title: MUJA: manipulation under joint anesthesia/analgesia: a treatment approach for recalcitrant low back pain of synovial joint origin.
abstract: OBJECTIVE
  These four cases show how application of manipulation under joint anesthesia/analgesia (MUJA) may benefit the patient with low back pain (LBP) of synovial joint origin when prior treatment options fail. We propose that MUJA should be considered as a treatment option for those with recalcitrant synovial joint-mediated LBP.
  
  
  METHODS
  We report four cases of patients with LBP successfully treated by this protocol. These four patients were neurologically normal and suffered from lumbar zygapophyseal joint and/or sacroiliac joint mediated pain diagnosed by fluoroscopically guided, contrast enhanced, intra-articular anesthetic injections. There were various radiographic findings.
  
  
  RESULTS
  All four individuals were treated with manipulation after facilitatory intra-articular anesthetic/corticosteroid injections into lumbar zygapophyseal and/or sacroiliac joints. Some also required physical therapy interventions to resolve their LBP.
  
  
  CONCLUSIONS
  Anecdotal success with MUJA is enticing; MUJA appears to be a viable alternative for those patients in whom traditional treatment options for LBP of synovial joint origin have failed. However, prospective, quality research is required before MUJA can be formally validated or not in the treatment of documented lumbar zygapophyseal joint and/or sacroiliac joint mediated LBP.
authors.affiliation: Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, USA.
authors.forename: P
authors.initials: P
authors.lastname: Dreyfuss
authors.forename: M
authors.initials: M
authors.lastname: Michaelsen
authors.forename: M
authors.initials: M
authors.lastname: Horne
mesh_terms: D000328:Adult; D000698:Analgesia; D000765:Anesthesia, Conduction; D002684:Chiropractic; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged