Clinical and Radiological Outcomes of Transarterial Embolization for Adhesive Capsulitis

Abstract

Objective: To assess the effect of transarterial embolization (TAE) for adhesive capsulitis (AC) by evaluating clinical outcomes and changes in inflammation using magnetic resonance imaging (MRI).

Materials and methods: Patients who had undergone TAE between August 2020 and August 2023 for AC refractory to conservative treatments without any invasive procedures for more than 3 months, and had undergone baseline and 3-month post-AC follow-up contrast-enhanced MRI evaluations, were included. A suspension mixture of 500 mg imipenem/cilastatin in 10 mL of iodinated contrast agent was used for TAE. MRI results were analyzed to assess periarticular capsule/ligament inflammation. Clinical assessments included pain scores using the numeric rating scale (NRS) and functional scores using the quick disabilities of the arm, shoulder, and hand (Quick DASH) questionnaire.

Results: Twenty-five patients (female:male, 14:11; age, 54.9 ± 7.1 years) were included. Significant reductions in average NRS pain scores as well as improvements in Quick DASH scores and range of motion, including anterior flexion and abduction, were observed at 1, 3, and 6 months after TAE (all P < 0.001). MRI analyses revealed that TAE significantly decreased the grades of axillary recess capsule enhancement, rotator interval (RI) capsule T2 signal intensity, and RI capsule enhancement (all P ≤ 0.004).

Conclusion: TAE may be an effective and safe therapeutic approach for AC refractory to conservative treatments, alleviating pain and supporting functional recovery. The observed MRI findings suggest that the effectiveness of TAE for AC may be attributed to the reduction of inflammation and the elimination of angiogenesis.

Keywords: Adhesive capsulitis; Angiogenesis; MRI; Pain; Transarterial embolization.

Fig. 1. Flowchart showing patient selection. AC = adhesive, TAE = transarterial embolization

Fig. 2. Selective angiography demonstrating successful transarterial TAE with imipenem/cilastatin for abnormal angiogenesis in a 57-year-old male patient with adhesive capsulitis in the left shoulder. A: DSA via the right thoracoacromial artery shows blush-like abnormal neo-vessel formation at the rotator interval before TAE (arrow). B: DSA via the right thoracoacromial artery demonstrates elimination of the neo-vessels after TAE (arrow). C, D: Pre-TAE MRI scans show vivid capsule enhancement (arrows, C) on oblique coronal T1-weighted fat-saturated contrast-enhanced image and fat infiltration within the rotator interval on oblique sagittal T1-weighted fat-saturated (arrowheads, D), indicative capsulitis and synovitis with inflammation and edema. E, F: Post-TAE MRI scans demonstrate significant decrease in the enhancement (arrows, E) and decrease in fat infiltrates within the rotator interval (arrowheads, F), indicating reduced infiltrates/edema. Additionally, a decrease in capsule thickness is observed in both areas. TAE = transarterial embolization, DSA = digital subtraction angiography