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TAME & Musculoskeletal Embolization

[De Quervain's Disease/Stenosing Tenosynovitis] [Transarterial Microembolization (TAME)] Successful Case Sharing

Author and reviewer: Bow Wang, M.D.
Author: Bow Wang, M.D.

[De Quervain's Disease/Stenosing Tenosynovitis] [Transarterial Microembolization (TAME)] Successful Case Sharing — related image 1

Ms. H, 42 years old, has suffered from persistent pain on the thumb side of her left wrist. The pain has worsened in the past month, especially in the morning or when making wrist-twisting movements, severely impacting her quality of life and sleep. Even with medication, rehabilitation, and wearing a wrist brace, the pain remains unbearable. Her pain score is as high as 7-8 out of 10.

Bow Wang, M.D., based on medical history and physical examination (Finkelstein's Test), diagnosed [Mommy's Thumb/De Quervain's Tenosynovitis]... [Disease], and examinations with ultrasound and magnetic resonance imaging (MRI) showed inflammation and swelling of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons and their surrounding synovium.

[De Quervain's Disease/Stenosing Tenosynovitis] [Transarterial Microembolization (TAME)] Successful Case Sharing — related image 2
After discussion, Transarterial Microembolization (TAME) was performed on Ms. H. Under X-ray fluoroscopy guidance, local anesthesia, and arterial angiography, Bow Wang, M.D. injected contrast agent to identify excessively proliferating and disordered capillary-like vessels in the inflamed and swollen areas; then, embolizing drugs were injected through a microcatheter to remove these abnormal capillary-like vessels.

Two weeks after treatment, Ms. H's pain score on the radial side of her wrist dropped significantly from 7-8 to 2-3, her range of motion also improved markedly, and her quality of life significantly increased.

[Stenosing tenosynovitis], also known as [De Quervain's] Tenosynovitis, commonly known as "mommy's thumb," is mainly caused by repetitive, long-term hand movements, especially the thumb. The abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons become inflamed due to excessive friction caused by repetitive thumb movements at the most prominent point across the radial bone of the wrist.

Patients experience pain on the thumb-side of the wrist. Thumb movements (such as clenching a fist or gripping), especially when combined with wrist twisting movements (such as wringing a towel), cause pain on the thumb side of the wrist. In severe cases, swelling and tenderness may be visible in the area. Symptoms are usually most pronounced in the morning and lessen significantly after some activity. However, the pain worsens again with continued repetitive thumb/wrist movements.

This condition is commonly seen in women aged 35-55 or postpartum. It typically occurs when mothers hold their babies, change diapers, or lift them up, hence the name "mommy's thumb." However, it can also affect people of all genders, especially those who frequently use their fingers and wrists. Examples include those who use mobile phones or tablets extensively, gamers, knitters or sewer workers, hairdressers, and housewives.

[Mommy's Thumb (De Quervain's)] Treatment for [syndrome] includes rest, medication, physical therapy, braces, and local injections. Recent literature shows that chronic inflammation is accompanied by disordered proliferation of capillary-like micro-arteries and associated pain nerves. [Transarterial Microembolization (TAME)] achieves anti-inflammatory, swelling-reducing, and analgesic effects by embolizing and clearing these disordered capillary-like micro-arteries. However, Bow Wang, M.D. reminds that [Transarterial Microembolization (TAME)] treatment 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 traditional treatments. Continued rehabilitation is recommended after treatment.

This treatment is not suitable in the following situations:

1. Severe tendon or ligament damage or rupture
2. Poor kidney function (eGFR) <30 mL/min/1.73m2)
3. Low platelet count, abnormal coagulation function
4. Patient unable to lie flat for two hours
5. 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 have a thorough discussion with their doctor and family to understand the treatment process and related precautions before receiving treatment for better assurance.




This page is for medical education and academic communication. It does not replace individual diagnosis or treatment advice.

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