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 fluoroseopically guided intraarticular injection(s) of anesthetic and corticosteriod agents with targeted, manual mobilizations and/or manipulations of the injected joint(s). Discussion: 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 synovialjoints) 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-oceipital and lateral atlantoaxial 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. Conclusion: 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. (J Manipulative Physiol Ther 2000;23:127–9)