Manipulation under anesthesia (MUA) is a procedure for severe frozen shoulder (adhesive capsulitis), where the shoulder joint capsule has become tight and scarred. This tightness restricts movement and causes significant pain, failing to respond to conservative treatments like physical therapy. During the procedure, a physician gently forces the shoulder through its full range of motion while the patient is under general anesthesia, breaking up the adhesions and scar tissue. The immediate goal of MUA is to restore a near-normal passive range of motion in the joint. This intervention is demanding and requires serious commitment to rehabilitation, but it is an effective method for liberating a restricted shoulder.
The Immediate Aftermath
Waking up from the procedure, the shoulder will likely feel numb due to a local anesthetic nerve block administered during or immediately after the MUA. This numbness is temporary and can last anywhere from a few hours up to 24 hours. Once the nerve block wears off, a significant level of pain will return, though it will be different from the stiffness pain experienced before the procedure.
Pain management is crucial during this initial 24 to 48-hour period and involves prescription opioid pain medications, often combined with over-the-counter anti-inflammatories like ibuprofen. Applying ice packs for 15 to 20 minutes several times a day helps manage both pain and swelling. Patients are typically discharged the same day but must arrange for an adult to drive them home, as anesthesia and pain medications make driving unsafe. The use of a sling is often temporary, intended only for transport and comfort, and many protocols advise discontinuing its use once the nerve block has worn off to encourage movement.
Intensive Physical Therapy: The Key to Success
The success of shoulder manipulation hinges entirely on the intensity and immediacy of the physical therapy that follows. Therapy must begin almost immediately, often on the day of the procedure or the next day, to prevent the newly broken scar tissue from reforming. This initial phase is characterized by aggressive range-of-motion exercises performed multiple times a day, which are necessary for a successful outcome.
Therapy sessions may be scheduled daily for the first week or two to ensure maximum compliance and motion gain. The primary focus is on passive range of motion (PROM), where the therapist moves the patient’s arm to the limits of the new range achieved during the MUA. Patients are also taught active-assisted range of motion (AAROM) exercises, such as using a pulley or a cane to move the arm, which they must perform diligently at home several times a day. Early exercises include gravity-assisted movements like pendulum swings, which help maintain the mobility gained without stressing the joint excessively. The relationship with the therapist is important during this phase, as they guide the patient through painful stretches necessary to maintain the joint’s new freedom.
Expected Recovery Timeline and Functional Milestones
Recovery typically spans several months following the initial intensive mobilization phase. Patients may be cleared to resume driving approximately one week after the MUA, provided they are no longer taking narcotic pain medication and have regained sufficient control and movement. Light daily activities, such as dressing and personal hygiene, should be integrated quickly to encourage normal use of the arm.
Functional milestones continue to be met over the following weeks and months, with many patients returning to desk-based work within one week. Regaining full functional range of motion typically takes longer, often progressing over three to six months. While motion is restored immediately by the MUA, regaining strength takes longer and is the focus of later-stage rehabilitation, starting around four to eight weeks post-procedure. Full return to activities that require overhead use or heavy lifting may not occur until four to six months after the procedure.
Warning Signs and When to Contact Your Doctor
Patients should be vigilant for signs that may indicate a complication requiring immediate medical attention. Any of these symptoms warrant contacting the surgical team or seeking emergency care:
- A persistent fever, excessive redness, warmth, or drainage from any incision sites, which may indicate infection.
- Sudden onset of new or increasing numbness, tingling, or weakness in the hand or arm, suggesting a traction injury to the nerves.
- A sudden, sharp increase in pain.
- A rapid, dramatic loss of the range of motion gained during the MUA, which may indicate re-formation of scar tissue or a rare fracture of the upper arm bone.