Shoulder Manipulation 

(with Anesthesia)

In the process Shoulder Manipulation under Anesthesia, the patient is brought into the operating room and given a general anesthetic by an anesthesiologist. With the patient asleep and with their muscles paralyzed, the shoulder is then taken through a “range of motion”. In the course of manipulating the shoulder to reach a nearly full range of motion, popping sounds can often be heard inside the joint, signifying a tearing of the adhesions. At the same time, it is possible to gradually stretch the muscles that are external to the shoulder joint.

When a patient wakes up from this procedure, their shoulder is often a bit more painful than it was before the procedure. A special effort is made to control shoulder pain after a manipulation under anesthesia with narcotic pain medications so that the patient is able to move their shoulder without fear of disabling pain. The most important part of this process actually comes after the manipulation, because physical therapy is used to insure that the improvements in motion are not lost by inactivity. Therefore, it is very important that patients who have had a manipulation under anesthesia have easy access to physical therapy and are motivated to complete their home exercise.

Preparation for Shoulder Manipulation

• Make sure you have received any equipment you will need when you get home from the hospital. This may include a shoulder sling, ice packs or coolers, or heating pads. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.
• Problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.
• You will probably be told not to eat or drink anything after midnight on the night before your surgery.
• You will be unable to drive, arrange for someone to help take you out of the hospital and drive you home when you are released.
• Wear a soft, comfortable shirt that will not irritate your skin when worn under a shoulder sling. 

Shoulder Manipulation procedure

Shoulder Manipulation is a relatively simple and brief procedure that is performed in a hospital or outpatient clinic. You usually are given a regional anesthesia, to numb your shoulder and neck area. This is administered with an injection in the side of your neck. You also are put under general anesthesia, and may be given a mild sedative to help you relax. While lying on your back, the physician takes your arm and moves it through its range of motion.  You usually are taken directly to the physical therapy area of the medical center to begin passive motion exercises

Recovery

Following the Shoulder Manipulation Procedure of your shoulder, and depending on the degree of pain you are experiencing, your physician may want you to focus on relieving your pain rather than increasing your range of motion. This involves rest, ice, medication, and in some cases, immobilization of your shoulder. You will be asked to refrain from using the affected shoulder as much as possible. You should avoid putting strain on your shoulder, raising your arm over your head, or lifting heavy objects. Physicians often prescribe a removable sling to immobilize your shoulder, but will want you to wear for as short a period of time as possible as motion is important during this time. Depending on the severity of your pain, your physician also may prescribe non-steroidal anti-inflammatory medications. Icing your shoulder for 20 to 30 minutes at a time, three or four times a day, also can help relieve pain and inflammation. Some patients are given corticosteroid injections to ease pain. The amount and frequency can vary and you will likely wear a sling for at least a few days. Rehabilitation, using the exercises you learned at the hospital, usually can begin immediately

Risks

Shoulder Manipulation (with Anesthesia) has been around since 1938 when it was brought to the United States from Great Britain.  Even back in the early days of Shoulder Manipulation (with Anesthesia), there was a high rate of success with minimal risk.