Manipulation Under Anesthesia

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ISBN: 9780849317002 | 0849317002
Cover: Hardcover
Copyright: 4/21/2005

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Spinal manipulation under anesthesia (MUA) is a procedure intended for patients who suffer from musculoskeletal disorders in conjunction with biomechanical dysfunction. MUA is performed using monitored anesthesia care. Manipulation Under Anesthesia is the first book to present the procedure from a historical perspective to present day use. It is a compilation of information that is used as both a reference and as an educational aid for doctors. It contains information on the history, scientific use, and logistics for use in hospitals. It discusses justification for the procedure from both a clinical and patient management standpoint. Also included are an anesthesiology chapter and patient selection criteria.

PART I

An Historical Perspective on Manipulation Under Anesthesia

(6)

Robert S. Francis

Introduction

(1)

Manipulation Under Anesthesia: Historical Considerations

(4)

References

(2)

The Scientific Basis of Manipulation Under Anesthesia

(32)

Robert C. Gordon

Robert S. Francis

Anthony B. Morovati

Basic Spinal Anatomy in Relation to MUA

(3)

Robert C. Gordon

Functions of the Motion Unit

(2)

The Facet Articulation as It Pertains to MUA

(1)

References

(1)

Manipulation Under Anesthesia: Pathomechanics

(10)

Robert S. Francis

The Source of Back Pain

(1)

Articular Neurology

(2)

Proprioceptive Neurofacilitation

(1)

Pressure Hierarchy of the Intervertebral Foramen (IVF)

(1)

The Intervertebral Disc

(2)

Cavitation

(1)

References

(1)

The Myofascial Component and Predetermining Factors to Consider in MUA

(16)

Anthony B. Morovati

Background and Principles

(1)

Clinical Characteristics of Trigger Points

(1)

Common Causes of Myofascial Trigger Points (i.e., Perpetuating Factors): Mechanical Stressors

(1)

Structural Inadequacies

(1)

Postural Stressors

(1)

Other Mechanical Stresses

(1)

Common Causes of Myofascial Trigger Points (i.e., Perpetuating Factors): Continued Genetics

(1)

Common Causes of Myofascial Trigger Points (i.e., Perpetuating Factors): Nutritional/Chemical Inadequacies

(1)

Deficiency

(1)

Dependence

(1)

Insufficiency

(1)

Prevalence of Unrecognized Hypovitaminosis

(7)

Therapeutic Approach to Nutritional Deficiencies

(1)

Metabolic and Endocrinological

(1)

Hypoglycemia

(1)

Gouty Diathesis

(1)

Nerve Impingement

(1)

References

(2)

Mechanisms of Spinal Pain and Pain Modulation

(18)

James Giordano

Thomas Schultea

Introduction

(13)

Mechanisms of Spinal Pain

(1)

Structural Considerations

(2)

Receptors and Primary Afferent Typology

(1)

Primary Nociceptive Afferents

(2)

Neurochemistry of Spinal Pain Transmission

(2)

Ascending Pain Pathways: Anterolateral System

(1)

Mechanisms of Endogenous Pain Modulation

(2)

Spinal Mechanisms

(2)

Ascending Pain Pathways: Posterior System

(1)

Hormonal Mechanisms

(1)

Acknowledgment

(1)

References

(5)

The Core of the MUA Procedure: Tissue Injury Repair Sequence and Fibrous Release with Manipulation

(12)

Robert C. Gordon

How Fibrotic Adhesions Form

(1)

Muscle Physiology and the Fibrosus Release Procedure as It Pertains to MUA

(2)

Hypothesis for Neurological Conduction of Action Potential and Muscle Contraction During and Following the MUA Procedure

(3)

Traction Stretching with MUA

(1)

Stress--Strain Curve

(3)

References

(3)

Manipulative Energy

(26)

Timothy S. Kersch

Low- vs. High-Force MUA

(1)

The Doctor System

(1)

The Patient System

(5)

Patient System Graph

(2)

