Transarterial Embolization for Adhesive Capsulitis of the Shoulder: Midterm Outcomes on Function and Pain Relief
Clinical question
Is transarterial embolization for adhesive capsulitis of the shoulder safe and effective?Take away point
Transarterial embolization for adhesive capsulitis of the shoulder is safe, effective, and with long-lasting clinical improvements.Reference
Lanciego, C., Puentes-Gutierrez, A., Sánchez-Casado, M., Cifuentes-Garcia, I., Fernández-Tamayo, A., Dominguez-Paillacho, D., Ciampi-Dopazo, J.J. and Marquina-Valero, M.A., 2024. Transarterial Embolization for Adhesive Capsulitis of the Shoulder: Midterm Outcomes on Function and Pain Relief. Journal of Vascular and Interventional Radiology, 35(4), pp.550-557.Click here for abstract
Study design
Prospective, observational, descriptive study
Figure 4(a) Pre-embolic angiogram in the late arterial phase showed areas of hyperemia in territories dependent on the thoracoacromial and anterior humeral circumflex arteries (white arrowheads). (b) Postembolic angiogram showed resolution of the hyperemia after embolization with imipenem/cilastatin sodium (black arrowheads).
Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by pain and progressive loss of both active and passive shoulder mobility, leading to functional disability. While most cases respond to conventional treatments such as physical therapy and medication, about 30% of cases remain refractory to these interventions, resulting in chronic symptoms. Recent studies have explored the role of increased vascularization in adhesive capsulitis and have evaluated the effectiveness of transarterial embolization (TAE) in treating refractory cases by occluding arterioles to reduce inflammation and pain.
This prospective study, conducted from January 2018 to May 2023, involved embolizing arterioles in patients with MRI-compatible adhesive capsulitis and persistence of symptoms for more than 3 months who had not responded to standard treatment. Participants were selected based on clinical and magnetic resonance imaging criteria. Exclusion criteria included patients under 18, those with systemic diseases, shoulder fractures, or a history of shoulder surgery. The embolization procedures were carried out by experienced interventional radiologists and involved arteriography to identify the hypervascular arterial supply to the shoulder capsule (early vascular filling, hyperemia, anomalous vessels, or early venous return,), followed by selective catheterization and embolization using small amounts (0.2–0.4 mL) of suspended microparticles (10–70 μm) formed by diluting a mixture of 500-mg imipenem (IMP) and 500-mg cilastatin sodium (CS) (Aurovitas, Teramo, Italy) in 5–10 mL of iodinated contrast. Embolization endpoint was complete or nearly complete stasis. Safety was assessed by recording adverse events, and effectiveness was measured by improvements in pain and range of motion over a 6-month period post-procedure followed by monthly interview by rehabilitation physicians.
The study included 20 patients, with 60% being women, 95% right-handed, and 30% having diabetes. Significant improvements were noted in shoulder mobility and function, as well as reductions in various types of pain, especially nocturnal pain. No significant adverse events were reported, and most patients experienced sustained benefits, with 70% reporting cessation of analgesic use during long-term follow-up. However, diabetic patients had a less favorable long-term response as they continue to require analgesics.
Musculoskeletal embolization, aiming to break the circle of hypervascularization, pain, and inflammation, is emerging as a potential treatment for inflammatory musculoskeletal conditions refractory to conventional therapy. This study's findings support the safety and effectiveness of TAE, with significant improvements in pain and shoulder mobility observed early on and maintained over time. The use of IMP/CS as an embolic agent appears to be safe, with a low rate of adverse events. While the study adds valuable information to the field, limitations such as a small sample size and lack of a control group suggest a need for larger, multicenter studies with longer follow-up periods to further validate the long-term effectiveness and establish TAE as a standard treatment option for adhesive capsulitis.
