[Adhesive Capsulitis/Fibrosis] [Transarterial Microembolization (TAME)] Successful Case Sharing

Author: Bow Wang, M.D.

Ms. K, 72 years old, had been experiencing left shoulder pain for over six months. Raising her shoulder forward or backward to a certain angle caused pain, making even fastening her bra difficult. After seeking medical attention, she was diagnosed with adhesive capsulitis of the shoulder, commonly known as "frozen shoulder," also called "adhesive capsulitis" or "adhesive shoulder periarthritis." Despite undergoing long-term rehabilitation and joint expansion injections, Ms. K's pain persisted without significant improvement. The pain was so severe that she couldn't raise her arm, lift heavy objects, or even sleep soundly at night when turning over and pressing on the affected side, causing excruciating pain and significantly impacting her quality of life.

After traditional treatments proved ineffective, she consulted orthopedic specialists at National Cheng Kung University Hospital and was subsequently referred to the Interventional Medicine Center for further discussion. Following the discussion, Bow Wang, M.D. performed the [Transarterial Microembolization (TAME)] procedure on Ms. K. Guided by X-ray fluoroscopy and under local anesthesia, a microcatheter was inserted through the radial artery in her wrist to locate the painful area in her shoulder. Under arterial angiography, contrast agents were injected to identify newly formed capillary-like vessels in the shoulder joint capsule. Embolizing medication was then injected through the microcatheter to remove these abnormal capillary-like vessels.

Under arterial angiography, contrast agent is injected to identify newly formed capillary-like vessels in the shoulder joint capsule; then, embolizing medication is injected through a microcatheter to remove these abnormal capillary-like vessels.

On the afternoon of the treatment, Ms. K's shoulder range of motion and pain level showed significant improvement.

After treatment and a month of continuous rehabilitation, Ms. K's shoulder range of motion and pain level continued to show significant improvement.

Because of the improved shoulder pain and range of motion, Ms. K's quality of life also improved.

Adhesive capsulitis of the shoulder, commonly known as "frozen shoulder," is also called "adhesive capsulitis" or "adhesive shoulder periarthritis." Shoulder pain and adhesions occur due to shoulder injury or unexplained inflammation of the joint capsule, leading to a progressively narrowing range of motion in the shoulder joint. Because this condition commonly affects middle-aged and older people, especially those around fifty, it is called "fifty-shoulder" or "frozen shoulder," although it can also affect people in their forties, sixties, and seventies. Initially, the pain is intermittent and does not interfere with daily life or work. However, after one or two months, the range of motion in the affected shoulder joint begins to be restricted. Once the affected shoulder joint reaches a certain angle, the patient experiences severe pain, which may radiate upwards from the shoulder to the neck or along the upper arm to the elbow.

For example, the affected hand may be unable to reach behind the back or into a back pocket; women may have difficulty zipping up the back of their bras. Raising the arm to comb hair, holding chopsticks or a bowl may also be problematic. Even bumping into someone while walking can cause severe pain in the affected shoulder.

Traditional treatments, besides anti-inflammatory and analgesic drugs, thermotherapy, electrotherapy, local steroid injections into the joints, joint expansion injections, and manual rehabilitation, have recently been found in animal studies, including mouse experiments, to be closely related to abnormal microvascularization in chronic arthritis. These abnormal microvessels lead to the formation of inflammatory cells and tiny pain-related nerves, resulting in joint swelling and chronic pain.

【Transarterial Microembolization (TAME)】is administered via arterial injection, embolizing and blocking the abnormal microvascularization and related pain nerve innervation caused by arthritis, thereby improving pain caused by chronic joint inflammation. After pain relief, combining this with subsequent manual rehabilitation therapy will yield good therapeutic results.

However, Bow Wang, M.D. reminds users that the application of 【Transarterial Microembolization (TAME)】 in "adhesive capsulitis/frozen shoulder" also 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.

Furthermore, differential diagnosis with other common shoulder joint diseases is necessary.In addition to clinical symptoms, medical imaging such as X-rays, ultrasound, and even MRI can aid in disease diagnosis.

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

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