Interscapular Pain Treated with TAME — Case Report

Mr. C, 45 years old, had been experiencing right back pain for over two years. After seeking medical attention, he was diagnosed with "gaohuang pain" (a condition characterized by pain in the upper right back). He underwent rehabilitation, local injections, and regenerative medicine treatments, but the pain did not significantly improve, and his pain index reached the highest level of 10. Mr. C consulted National Cheng Kung University Hospital Orthopedics and was subsequently referred to the Interventional Medicine Center for further discussion.

After discussion, Bow Wang, M.D. ultimately chose to perform "transarterial embolization for inflamed arteries" on Mr. C. Guided by X-ray fluoroscopy and under local anesthesia, a microcatheter was inserted into the painful area via radial artery puncture. Under arterial angiography, contrast agent was injected to identify newly formed capillary-like vessels; then, embolizing medication was injected through the microcatheter to remove these abnormal capillary-like vessels.

After the embolization procedure, two weeks later, Mr. C's pain index in his right shoulder dropped to 2 points.

(Video recorded with patient consent)

However, Bow Wang, M.D. reminds patients that the application of transarterial embolization (TAE) for "gaohuang pain" has limitations. The main indication is a pain index exceeding 5 points, and patients who have not shown significant improvement after more than three months of various treatments.

This treatment is not suitable in the following situations:

1. Severe tendon or ligament damage or rupture

2. Pain accompanied by other nerve compression symptoms, such as numbness

3. Poor kidney function (eGFR < 30 mL/min/1.73m2)

4. Low platelet count, abnormal coagulation function

5. The patient is unable to lie flat for two hours

6. Pregnancy

Side effects of the treatment may include local hematoma and bruising at the puncture site; temporary local discoloration at the embolization site may occur, which will improve and disappear within several days to a month.

It is recommended that patients undergo a detailed evaluation by a physician to confirm the true source of pain, and have a thorough discussion with their doctor and family to understand the treatment process and related precautions before receiving treatment for better assurance.

Furthermore, Bow Wang, M.D. reminds patients that after treatment, it is still important to pay attention to adequate rest and protection, and to do appropriate exercise and maintenance every day. This will allow the tissues room to repair and adapt to the load, and make it less likely for the condition to worsen again.