Restoring Forces

(1)

Damping Forces

(2)

A ``Dynamic Impression''

(12)

High-Force Manipulation

(1)

Manipulation Timeline

(2)

The Successful High-Force Manipulation

(1)

Muscle Guarding Ineffectual

(1)

Low-Force Manipulation

(5)

High Force vs. Low Force

(1)

Dose-Response

(1)

Safety

(1)

The MUA Procedure

(2)

From Art to Science

(2)

References

(3)

Indications and Contraindications for MUA

(8)

Robert C. Gordon

Indications

(5)

Cervical Spine

(1)

Thoracic Spine

100

(1)

Lumbar Spine

100

(1)

Nerve Entrapment

101

(1)

Diagnosis

101

(1)

Acute Gouty Arthritis

101

(1)

Differential Diagnosis

102

(1)

Disc Protrusion (as Indicated on MRI)

102

(1)

Differential Diagnosis

103

(1)

References

103

(2)

MUA Principles and Practices

105

(8)

Robert C. Gordon

MUA Principles and Practice

106

(5)

Standards and Protocols

106

(1)

Clinical Justification

106

(1)

Diagnosis

107

(1)

Frequency and Follow-Up

107

(3)

Safety

110

(1)

Role of the Medical Specialist in MUA

111

(1)

References

111

(2)

Support for MUA: Evidence-Based Research and Literature Review

113

(10)

Robert C. Gordon

Protocols for Determining Patient Progress Prior to and Following the MUA Procedure

117

(2)

Subjective Change

117

(1)

Objective Change

117

(1)

Hypothesis for Parameters in Determining Number of MUAs Required for Completion of Desired Therapeutic Result

117

(1)

Parameters for Selection of the Number of MUAs

117

(2)

Introduction of MUA to Patient

119

(1)

Obtaining Patient Acceptance for MUA

120

(1)

Developing a Rapport for Authorization

120

(1)

References

121

(2)

Evaluation of the MUA Patient

123

(14)

Robert C. Gordon

The Importance of the History and Physical

123

(1)

Examination and Testing Strategy

124

(1)

Responsibilities for the Certified MUA Practitioner in Recording a Complete Patient Chart

124

(7)

History

125

(1)

The Physical Examination

126

(1)

Radiographic Concerns with MUA

127

(1)

Radiological Nomenclature and Classification of Lumbar Disc Pathology

128

(1)

Clarification of Nomenclature

128

(2)

Diagnostic Impression

130

(1)

Guideline for Creating an H&P

131

(4)

Samples of History and Physical

132

(1)

Case 1

132

(1)

Case 2

133

(2)

References

135

(2)

Anesthesia

137

(14)

Anthony Rogers

Robert C. Gordon

Introduction

137

(2)

Robert C. Gordon

Scientific Validity for MUA

139

(1)

Why Should We Use MUA?

139

(1)

What Makes MUA the Procedure of Choice over Other Treatments?

139

(1)

What Makes MUA Different from Conservative Therapy?

139

(1)

Anesthesia Component in MUA

139

(4)

Anthony Rogers

Inhalational Anesthetics

140

(1)

Regional Anesthesia

140

(1)

Monitored Anesthesia Care

141

(1)

Conscious Sedation

142

(1)

Pharmacology of Commonly Used Sedating Agents

142

(1)

Choice of Anesthesia (From a Nonanesthesiologist's Perspective)

143

(2)

Robert C. Gordon

Guidelines for the Use of Monitored Anesthesia Care (For the Nonanesthesiologist)

145

(1)

Anthony Rogers

Emergency Life Support

146

(1)

Anthony Rogers

Manipulation Under Joint Anesthesia/Analgesia (MUJA)

147

(2)

Robert C. Gordon

References

149

(2)

Preanesthesia Evaluation

151

(10)

Ramona Carter

Introduction

151

(1)

Levels of Anesthesia

151

(2)

Timing of Evaluation

153

(1)

Reasons for Screening

153

(1)

