[Taiwan Orthopedic Arthroscopy Winter Symposium 2022] [Academic Exchange] [Adhesive Capsulitis/Frozen Shoulder] [Transarterial Microembolization (TAME)] 2022-1-22

I was honored to be invited by Senior Orthopedic Surgeon Hsu Kai-Lan and Director Su Wei-Ren to participate in the Winter Symposium co-organized by the Republic of China Arthroscopy and Knee Society and the Taiwan Shoulder and Elbow Society.

As the theme of this conference was "Dialogue between Orthopedic Surgeons and Physical Therapists," the National Federation of Physical Therapists of the Republic of China was invited, allowing me to hear many experienced orthopedic surgeons and physical therapists share their treatment experiences.

I also took this opportunity to share a basic introduction, a review of important literature, and relevant treatment experience from Cheng Kung University regarding the application of 【Transarterial Microembolization (TAME)】 in 【adhesive capsulitis/frozen shoulder】.

With the patient's prior permission, I shared a successful case of applying inflammatory vascular embolization analgesia to 【adhesive capsulitis/frozen shoulder】 at today's meeting.

Ms. L, 56 years old, had been experiencing right shoulder pain for over a year. The pain would occur when she raised her shoulder forward or backward to a certain angle. After seeking medical attention, she was diagnosed with 【adhesive capsulitis】, commonly known as 【frozen shoulder】, also called 【adhesive capsulitis】 or 【adhesive shoulder periarthritis】. After receiving local injection therapy and rehabilitation, Ms. L's pain and range of motion remained unresolved. She then consulted with National Cheng Kung University Hospital Interventional Medical Center for further discussion.

After identifying the corresponding vessels for the newly formed capillary-like vessels in the shoulder joint capsule under arterial angiography, embolizing medication was injected through the microcatheter to remove these abnormal capillary-like vessels. After the treatment, Ms. L's shoulder pain and range of motion improved significantly, and her quality of life also improved.

Significant improvement in right shoulder elevation before and after treatment (photos uploaded with patient's consent)

Adhesive capsulitis of the shoulder, commonly known as "frozen shoulder," is also called "adhesive capsulitis" or "adhesive shoulder periarthritis." After a shoulder injury or for unknown reasons, inflammation of the joint capsule leads to pain, adhesions, and a progressively narrowing range of motion in the shoulder joint.

Recent research, including mouse studies, has found a close correlation between pain from chronic arthritis and abnormally formed microvessels and inflammatory cells. These abnormal microvessels promote the formation of inflammatory cells and tiny pain-related nerves, resulting in joint swelling and chronic pain.

【Transarterial Microembolization (TAME)】, administered via arterial injection, embolizes and blocks the abnormally formed microvessels and related pain nerve innervation caused by arthritis, thereby improving pain caused by chronic joint inflammation.

However, Bow Wang, M.D. reminds users that transarterial embolization (TAE) for adhesive capsulitis/frozen shoulder has limitations. The main indication is a pain index exceeding 5 points, with no significant improvement after more than three months of various treatments.

Furthermore, differential diagnosis with other common shoulder joint diseases is necessary. Besides clinical symptoms, X-rays, ultrasound, and even MRI can aid in diagnosis.

Furthermore, 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

Treatment side effects 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 detailed evaluation by a physician to confirm the true source of pain and the diagnosis, and have a thorough discussion with their doctor and family to understand the treatment process and related precautions before receiving treatment for better assurance.