TAME & Musculoskeletal Embolization
TAME for Refractory Frozen Shoulder: Pain, Mobility, and Evidence
For most people with frozen shoulder, medication, rehabilitation, home stretching, and appropriate injections remain first-line care. When substantial pain—especially night pain—persists for months despite appropriate conservative treatment, TAME may be considered as one minimally invasive option after specialist evaluation.
Current studies suggest possible improvements in pain, range of motion, and function. Most evidence, however, comes from single-arm studies and small retrospective comparisons, so the published averages should not be interpreted as a guaranteed individual result.
Frozen shoulder is more than a “stuck” shoulder
The formal term for frozen shoulder is adhesive capsulitis. Typical features include shoulder pain, night pain, and restriction of both active and passive motion. The course is often divided into three phases, although timing and severity vary widely between patients.
Pain-dominant phase
Pain progressively increases, often with prominent night pain, while motion begins to decline. Inflammation and neovascularity may be more active during this stage.
Stiffness-dominant phase
Pain may ease somewhat, while capsular contracture and restricted motion become the main concerns.
Recovery phase
Pain and stiffness gradually improve, but recovery rates vary and some patients retain a range-of-motion deficit.
Common sites of inflammation include the rotator interval, coracohumeral ligament, axillary capsule, and inferior glenohumeral ligament. These areas may show high signal on T2-weighted images or enhancement after contrast administration.
Why might TAME improve pain?
Chronically inflamed tissue may develop pathologic neovascularity, sometimes accompanied by sensory nerve fibers. The rationale of TAME is to use a catheter to identify abnormal small vessels supplying the inflamed region and reduce abnormal perfusion, potentially interrupting persistent inflammation and pain.
Frozen shoulder also involves fibrosis and capsular contracture. TAME primarily targets vascular signals associated with pain and inflammation. It does not replace subsequent stretching and rehabilitation, and embolization alone cannot be expected to resolve every component of stiffness.
What can MRI and MRA show?
MRI is useful not only for supporting the diagnosis of adhesive capsulitis, but also for excluding rotator cuff tears, advanced arthritis, tumors, and other abnormalities that may affect treatment. Six commonly studied MRI features include:
Dynamic contrast-enhanced MRA provides additional vascular information. It may depict periarticular neovascularity, potential feeding arteries, and anatomic variants for preprocedural planning. The final target still requires confirmation with selective angiography during the procedure.
How is TAME performed?
TAME is an image-guided endovascular procedure. The exact approach varies with vascular anatomy, target location, operator experience, and embolic material. A conceptual workflow is outlined below:
Preprocedural assessment
Review symptoms, range of motion, prior treatment, and imaging; exclude conditions that make embolization inappropriate.
Arterial access
Under local anesthesia and ultrasound guidance, access may be obtained through a wrist, elbow, or groin artery depending on the case.
Selective angiography
A microcatheter evaluates branches such as the thoracoacromial, suprascapular, or circumflex humeral arteries to identify abnormal staining that corresponds to the painful region.
Controlled embolization
Pathologic vascular staining is gradually reduced while avoiding reflux and nontarget embolization.
Postprocedural observation
The access site, skin color, pain, and neurovascular status are checked, followed by compression and observation appropriate to the access route.
Motion and rehabilitation
As pain improves, stretching and range-of-motion exercises are progressively resumed so that reduced pain does not obscure persistent capsular stiffness.
The target is abnormal microvascular staining, not the sacrifice of major arteries. Detailed knowledge of shoulder vascular variants and selective angiography are essential for reducing the risk of nontarget embolization.
What do current studies show?
A 2025 study coauthored by Bow Wang included 25 patients who underwent TAE for refractory adhesive capsulitis. Technical success was achieved in all patients, and the study-defined clinical success rate at three months was 88%. Because this was a retrospective single-arm study, the numbers describe that study population and do not guarantee an individual result.1
Mean pain score (NRS) decreased over time
Values are means for the study population; lower scores indicate less pain.
| Time | Mean NRS |
|---|---|
| Baseline | 7.0 |
| 1 month | 3.7 |
| 3 months | 2.1 |
| 6 months | 1.2 |
| Outcome | Baseline | 1 month | 3 months | 6 months |
|---|---|---|---|---|
| Mean NRS pain score | 7.0 | 3.7 | 2.1 | 1.2 |
| Mean QuickDASH score | 52.1 | 33.5 | 19.0 | 11.5 |
| Forward elevation | 98.0° | 120.4° | 140.0° | 152.4° |
| Abduction | 79.2° | 105.6° | 139.2° | 149.6° |
A 2026 systematic review and meta-analysis included 12 single-arm studies and 329 shoulders. Pooled results suggested improvement in pain, external rotation, and functional scores over follow-up. Heterogeneity was high, however, and randomized controlled trials were lacking; the authors emphasized the need for higher-quality evidence.3
Where does TAME fit among other treatments?
There is no single pathway for treating frozen shoulder. Most patients first receive medication, physical therapy, home exercise, or injection. If symptoms persist, interventional or surgical options may be discussed according to whether pain or stiffness predominates, the imaging findings, and the patient's overall health.