Medical Evaluation

153

(1)

Prior Anesthesia History

154

(1)

Physical Exam

155

(1)

ASA Classification

156

(1)

ASA Physical Status Classification

156

(1)

Diagnostic Testing

156

(2)

Hemoglobin/Hematocrit

157

(1)

Platelets

157

(1)

Coagulation Studies, PT/PTT/INR

157

(1)

Blood Urea Nitrogen (BUN)/Creatinine (Cr)

157

(1)

Liver Function Tests (LFTs)

157

(1)

Chest X-Ray (CXR)

158

(1)

Electrocardiogram (EKG) in Noncardiac Surgery Assessment

158

(1)

Summary

158

(1)

References

159

(2)

MUA Procedure Protocol

161

(50)

Robert C. Gordon

Traction Stretching with MUA

161

(1)

Stress-Strain Curve

162

(2)

MUA Techniques

164

(1)

Responsibilities of the First Assistant

164

(1)

The MUA Procedure

164

(44)

The Cervical Spine

165

(9)

The Thoracic Spine

174

(4)

The Lumbar Spine

178

(30)

Patient's Information/Instructions Following Anesthesia

208

(1)

References

209

(2)

Post-MUA Physical Therapy and Rehabilitation Guidelines

211

(18)

Fred E. Russo

PART II

Hospital Staff Privileges and Ambulatory Surgical Center Protocols (For the Chiropractic Physician)

229

(40)

Robert C. Gordon

Developing Chiropractic--Hospital Relationships

232

(1)

Initial Contacts

232

(1)

Chief of Anesthesiology

232

(1)

Hospital Administrator

232

(1)

Physical Medicine Relationship

232

(1)

Podiatrist

233

(1)

Orthopedist

233

(1)

Neurologist

233

(1)

Internist/General Practitioner

233

(1)

Interhospital Politics

233

(1)

Interrelating with Hospital Employees, Administration, Staff, and Other Professionals

234

(1)

Executive Board of Directors

234

(2)

Sample Cover Letter Presenting MUA Technique to a Hospital

235

(1)

Samples of Chiropractic Department Bylaws from Different Hospitals

236

(1)

Delineation of Privileges for the Chiropractic Services Program: Manipulation Under Anesthesia Specific

237

(1)

Bylaws for Chiropractic Departments in Ambulatory Surgical Centers and Hospitals

238

(1)

Medical Staff

238

(5)

Division of Medical Staff

238

(2)

Clinical Department

240

(1)

Membership Qualifications

240

(3)

Hospital Department of Chiropractic --- Rules and Regulations

243

(3)

Preamble

243

(1)

Purpose

243

(1)

Membership

244

(1)

Qualifications

244

(1)

Ethics and Ethical Relationships

244

(1)

Terms of Appointments

244

(1)

Procedure of Appointment

244

(1)

Department

245

(1)

Officers and Committees

245

(1)

Officers

245

(1)

Sponsorship

245

(1)

Meetings

246

(1)

Regular Meetings

246

(1)

Special Meetings

246

(1)

Attendance at Meetings

246

(1)

Quorum

246

(1)

Agenda

246

(1)

Application for Chiropractic Staff Privileges (Hospital or Ambulatory Surgical Center)

246

(1)

The Scientific Basis of Chiropractic as Pertaining to Chiropractic Philosophy for the Chiropractic Physician

247

(2)

Department of Chiropractic Services

249

(2)

Preamble

249

(1)

Objectives of the Department of Chiropractic Services

249

(1)

Chiropractic Protocol and Procedures

250

(1)

Normal Office Patient Procedures

250

(1)

Procedures Required for MUA

250

(1)

Sample Bylaws for a Hospital-Based Chiropractic Department

251

(2)

Article I

251

(1)

DCS Membership Specifications

251

(1)

Membership

251

(1)

Qualifications

251

(1)

Application for Membership

251

(1)

Appointment to the Department of Chiropractic Services

251

(1)

Appeals

252

(1)

