesions) around joints, nerve roots, tendons, ligaments and muscle. This test is important because it confirms the presence of adhesions and the medical need for manipulation under anesthesia.
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