TAME & Musculoskeletal Embolization
Finger Osteoarthritis Treated with TAME — Case Report
Author: Bow Wang, M.D.
The finger joints of both hands are swollen and deformed; X-rays show changes in osteoarthritis of the fingers.
Ms. L, 52 years old, is a housewife with previous experience playing the mandolin. She has suffered from pain and deformity in the distal finger joints of both hands for several years. Due to the pain being rated out of 10, she has to constantly endure this swelling and pain, resulting in decreased finger dexterity. Ms. L visited the National Cheng Kung University Hospital Interventional Medical Center for further discussion.
The crossed-out area in the image indicates the location of Ms. L's joint pain.
After consultation, Bow Wang, M.D. performed X-rays and blood tests on Ms. L, diagnosing her with "osteoarthritis of the fingers." Following discussion, Ms. L underwent "transarterial embolization therapy for inflammatory arterial disease."
Guided by Bow Wang, M.D. and X-ray fluoroscopy, under local anesthesia, a microcatheter was inserted into the painful area via arterial puncture in the hand using ultrasound. Embolizing medication was then injected through the microcatheter under arterial angiography.
Medication was administered to the finger joints via artery.
After treatment (After treatment, Ms. L's pain was significantly reduced and improved, with her pain score decreasing from [previous score].The full score of 10 points has been significantly reduced to 2 to 3 points.
Osteoarthritis of the fingers is common in women over 50 years of age. This is due to decreased female hormones, a lack of factors protecting joints, and long-term repetitive strain work, such as hairdressing, teaching, or housewifery.
Patients experience hard or bony swelling in the distal interphalangeal joints of the fingers, medically known as Heberden's nodes. This is a manifestation of osteoarthritis, resulting from repeated joint injury causing cartilage damage, further narrowing of the joint, and the formation of bone spurs.
Initially, the affected joint may experience chronic swelling or sudden redness and swelling, leading to a decrease in hand dexterity. In severe cases, like Ms. L, even light touch causes excruciating pain, making daily activities such as washing hair, using a mobile phone, typing, wringing out a towel, and opening a bottle difficult.
Common treatments for osteoarthritis of the fingers include medication such as oral analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and topical ointments to control pain and inflammation/swelling. Recent research has found a close correlation between pain in chronic arthritis and abnormal microvascular formation. These abnormal microvessels lead to the formation of inflammatory cells and tiny pain-related nerves, resulting in joint swelling and chronic pain.
"Transarterial Inflammatory Vessel Embolization" (TAVIC) involves arterial injection to embolize and block the abnormal microvessels and related pain nerve innervations caused by osteoarthritis of the fingers, thereby improving finger pain caused by chronic joint inflammation.
However, Bow Wang, M.D. cautions that TAVIC has limitations in its application to osteoarthritis of the fingers. The main indications are a pain index exceeding 5 points and no significant improvement after more than three months of various treatments.
Furthermore, differential diagnosis with rheumatoid arthritis is necessary. Rheumatoid arthritis is characterized by stiffness in the joints, especially upon waking in the morning, lasting for more than an hour; osteoarthritis usually develops slowly but is particularly painful in cold, damp weather or when moving the joints. Rheumatoid arthritis can affect joints throughout the body, typically affecting the wrist joints; while osteoarthritis usually develops slowly, most commonly causing swelling in the finger joints, especially the distal interphalangeal joints. In addition to clinical symptoms, X-rays and blood tests for rheumatoid factor can aid in 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 identify the true source of pain, and have a full discussion with their doctor and family to understand the treatment process and related precautions before receiving treatment for better assurance.
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This page is for medical education and academic communication. It does not replace individual diagnosis or treatment advice.
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