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

Author: Bow Wang, M.D.

Ms. L, 42 years old, had been experiencing right shoulder pain for over a year. She experienced pain when raising her shoulder forward or backward to a certain angle, making even fastening her bra difficult. After seeking medical attention, she was diagnosed with "adhesive capsulitis," commonly known as "frozen shoulder." Despite undergoing long-term rehabilitation, local injections, and joint expansion injections, Ms. L's pain and range of motion showed no significant improvement. She was in so much pain that she could not raise her arm or lift heavy objects, severely impacting her daily life.

After traditional treatments proved ineffective, she consulted Dr. Hsu Kai-Lan, an orthopedic surgeon at National Cheng Kung University Hospital Clinic, and was subsequently referred to the Interventional Medicine Center for further discussion.

Following the discussion, Bow Wang, M.D. performed a procedure on Ms. L. 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.

Adhesive capsulitis of the shoulder, commonly known as "frozen shoulder," is also called "adhesive capsulitis" or "adhesive shoulder periarthritis." It occurs when the shoulder joint capsule becomes inflamed due to injury or unexplained reasons, leading to pain, adhesions, and a progressively narrowing range of motion in the shoulder joint.

Prompt treatment is crucial from the onset of symptoms. In addition to heat and electrotherapy, joint dilation injections are recommended to reduce inflammation and open the joint capsule. Manual therapy to loosen the adhesions is also essential. Daily stretching exercises at home are also important to help loosen the adhesions in frozen shoulder!

Recent research, including studies in mice, has found a close correlation between pain and range of motion in adhesive capsulitis and abnormally proliferating, disordered arteries. These abnormally proliferating, disordered arteries lead to the formation of inflammatory cells and tiny, pain-related nerves, resulting in joint swelling and chronic pain.

"Transarterial Microembolization (TAME) Treatment" uses arterial injection to embolize and clear these abnormally newly formed, disordered micro-arteries and block the accompanying pain nerves, thereby improving pain caused by chronic joint inflammation.

However, Transarterial Microembolization (TAME) has limitations in its application to "adhesive capsulitis/frozen shoulder." Its main indication is a pain index exceeding 5 points, and patients who have not seen significant improvement after more than three months of various traditional treatments.

Furthermore, differential diagnosis with other common shoulder joint diseases is necessary. In addition to 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.