TAME primarily emphasizes
- Reducing pain associated with chronic inflammation and neovascularity
- A minimally invasive endovascular approach
- Continued stretching and rehabilitation after treatment
Arthroscopic capsular release primarily emphasizes
- Directly releasing a contracted, fibrotic capsule
- Anesthesia and postoperative rehabilitation
- Patients judged to require surgical release
A retrospective comparison by Bow Wang's team included 40 patients. At three months, the TAME group had a lower pain score (2.6 vs 4.7). At six months, pain, range of motion, and function did not differ significantly between groups. These findings suggest that TAME may be associated with earlier pain improvement, but the study was not randomized and cannot establish that one treatment is comprehensively superior to the other.4
Safety, common reactions, and limitations
No serious adverse event occurred in the 25-patient study described above. Recorded events included transient access-site hematoma, skin erythema, and postembolization ischemic pain; all resolved within two weeks with analgesic treatment. More than one event could occur in the same patient, so the percentages below should not be added together.1
Uncommon but important risks include arterial spasm, dissection or thrombosis, nontarget embolization, skin ischemia, neurologic symptoms, contrast reactions, and access-site pseudoaneurysm. Shoulder arteries may lie near cervical or vertebral arterial branches, making vascular-anatomic interpretation, microcatheter positioning, and avoidance of reflux essential.
This includes people with a severe contrast allergy, substantial renal impairment, a coagulation disorder, disease of the intended access artery, pregnancy, or imaging that indicates another primary cause of pain. The treating physician must determine actual contraindications and risks for each patient.
Frequently asked questions
Is TAME a first-line treatment for frozen shoulder?
Usually not. Medication, rehabilitation, home exercise, and appropriate injection remain first-line options for most patients. TAME is mainly considered when moderate-to-severe pain or night pain persists despite conservative treatment.
Does rehabilitation become unnecessary after TAME?
No. TAME may reduce pain and inflammation, making stretching more tolerable, but capsular stiffness and fibrosis usually still require progressive motion and rehabilitation.
Does MRI always require contrast?
Not every patient with frozen shoulder needs contrast-enhanced MRI or MRA. When capsular enhancement, neovascularity, or preprocedural planning must be assessed, contrast imaging may be considered according to renal function, allergy history, and the clinical purpose.
Should I expect the same improvement reported in the studies?
No. Published values are group averages from selected study populations. Individual response may be influenced by disease phase, degree of fibrosis, coexisting shoulder abnormalities, vascular anatomy, and adherence to rehabilitation.
References and image licensing
- Liang KW, Lin HY, Hsu KL, et al. Clinical and Radiological Outcomes of Transarterial Embolization for Adhesive Capsulitis. Korean J Radiol. 2025;26(3):230-238. doi:10.3348/kjr.2024.0883. Numerical data were redrawn as original HTML charts for this page; the article's original figures, governed by CC BY-NC, were not reproduced.
- Pan CY, Liang KW, Chen TR, et al. Added value of pre-procedural magnetic resonance angiography in transarterial embolization for refractory musculoskeletal pain. Front Med. 2024;11:1471504. doi:10.3389/fmed.2024.1471504. Figure 1 © 2024 Pan et al., licensed under CC BY 4.0.
- Allaw S, Khabaz K, Yu Q, Ahmed O. Transarterial Embolization for Refractory Adhesive Capsulitis and Related Tendinopathies: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol. 2026;37(2):107896. doi:10.1016/j.jvir.2025.10.027.
- Wang B, Kuan FC, Gean CY, et al. Comparison of therapeutic efficacy between arthroscopic capsular release and transarterial musculoskeletal embolization in patients with adhesive capsulitis of the shoulder. J Shoulder Elbow Surg. 2026. doi:10.1016/j.jse.2026.03.011.
- Okuno Y, Iwamoto W, Matsumura N, et al. Clinical Outcomes of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment. J Vasc Interv Radiol. 2017;28(2):161-167.e1. doi:10.1016/j.jvir.2016.09.028.
- Okuno Y, Yasumoto T, Koganemaru M, et al. Transarterial Embolization of Neovascularity for Refractory Nighttime Shoulder Pain: A Multicenter, Open-Label, Feasibility Trial. J Vasc Interv Radiol. 2022;33(12):1468-1475. doi:10.1016/j.jvir.2022.08.016.
- Pessis E, Mihoubi F, Feydy A, et al. Usefulness of intravenous contrast-enhanced MRI for diagnosis of adhesive capsulitis. Eur Radiol. 2020;30:5981-5991. doi:10.1007/s00330-020-07003-4.
Medical disclaimer: This page provides general medical information and a summary of research. It does not replace an in-person consultation and does not guarantee a specific outcome. Suitability for TAME must be assessed by a physician using the patient's history, physical examination, imaging, prior treatment, and individual risk. Study data apply to the populations enrolled in each cited study.
This page is for medical education and academic communication. It does not replace individual diagnosis or treatment advice.
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