Mid-Term Results of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment

Abstract

Purpose

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.

Results

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.

Conclusions

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.

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Abbreviations

AC:

Adhesive capsulitis

DSA:

Digital subtraction angiography

IMP/CS:

Imipenem/cilastatin sodium

MRI:

Magnetic resonance imaging

ROM:

Range of motion

TAE:

Transcatheter arterial embolization

VAS:

Visual analogue scale

References

  1. 1.

    Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elb Surg. 2011;20:502–14.

    Article  Google Scholar 

  2. 2.

    Bunker TD. Frozen shoulder: unravelling the enigma. Ann R Coll Surg Engl. 1997;79:210–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 4.

    Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder. A long-term follow-up. J Bone Joint Surg A. 1992;74:738–46.

    CAS  Article  Google Scholar 

  5. 5.

    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.

    Article  Google Scholar 

  6. 6.

    Guyver PM, Bruce DJ, Rees JL. Frozen shoulder—a stiff problem that requires a flexible approach. Maturitas. 2014;78:11–6.

    CAS  Article  Google Scholar 

  7. 7.

    Tamai K, Akutsu M, Yano Y. Primary frozen shoulder: brief review of pathology and imaging abnormalities. J Orthop Sci. 2014;19:1–5.

    Article  Google Scholar 

  8. 8.

    Xu Y, Bonar F, Murrell GAC. Enhanced expression of neuronal proteins in idiopathic frozen shoulder. J Shoulder Elb Surg. 2012;21:1391–7.

    CAS  Article  Google Scholar 

  9. 9.

    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.

    Article  Google Scholar 

  10. 10.

    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.

    Article  Google Scholar 

  11. 11.

    Anton HA. Frozen shoulder. Can Fam Physician. 1993;39:1773–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. 12.

    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.

    PubMed  Google Scholar 

  13. 13.

    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.

    Article  Google Scholar 

  14. 14.

    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.

    CAS  Article  Google Scholar 

  15. 15.

    Smith SP, Devaraj VS, Bunker TD. The association between frozen shoulder and Dupuytren’s disease. J Shoulder Elb Surg. 2001;10:149–51.

    CAS  Article  Google Scholar 

  16. 16.

    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.

    Article  Google Scholar 

  17. 17.

    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.

    Article  Google Scholar 

  18. 18.

    Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2011;19:536–42.

    Article  Google Scholar 

  19. 19.

    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.

    CAS  Article  Google Scholar 

  20. 20.

    Ide J. Frozen shoulder. Adv Shoulder Surg. 2016;39:205–14.

    Article  Google Scholar 

  21. 21.

    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.

    Article  Google Scholar 

  22. 22.

    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.

    Article  Google Scholar 

  23. 23.

    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.

    Article  Google Scholar 

  24. 24.

    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.

    Article  Google Scholar 

  25. 25.

    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.

    Article  Google Scholar 

  26. 26.

    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.

    Article  Google Scholar 

  27. 27.

    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.

  28. 28.

    Ramirez J. Adhesive capsulitis: Diagnosis and management. Am Fam Physician. 2019;99:297–300.

    PubMed  Google Scholar 

  29. 29.

    Hawi N, von Falck C, Krettek C, Meller R. Typical alterations of frozen shoulder in MRI examinations. Unfallchirurg. Springer Medizin. 2019;122:944–9.

    CAS  Google Scholar 

  30. 30.

    Goldstein B. Shoulder anatomy and biomechanics. Phys Med Rehabil Clin N Am. 2004;15:313–49.

    Article  Google Scholar 

  31. 31.

    Lugo R, Kung P, Ma CB. Shoulder biomechanics. Eur J Radiol. 2008;68:16–24.

    Article  Google Scholar 

  32. 32.

    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.

    Article  Google Scholar 

  33. 33.

    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.

    CAS  Article  Google Scholar 

  34. 34.

    Mengiardi B, Pfirrmann CWA, Gerber C, Hodler J, Zanetti M. Frozen shoulder: MR arthrographic findings. Radiology. 2004;233:486–92.

    Article  Google Scholar 

  35. 35.

    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.

    Article  Google Scholar 

  36. 36.

    Grey RG. The natural history of ‘idiopathic’ frozen shoulder. J Bone Joint Surg Am. 1978;60:564.

    CAS  PubMed  Google Scholar 

  37. 37.

    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.

    PubMed  Google Scholar 

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Funding

This study was not supported by any funding.

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Correspondence to Ana María Fernández Martínez MD.

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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.

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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

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Keywords

  • Adhesive capsulitis
  • Shoulder
  • Stiffness
  • Imipenem/cilastatin sodium