Skip to main content
SpringerLink
Log in

Short-term Results of Transcatheter Arterial Embolization for Chronic Medial Epicondylitis Refractory to Conservative Treatment: A Single-Center Retrospective Cohort Study

CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Cite this article

Abstract

Purpose

To evaluate the effectiveness and safety of transcatheter arterial embolization (TAE) for chronic medial epicondylitis (ME) refractory to conservative treatments.

Materials and Methods

This retrospective study included ten patients (14 procedures) who underwent TAE between May of 2018 and April of 2020 to treat chronic ME refractory to conservative treatments for at least 3 months. Imipenem/cilastatin sodium was used in 12 procedures, and quick-soluble gelatin sponge particles were used in the ensuing two procedures as an embolic agent. The visual analogue scale (VAS, 0–10) score and Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scores were assessed at baseline and at different post-treatment times (1 day; 1 week; 1, 3, and 6 months; and an open period). The clinical success of the procedure was defined as a decrease of more than 70% in the Quick-DASH scores at 6 months compared to the baseline.

Results

Clinical success was achieved in 12 of 14 procedures (85.7%). No major complications were observed during the follow-up periods. The mean VAS scores were significantly decreased at 1 day, 1 week, 1 month, 3 months and 6 months (7.6 at baseline vs. 3.6, 3.6, 3.6, 3, and 0.9 after treatment; all P < .01). The mean Quick-DASH scores at baseline decreased significantly at 1 day, 1 week, and at 1, 3, and 6 months after treatment (71.9 vs. 48.5, 44, 37.7, 30.2, and 8.4; all P < .01). These improvements endured in nine patients for up to 12 months after treatment.

Conclusion

TAE effectively and safely relieved pain and promoted functional recovery in chronic ME patients refractory to conservative treatments. TAE may be a feasible treatment option for patients with ME intractable to conservative treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Harrington JM, Carter JT, Birrell L, Gompertz D. Surveillance case definitions for work related upper limb pain syndromes. Occup Environ Med. 1998;55:264–71.

    Article  CAS  Google Scholar 

  2. Tarpada SP, Morris MT, Lian J, Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 2018;15:107–10.

    Article  Google Scholar 

  3. Descatha A, Leclerc A, Chastang J-F, Roquelaure Y. Medial epicondylitis in occupational settings: prevalence, incidence and associated risk factors. J Occup Environ Med. 2003;45:993.

    Article  CAS  Google Scholar 

  4. Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006;164:1065–74.

    Article  Google Scholar 

  5. Ikpe S, Lesniak B. Biologics and cell-based treatments for upper extremity injuries. Oper Tech Orthop. 2016;26:177–81.

    Article  Google Scholar 

  6. Lee SS, Kang S, Park NK, et al. Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis. Ann Rehabil Med. 2012;36:681.

    Article  Google Scholar 

  7. Binder A, Hazleman B. Lateral humeral epicondylitis—a study of natural history and the effect of conservative therapy. Rheumatology. 1983;22:73–6.

    Article  CAS  Google Scholar 

  8. Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466:1539–54.

    Article  Google Scholar 

  9. Skjong CC, Meininger AK, Ho SS. Tendinopathy treatment: where is the evidence? Clin Sports Med. 2012;31:329–50.

    Article  Google Scholar 

  10. Baumgard SH, Schwartz DR. Percutaneous release of the epicondylar muscles for humeral epicondylitis. Am J Sports Med. 1982;10:233–6.

    Article  CAS  Google Scholar 

  11. Gabel GT, Morrey B. Operative treatment of medial epicondylitis. J Bone Joint Surg. 1995;77:1065–9.

    Article  CAS  Google Scholar 

  12. Iwamoto W, Okuno Y, Matsumura N, et al. Transcatheter arterial embolization of abnormal vessels as a treatment for lateral epicondylitis refractory to conservative treatment: a pilot study with a 2-year follow-up. J Shoulder Elbow Surg. 2017;26:1335–41.

    Article  Google Scholar 

  13. 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 

  14. Hwang JH, Park SW, Kim KH, 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 

  15. 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(161–167):e161.

    Article  Google Scholar 

  16. Okuno Y, Oguro S, Iwamoto W, et al. Short-term results of transcatheter arterial embolization for abnormal neovessels in patients with adhesive capsulitis: a pilot study. J Shoulder Elbow Surg. 2014;23:e199–206.

    Article  Google Scholar 

  17. Filippiadis D, Binkert C, Pellerin O, et al. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol. 2017;40:1141–6.

    Article  CAS  Google Scholar 

  18. Alfredson H, Öhberg L, Forsgren S. Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? Knee Surg Sports Traumatol Arthrosc. 2003;11:334–8.

    Article  Google Scholar 

  19. Jackson JR, Seed MP, Kircher CH, et al. The codependence of angiogenesis and chronic inflammation. FASEB J. 1997;11:457–65.

    Article  CAS  Google Scholar 

  20. Bonnet C, Walsh D. Osteoarthritis, angiogenesis and inflammation. Rheumatology. 2005;44:7–16.

    Article  CAS  Google Scholar 

  21. Perrot S, Guilbaud G. Pathophysiology of joint pain. Rev Rhum Engl Ed. 1996;63:485–92.

    CAS  PubMed  Google Scholar 

  22. Lee SH, Hwang JH, Kim DH, et al. Clinical outcomes of transcatheter arterial embolisation for chronic knee pain: mild-to-moderate versus severe knee osteoarthritis. Cardiovasc Intervent Radiol. 2019;42:1530–6.

    Article  Google Scholar 

  23. 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 

  24. Bagla S, Piechowiak R, Hartman T, et al. Genicular artery embolization for the treatment of knee pain secondary to osteoarthritis. J Vasc Interv Radiol. 2020;31:1096–102.

    Article  Google Scholar 

  25. Okuno Y, Korchi AM, Shinjo T, et al. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28:995–1002.

    Article  Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Author notes

  1. Jae Hwan Lee and Dong Hyun Kim have equally contributed to this work.

Authors and Affiliations

  1. Department of Radiology, Seoul National University Bundang Hospital, Bundang, Seongnam, Republic of Korea

    Jae Hwan Lee, Won Seok Choi & Chang Jin Yoon

  2. Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Dong Hyun Kim, Minuk Kim & Young Ho So

  3. Department of Radiology, H Plus Yangji Hospital, Nambusunhwan-ro, Gwanakgu, 1636, Seoul, Republic of Korea

    Sang Hwan Lee

  4. Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea

    Jin Ho Hwang

  5. Department of Radiology, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea

    Soo Buem Cho

  6. Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Republic of Korea

    Young Jae Kim

Authors
  1. Jae Hwan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dong Hyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sang Hwan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin Ho Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Soo Buem Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Minuk Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Young Ho So
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Young Jae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Won Seok Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chang Jin Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang Hwan Lee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This retrospective study was approved by the institutional review board (IRB). For this type of study formal consent is not required.

Informed Consent

This study has obtained IRB approval from H Plus Yangji Clinical Research Center and the need for informed consent was waived.

Consent for publication

For this type of study consent for publication is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J.H., Kim, D.H., Lee, S.H. et al. Short-term Results of Transcatheter Arterial Embolization for Chronic Medial Epicondylitis Refractory to Conservative Treatment: A Single-Center Retrospective Cohort Study. Cardiovasc Intervent Radiol 45, 197–204 (2022). https://doi.org/10.1007/s00270-021-02878-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-021-02878-2

Keyword

search

Navigation