Shoulder manipulation at Wessex Hospital

What is shoulder manipulation under anaesthetic?

Shoulder manipulation under anaesthetic (MUA) loosens a stiff, tight shoulder joint while you are asleep, so you can regain movement you have lost. Your surgeon firmly but carefully stretches your arm through its complete range, working the tight lining around the joint loose, sometimes alongside keyhole surgery to help free it up further from the inside.

What conditions does it treat?

This procedure is used for:

• frozen shoulder (adhesive capsulitis), where the joint lining becomes inflamed and tight, often without any obvious cause, and around 1 in 5 people go on to develop it in the other shoulder too
• ongoing stiffness after a significant shoulder injury or a previous operation, where scar tissue has tightened the joint lining and is restricting movement.

What are the benefits of shoulder manipulation?

For most people, this procedure brings a considerable improvement in how far the shoulder can move and a real reduction in pain, with around 85 to 90 in every 100 people satisfied with the outcome.

It can also mean avoiding a longer wait for stiffness to ease naturally, which for frozen shoulder can otherwise take 18 months to 2 years, or longer if you have diabetes.

Are there different types or surgical approaches?

Yes. Some people have manipulation alone, where the surgeon stretches the arm to release the tightness without any cuts being made. Others have this combined with keyhole surgery, known as an arthroscopic capsular release, where a small number of tiny incisions (sources describe anywhere from two to four, each around 5 to 10mm) allow a camera and fine instruments into the joint so the tight, scarred lining can be released from the inside under direct view.

A nerve block is sometimes used alongside either approach, numbing your arm for several hours after the procedure to help keep you comfortable as the anaesthetic wears off.

What happens before the operation?

Before this procedure, you will usually have:

• already tried other options, such as changing your activity, painkillers or anti-inflammatories, steroid injections, a stretching injection into the joint (hydrodilatation), or physiotherapy
• a chance to buy paracetamol and anti-inflammatory tablets to have ready at home
• an outpatient physiotherapy appointment arranged in advance, since physiotherapy needs to start very soon after your operation.

What happens during the procedure?

1. A general anaesthetic sends you to sleep for the whole procedure, sometimes paired with a nerve block that leaves the arm numb for several hours afterwards.
2. Your surgeon stabilises your shoulder blade, then firmly but carefully takes your arm through its full range of movement in stages, stretching and tearing the tight lining around the joint to release it.
3. If you are also having a capsular release, a small number of tiny cuts are made (typically two to four, each around 5 to 10mm) so a camera and fine instruments can release the tight lining from the inside.
4. Before you wake up, a slow-release local anaesthetic goes into the shoulder, often together with a steroid, to keep pain and swelling down.
5. A physiotherapist sees you as soon as possible afterwards, often in the recovery area, so you can see and begin using the movement you have gained.

What does recovery look like?

Nearly everyone goes home the same day. Your arm is supported in a sling to begin with, simply because it is still numb, and most people can manage without it after a day or two. Your shoulder is likely to be sore, especially over the first week and sometimes for up to six weeks, and if you had a capsular release, your dressings usually need to stay dry for five to seven days while the small wounds heal.

Physiotherapy starts straight away, often within a day or two, and continuing your exercises at home for several months is essential to keep the movement you have gained. It is common to lose a little of it again over the first three weeks despite doing everything right, before things improve over the following month.

Ice packs can ease the pain, though they are not suitable for everyone. Skip them if you are diabetic, have Raynaud's, or have any sign of infection, and avoid icing the left side specifically if your heart is affected.

Driving and desk-based work are usually possible within one to three weeks, manual or lifting work can take four to six weeks, and there is no set time to wait before returning to sport or leisure activities beyond how your shoulder feels. A follow-up appointment is arranged, timed anywhere from a few weeks to a few months afterwards depending on your hospital.

What are the risks and complications?

No procedure is entirely without risk, and this one is no different. Points worth knowing include:

• the shoulder failing to improve as much as hoped, in terms of pain or movement, in up to around 3 in 10 people
• a small risk of infection, mainly relevant if you also had keyhole surgery
• a small risk of complications from the general anaesthetic, such as feeling sick, or rarely something more serious
• a small risk of damage to nearby nerves or blood vessels
• a very small risk of fracturing the upper arm bone during the manipulation
• the shoulder stiffening up again over time, which is more likely if you have insulin-dependent diabetes, sometimes within just a few weeks.