This article presents a study investigating the use of transarterial embolization as a treatment for adhesive capsulitis (frozen shoulder), which is a condition causing pain and restricted movement in the shoulder. The results suggest that embolization is a safe procedure that can offer significant relief from pain and functional disability in patients with adhesive capsulitis. Clinicians and healthcare professionals could benefit from understanding the potential of transarterial embolization as an alternative treatment for adhesive capsulitis, particularly in cases where standard therapies are ineffective. However, to integrate this knowledge into clinical practice, additional information such as standardized protocols, long-term outcomes validation, comparison with other treatments, and specific considerations for patient selection (e.g., the impact of diabetes on treatment efficacy) would be valuable. Trans-arterial embolization may be considered in the management pathway of shoulder adhesive capsulitis.
Funding Source
NoneSetting
AcademicFigure
Summary
Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by pain and progressive loss of both active and passive shoulder mobility, leading to functional disability. While most cases respond to conventional treatments such as physical therapy and medication, about 30% of cases remain refractory to these interventions, resulting in chronic symptoms. Recent studies have explored the role of increased vascularization in adhesive capsulitis and have evaluated the effectiveness of transarterial embolization (TAE) in treating refractory cases by occluding arterioles to reduce inflammation and pain.
This prospective study, conducted from January 2018 to May 2023, involved embolizing arterioles in patients with MRI-compatible adhesive capsulitis and persistence of symptoms for more than 3 months who had not responded to standard treatment. Participants were selected based on clinical and magnetic resonance imaging criteria. Exclusion criteria included patients under 18, those with systemic diseases, shoulder fractures, or a history of shoulder surgery. The embolization procedures were carried out by experienced interventional radiologists and involved arteriography to identify the hypervascular arterial supply to the shoulder capsule (early vascular filling, hyperemia, anomalous vessels, or early venous return,), followed by selective catheterization and embolization using small amounts (0.2–0.4 mL) of suspended microparticles (10–70 μm) formed by diluting a mixture of 500-mg imipenem (IMP) and 500-mg cilastatin sodium (CS) (Aurovitas, Teramo, Italy) in 5–10 mL of iodinated contrast. Embolization endpoint was complete or nearly complete stasis. Safety was assessed by recording adverse events, and effectiveness was measured by improvements in pain and range of motion over a 6-month period post-procedure followed by monthly interview by rehabilitation physicians.
The study included 20 patients, with 60% being women, 95% right-handed, and 30% having diabetes. Significant improvements were noted in shoulder mobility and function, as well as reductions in various types of pain, especially nocturnal pain. No significant adverse events were reported, and most patients experienced sustained benefits, with 70% reporting cessation of analgesic use during long-term follow-up. However, diabetic patients had a less favorable long-term response as they continue to require analgesics.
Musculoskeletal embolization, aiming to break the circle of hypervascularization, pain, and inflammation, is emerging as a potential treatment for inflammatory musculoskeletal conditions refractory to conventional therapy. This study's findings support the safety and effectiveness of TAE, with significant improvements in pain and shoulder mobility observed early on and maintained over time. The use of IMP/CS as an embolic agent appears to be safe, with a low rate of adverse events. While the study adds valuable information to the field, limitations such as a small sample size and lack of a control group suggest a need for larger, multicenter studies with longer follow-up periods to further validate the long-term effectiveness and establish TAE as a standard treatment option for adhesive capsulitis.
Commentary
This article presents a study investigating the use of transarterial embolization as a treatment for adhesive capsulitis (frozen shoulder), which is a condition causing pain and restricted movement in the shoulder. The results suggest that embolization is a safe procedure that can offer significant relief from pain and functional disability in patients with adhesive capsulitis. Clinicians and healthcare professionals could benefit from understanding the potential of transarterial embolization as an alternative treatment for adhesive capsulitis, particularly in cases where standard therapies are ineffective. However, to integrate this knowledge into clinical practice, additional information such as standardized protocols, long-term outcomes validation, comparison with other treatments, and specific considerations for patient selection (e.g., the impact of diabetes on treatment efficacy) would be valuable. Trans-arterial embolization may be considered in the management pathway of shoulder adhesive capsulitis.
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