Manipulation under anaesthesia (MUA) is a procedure to improve movement in a stiff, frozen shoulder by gently and controlled stretching of the joint capsule while the patient is under anaesthesia. It may be combined with arthroscopic capsular release.
Under general anaesthesia or a nerve block, the surgeon gently moves the shoulder through its full range of motion, breaking the thickened, contracted joint capsule that is restricting movement. In many cases, an arthroscopic capsular release is also performed — the surgeon uses keyhole instruments to divide the tight capsule under direct vision. The procedure typically takes 15–30 minutes.
MUA is considered when frozen shoulder (adhesive capsulitis) causes severe stiffness and pain that has not responded to a prolonged course of physiotherapy, pain management, and possibly a corticosteroid injection. It is most commonly offered when the condition has been present for several months and the stiffness significantly limits daily activities.
Frozen shoulder is a self-limiting condition that eventually resolves on its own, typically over 12–30 months. Treatment options include physiotherapy, pain medication, corticosteroid injections (into the joint or under image guidance), and hydrodilatation (injection of fluid to stretch the capsule). Many patients improve without surgery.
Standard pre-assessment. This is a day-case procedure. You will need someone to take you home and should arrange for help as your arm may be sore after the manipulation.
The aim is to rapidly restore range of motion. Most patients experience a significant improvement in movement immediately after the procedure. Maintaining this improvement requires dedicated physiotherapy in the following weeks. The outcome is generally better when combined with arthroscopic release.
The shoulder may be sore for several days after manipulation. Pain relief is provided.
Some patients experience a return of stiffness if physiotherapy is not maintained.
Very rare risk of fracture of the humerus during manipulation, particularly in patients with weakened bone.
Rare stretching of nerves or vessels during the manipulation.
Extremely rare during controlled manipulation.
Usually performed under general anaesthesia with a nerve block to provide pain relief afterwards. The nerve block allows you to begin exercises in comfort on the day of surgery.
Intensive physiotherapy begins immediately — ideally on the day of the procedure while the nerve block is active. You will be given exercises to perform at home several times daily. Improvement depends heavily on commitment to the exercise programme. Most patients notice significant gains within the first few weeks. Return to normal activities is usually within two to six weeks.
Physiotherapy begins immediately. A follow-up with your surgeon is typically arranged at six weeks to assess progress.
In most cases, the improvement is maintained with continued exercises. A small proportion of patients experience some recurrence of stiffness.
You are under anaesthesia during the procedure and will not feel it. Post-operative discomfort is managed with pain relief and the nerve block.
Movement is improved immediately. Maintaining and building on this improvement requires daily exercises for several weeks.