Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin.
BACKGROUND
Manipulation under joint anesthesia/analgesia (MUJA) is an approach to treatment for patients with chronic, recalcitrant spinal axis pain of synovial joint origin. MUJA is the synthesis of fluoroscopically and corticosteroid agents with targeted, manual mobilizations and/or manipulations of the injected joint(s).


CONCLUSIONS
MUJA should be viewed with guarded optimism because its success is based solely on anecdotal experience. Many physicians (specializing in targeted intraarticular "blocks" of spinal synovial joints) and chiropractors (specializing in manual mobilization and manipulation of spinal synovial joints) in the Tyler, Texas, area have treated more than 1000 patients over a 7-year period with the MUJA protocol. This protocol includes treatment of the atlanto-occipital and lateral atantoaxial joints of the upper cervical spine, the zygapophysial joints of the cervical spine from C2-3 to C6-7, the thoracic spine and the lumbar spine, and the pelvic sacroiliac joints.


CONCLUSIONS
The following patient types are suitable candidates for MUJA: patients with dominant spinal axis pain who have been unable to progress despite the passage of sufficient time (>2 months) and the delivery of prior treatments, including spinal manipulative therapy; patients with pain so severe that standard manipulative therapy cannot be delivered with technical success; and patients with complex problems in whom the diagnosis of synovial joint-mediated spinal pain must be established before the safe delivery of manipulative therapy.
Michaelsen
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MR
D000700:Analgesics / Q000008:administration & dosage; D000772:Anesthesia, Local / Q000379:methods*; D003131:Combined Modality Therapy; D006801:Humans; D007270:Injections, Intra-Articular; D020393:Manipulation, Spinal / Q000379:methods*; D010147:Pain Measurement; D010148:Intractable Pain / Q000209:etiology / Q000628:therapy*; D013131:Spine / Q000503:physiopathology; D013585:Synovitis / Q000150:complications / Q000534:rehabilitation*; D016896:Treatment Outcome
D000700:Analgesics