Department of Chiropractic Services Governing Body

252

(1)

Chief of Chiropractic Services

252

(1)

Board of Chiropractic of the Department of Chiropractic Services

252

(1)

Responsibilities of Board Members of the Department of Chiropractic Services

252

(1)

Credentials Committee

253

(1)

Responsibilities of the Chiropractic Practitioner in the Hospital or Outpatient Surgical Center

253

(1)

Medical Chart Sequence

254

(9)

Consents

254

(1)

Medical Records/Hospital Record Keeping

254

(1)

Medical Records Department Signature Identification Record

255

(1)

Responsibilities for the Chiropractic Practitioner in Recordng a Complete Patient Chart

255

(1)

History

255

(1)

Report of MUA (Operation Report)

256

(1)

Dictating an Operative Report

256

(1)

Operative Report (Sample)

257

(1)

Informed Consent

258

(1)

Indication

258

(1)

Comments

258

(1)

The Procedure in Detail

258

(3)

Patient Instructions

261

(1)

Prognosis

261

(1)

Authorization to Admit Observers

262

(1)

Facility Charting

262

(1)

Patient Information

262

(1)

Legal Guide for Physicians

263

(1)

Hospital/Outpatient MUA Program

263

(1)

Hospital Admissions

263

(1)

Professional Protocol for the Operative Area and Recovery Area in a Hospital or Ambulatory Surgical Center

264

(1)

Consideration for MUA Patient Transport

265

(1)

Daily Progress Notes

266

(1)

The Discharge Summary for the MUA Procedure

266

(2)

Sample Discharge Summary

267

(1)

Postoperative DX

267

(1)

Indication

267

(1)

Rationale for Procedure

267

(1)

Procedure/Post-Procedure Course

268

(1)

Results Accomplished

268

(1)

Patient Instructions

268

(1)

Prognosis

268

(1)

References

268

(1)

Risk/Benefit Ratio of Manipulation Under Anesthesia

269

(4)

Robert C. Gordon

A Case for MUA

273

(12)

Robert C. Gordon

David Basch

Lawrence Petracco

Case 1

275

(3)

Chief Complaint

275

(1)

History of Present Condition

275

(1)

Past Medical History

275

(1)

Past Treatment History

276

(1)

Family, Social, Occupational History

276

(1)

Physical Examination (Pre-MUA)

276

(1)

Physical Examination

276

(1)

Deep Tendon Reflex Testing

276

(1)

Sensory Perception

276

(1)

Orthopedic Evaluation

276

(1)

Palpation

276

(1)

Diagnosis

277

(1)

Treatment Plan

277

(1)

Discussion

277

(1)

Physical Examination (Post-MUA)

277

(1)

Deep Tendon Reflex Testing

277

(1)

Sensory Perception

278

(1)

Orthopedic Evaluation

278

(1)

Palpation

278

(1)

Case 2

278

(4)

Chief Complaint

278

(1)

History of Present Condition

279

(1)

Past Medical History

279

(1)

Past Medical Treatment

279

(1)

Family, Social, Occupational History

279

(1)

Physical Examination (Pre-MUA)

279

(1)

Observations

279

(1)

Neurological Evaluation

280

(1)

Orthopedic Evaluation

280

(1)

Radiological Evaluation

280

(1)

Diagnosis

280

(1)

Treatment Plan

281

(1)

Discussion

281

(1)

MUA Has Both a Diagnostic and Therapeutic Use

282

(1)

Case 3

282

(2)

Chief Complaint

282

(1)

History of Present Condition

282

(1)

Past Medical History

282

(1)

Allergies

282

(1)

Physical Examination

282

(1)

Radiological Evaluation

283

(1)

Discussion

283

(1)

History Leading to MUA

283

(1)

Status Post-MUA

283

(1)

A Case for MUA

284

(1)

Sample Forms and Reports

285

(14)

Index

299

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Manipulation Under Anesthesia

Summary

Table of Contents

Supplemental Materials