To evaluate the mid-term clinical outcomes of transcatheter arterial embolization (TAE) for adhesive capsulitis (AC) resistant to medical treatments.
Materials and Methods
This is a prospective analysis performed between February 2016 and February 2020. Inclusion criteria for TAE were shoulder pain, restriction of movement and no response to conservative treatment for at least 3 months. Demographic variables, risk factors, technical aspects, adverse events, changes by visual analogue scale (VAS) for pain and physical examination before and after TAE were assessed.
This study included 40 patients with AC (35 women and 5 men; mean age 50 ± 9 years old). Abnormal vessels were observed in 31/40 (77.5%) procedures. As embolic agent, imipenem/cilastatin was used. The mean follow-up was 21.2 ± 10.5 months. Significant differences were obtained in terms of pain reduction before and 6 months after TAE with the median visual analogue scale (VAS) of 8 vs. 0.5, P = 0.0001. Substantial differences were found regarding mobility in flexion and abduction before and 6 months after embolization, respectively (79.5° ± 18.5° vs. 133° ± 24.5°, P = 0.0001; 72.4° ± 18.8° vs. 129.7° ± 27.9°, P = 0.0001). No complications occurred. Complete recovery was obtained in 37/40 (92.5%) patients and partial recovery in 2/40 (5%). No clinical recurrence appeared.
Clinical results of transcatheter arterial embolization with imipenem/cilastatin are effective and stable in the mid-term follow-up for patients presenting with AC resistant to conservative treatments.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Digital subtraction angiography
Magnetic resonance imaging
Range of motion
Transcatheter arterial embolization
Visual analogue scale
Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elb Surg. 2011;20:502–14.
Bunker TD. Frozen shoulder: unravelling the enigma. Ann R Coll Surg Engl. 1997;79:210–3.
Itoi E, Arce G, Bain GI, Diercks RL, Guttmann D, Imhoff AB, et al. Shoulder stiffness: current concepts and concerns. Arthroscopy. 2016;32:1402–14.
Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder. A long-term follow-up. J Bone Joint Surg A. 1992;74:738–46.
Ryan V, Brown H, Minns Lowe CJ, Lewis JS. The pathophysiology associated with primary (idiopathic) frozen shoulder: a systematic review. BMC Musculoskelet Disord. 2016;17:340.
Guyver PM, Bruce DJ, Rees JL. Frozen shoulder—a stiff problem that requires a flexible approach. Maturitas. 2014;78:11–6.
Tamai K, Akutsu M, Yano Y. Primary frozen shoulder: brief review of pathology and imaging abnormalities. J Orthop Sci. 2014;19:1–5.
Xu Y, Bonar F, Murrell GAC. Enhanced expression of neuronal proteins in idiopathic frozen shoulder. J Shoulder Elb Surg. 2012;21:1391–7.
Ryu JD, Kirpalani PA, Kim JM, Nam KH, Han CW, Han SH. Expression of vascular endothelial growth factor and angiogenesis in the diabetic frozen shoulder. J Shoulder Elb Surg. 2006;15:679–85.
Yang S, Park DH, Ahn SH, Kim J, Lee JW, Han JY, et al. Prevalence and risk factors of adhesive capsulitis of the shoulder after breast cancer treatment. Support Care Cancer. 2017;25:1317–22.
Anton HA. Frozen shoulder. Can Fam Physician. 1993;39:1773–7.
Amir-us-Saqlain H, Zubairi A, Taufiq I. Functional outcome of frozen shoulder after manipulation under anaesthesia. J Pak Med Assoc. 2007;57:181–5.
Huang Y-P, Fann C-Y, Chiu Y-H, Yen M-F, Chen L-S, Chen H-H, et al. Association of diabetes mellitus with the risk of developing adhesive capsulitis of the shoulder: a longitudinal population-based followup study. Arthritis Care Res (Hoboken). 2013;65:1197–202.
Aydeniz A, Gursoy S, Guney E. Which musculoskeletal complications are most frequently seen in type 2 diabetes mellitus? J Int Med Res. 2008;36:505–11.
Smith SP, Devaraj VS, Bunker TD. The association between frozen shoulder and Dupuytren’s disease. J Shoulder Elb Surg. 2001;10:149–51.
Vastamäki H, Kettunen Pt J, Vastamäki M, Vastamäki H, Kettunen J, Vastamäki M. The natural history of idiopathic frozen shoulder: a 2-to 27-year followup study. Clin Orthop Relat Res. 2012;470:1133–43.
Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, et al. Shoulder pain and mobility deficits: adhesive capsulitis. Clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2013;43:A1–31.
Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2011;19:536–42.
Wong CK, Levine WN, Deo K, Kesting RS, Mercer EA, Schram GA, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy (UK). 2017;103:40–7.
Ide J. Frozen shoulder. Adv Shoulder Surg. 2016;39:205–14.
Okuno Y, Matsumura N, Oguro S. Transcatheter arterial embolization using imipenem/cilastatin sodium for tendinopathy and enthesopathy refractory to nonsurgical management. J Vasc Interv Radiol. 2013;24:787–92.
Okuno Y, Oguro S, Iwamoto W, Miyamoto T, Ikegami H, Matsumura N. Short-term results of transcatheter arterial embolization for abnormal neovessels in patients with adhesive capsulitis: a pilot study. J Shoulder Elb Surg. 2014;23:e199–206.
Okuno Y, Iwamoto W, Matsumura N, Oguro S, Yasumoto T, Kaneko T, et al. Clinical outcomes of transcatheter arterial embolization for adhesive capsulitis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28:161–7.
Hwang JH, Park SW, Kim KH, Lee SJ, Oh KS, Chung SW, et al. Early results of transcatheter arterial embolization for relief of chronic shoulder or elbow pain associated with tendinopathy refractory to conservative treatment. J Vasc Interv Radiol. 2018;29:510–7.
Woodhams R, Nishimaki H, Ogasawara G, Fujii K, Yamane T, Ishida K, et al. Imipenem/cilastatin sodium (IPM/CS) as an embolic agent for transcatheter arterial embolisation: a preliminary clinical study of gastrointestinal bleeding from neoplasms. SpringerPlus. 2013;2:344.
Okuno Y, Korchi AM, Shinjo T, Kato S. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis. Cardiovasc Intervent Radiol. 2015;38:336–43.
Yamada K, Farsad K, Jahangiri Y, Li J, Gabr A, Anoushiravani A, Uchida B, Horikawa M. Abstract No. 434 Embolic characteristics of imipenem–cilastatin particles in vivo in the rat renal artery. J Vasc Interv Radiol. https://doi.org/10.1016/j.jvir.2019.12.495.
Ramirez J. Adhesive capsulitis: Diagnosis and management. Am Fam Physician. 2019;99:297–300.
Hawi N, von Falck C, Krettek C, Meller R. Typical alterations of frozen shoulder in MRI examinations. Unfallchirurg. Springer Medizin. 2019;122:944–9.
Goldstein B. Shoulder anatomy and biomechanics. Phys Med Rehabil Clin N Am. 2004;15:313–49.
Lugo R, Kung P, Ma CB. Shoulder biomechanics. Eur J Radiol. 2008;68:16–24.
Constant CR, Gerber C, Emery RJH, Søjbjerg JO, Gohlke F, Boileau P. A review of the Constant score: modifications and guidelines for its use. J Shoulder Elb Surg. 2008;17:355–61.
Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the Cirse classification system. Cardiovasc Intervent Radiol. 2017;40:1141–6.
Mengiardi B, Pfirrmann CWA, Gerber C, Hodler J, Zanetti M. Frozen shoulder: MR arthrographic findings. Radiology. 2004;233:486–92.
Bagla S, Piechowiak R, Hartman T, Orlando J, Del Gaizo D, Isaacson A. Genicular artery embolization for the treatment of knee pain secondary to osteoarthritis. J Vasc Interv Radiol. 2020;31:1096–102.
Grey RG. The natural history of ‘idiopathic’ frozen shoulder. J Bone Joint Surg Am. 1978;60:564.
Dudkiewicz I, Oran A, Salai M, Palti R, Pritsch M. Idiopathic adhesive capsulitis: long-term results of conservative treatment. Isr Med Assoc J. 2004;6:524–6.
This study was not supported by any funding.
Conflict of Interest
The authors declare that they have no conflict of interest.
The study performed was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board (IRB). Our hospital clinical research ethics committee approved this study.
Consent for Publication
Consent for publication was obtained for every individual person’s data included in the study.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Fernández Martínez, A.M., Baldi, S., Alonso-Burgos, A. et al. Mid-Term Results of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment. Cardiovasc Intervent Radiol 44, 443–451 (2021). https://doi.org/10.1007/s00270-020-02682-4
- Adhesive capsulitis
- Imipenem/cilastatin sodium