Dr. Sheila Forte’ holds dual licenses in Chiropractic and Nursing, and specializes in Manipulation Under Anesthesia (MUA).

EVALUATING PATIENTS AS CANDIDATES FOR MUA
Manipulation Under Anesthesia is a procedure that is intended for patients who suffer from sometimes acute, but mostly chronic musculoskeletal disorders in conjunction with biomechanical aberrencies. These patients have also been unresponsive to previous conservative therapy often these patients are candidates for pain management such as Epidural and Facet injection, or have already had a series of these injections offering no improvement in their conditions. Etilogy of their pain can, as mentioned before, be anything from disc bulge to failed back surgery. The MUA procedure is extremely beneficial for the patient who has back, neck and shoulder spasms accompanied with pain and terminal joint range of motion loss. These patients respond well to manipulation, physiotherapy, exercise, but their relief may only be temporary. The reason there is only temporary relief or no significant improvement is due to the formation of adhesions, fibrotic scar tissue around the muscles, ligaments, tendons, and bones. Also, some patients may be supersensitive to awake manipulation, as well as, stretching and exercising the muscles and movement of the joints. To ensure superior results with MUA, one of the most important considerations is patient selection

CONDITIONS THAT RESPOND WELL TO MUA

CONDITIONS THAT ARE NOT CONSIDERED FOR MUA
Malignancy, Fractures, Bone Disease, Tumors, T.B., Osteoporosis

PRE-MUA PROCEDURES

In addition to the parameters of patient selection, appropriate pre-MUA procedures are required. Traditional Chiropractic and physiotherapy for a minimum of 4-6 weeks (2-4 in acute cases), plain film radiographs and advanced imaging study (MRI/CT). Neurologic and or Orthopedic evaluation in conjunction with EMG/NC/SSEP studies may be performed. This will provide cross disciplinary confirmation that the procedure would be considered appropriate. Just prior to the MUA procedure, a medical history and physical examination is to be performed to assure that the patient is capable of undergoing the MUA procedure with no additional medical complications. Included with this evaluation should be a CBC, chest X-ray, and EKG (if the patient is over 40, or if physical condition warrants it). Finally, an anesthesia interview is provided. This is to assure that the anesthesia will be appropriate for the patient, and to assess if there are any projected complications from the anesthesia that should be addressed.

MUA PROCEDURE

Manipulation Under Anesthesia is performed under a conscious sedation with the consideration of an anesthesiologist. The patient is then taken through passive cervical/thoracic/lumbar spine ranges in flexion, lateral and rotation. Specific spinal manipulation is performed when the elastic barrier of resistance and the segment end range of motion is achieved. Then stretching of the paraspinal and surrounding supportive musclature is performed to promote cervical, thoracic, lumbar and pelvic flexibility in conjunction with attempting to restore the proper kinetic chains in the upper and lower extremities. The patient is awakened from the anesthesia and taken to recovery and monitored. The patient is discharged approximately one hour later.

POST-MUA AND FOLLOW-UP CARE

Post-MUA care varies from operator to operator. In an effort to minimize the re-formation of adhesions, passive manipulation and active exercises are prescribed on a daily basis. Some use of electrical muscle stimulation, hot moist packs and massage may also be prescribed. Vitamin E is given daily to combat the reformation of adhesions and fibrosis. The most important post-operative care is spinal manipulation. The frequency is deternmined by the individual patient's condition, and is usually daily for the first week, decreasing thereafter. The patient should be scheduled and integrated into an active rehabilitation/work hardening program within one to two post MUA weeks for a minimum of 4-6 weeks. Spinal Manipulation should be continued on a weekly basis until the patient is released from rehabilitation. This will insure muscle strengthening occurs without loss of phyiological function of the involved segments.