Manipulation Under Anaesthetic (MUA)
A Manipulation Under Anaesthetic (MUA) involves the patient being given a short general anaesthetic and the shoulder then being manipulated into certain positions to tear the thickened scar tissue of the capsule (shoulder joint lining) which is causing the stiffness. One advantage of this technique is that there are no risks of infection as no instruments are inserted into the shoulder joint to perform the surgery. However, the risks of an MUA include fracture of the bones in the shoulder which may break instead of the thickened stiff scar tissue tearing. Also, with an MUA there is a risk that normal structures within the shoulder such as the ligaments or tendons may also be torn instead of the thickened stiff scar tissue. Many studies have shown good results in terms of improvement of a patient's pain and range of movement despite this. However, because of these risks, I only recommend an MUA in the early stages of development of a frozen shoulder (within 4 months of onset) before the scar tissue in the capsule has become too mature and thickened which means that less force is needed to tear the capsule.

A Manipulation Under Anaesthetic is usually performed in the theatre anaesthetic room under heavy sedation/light general anaesthetic as a daycase procedure (the patient can go home the same day as the procedure). A combination of steroid and local anaesthetic is injected into the shoulder joint at the end of the manipulation.

Patients are encouraged to move the shoulder as much as possible and as soon as possible after the manipulation in combination with supervised physiotherapy. This is very important to prevent the shoulder stiffening up again and preserve the increased range of movement gained by performing the manipulation.

Patient's can return to driving and everyday activities as soon as they feel able, usually within 7-10 days although more manual work and strenuous activities should be avoided for at least 4 weeks.
 
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