Shoulder embolization

Frozen shoulder, also called adhesive capsulitis, happens when the capsule, the soft envelope around the shoulder joint, becomes inflamed, thick and tight. It usually causes deep, aching pain that is worse at night, followed by stiffness that makes it hard to reach overhead, behind your back or across your body. It is more common between ages 40 and 60, in women, and in people with diabetes or thyroid disease.

Frozen shoulder often gets better on its own, but slowly. It tends to move through a painful phase, a stiff phase and a thawing phase, which can take 1 to 3 years in total. Long-lasting shoulder pain can also come from tendinopathy, irritation of the rotator cuff tendons that lift and turn the arm.

In both conditions, the painful tissue grows extra tiny blood vessels, with small pain nerves alongside them. In shoulder embolization, an interventional radiologist, a doctor who uses X-ray to guide thin tubes through the blood vessels, places tiny particles in the small arteries feeding these inflamed areas. The goal is to calm the inflammation and pain so you can sleep better and move your shoulder in therapy, while the normal blood supply is kept.

Shoulder embolization was first described about a decade ago. Studies so far are small, mostly from a few centers, and often without a comparison group. In these studies many people with frozen shoulder reported quick relief of night pain and better movement within weeks, and serious complications were rare. Results for tendon pain are more limited.

Because frozen shoulder often improves with time anyway, we need larger, controlled trials to know how much of the benefit comes from embolization itself. We offer this treatment after an open discussion, usually when pain has lasted for months despite therapy and injections.

For patients with frozen shoulder, the night pain is often what wears them down the most. When I look at the angiogram, I often see a bright blush of small vessels around the front of the joint, right where the capsule is inflamed. I explain that this is a newer treatment, that the shoulder may improve over time on its own, and that embolization is meant to help them get through therapy with less pain, not to replace it.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

Before treatment we examine your shoulder and usually review an MRI or ultrasound to confirm the cause of your pain and rule out a tear that needs repair.

Physical therapy, anti-inflammatory medicines and a steroid injection into the joint are the usual first steps and help many people. Some doctors also stretch the capsule with a fluid injection (hydrodilatation). When pain and stiffness last, surgeons may release the capsule with keyhole surgery or move the shoulder under anesthesia. Embolization does not replace stretching; therapy is still important afterward.

The procedure is done at El Camino Hospital as an outpatient. Do not eat for about 8 hours before, and bring an adult to drive you home. See before your procedure and sedation.

1. 1
   Getting ready

   A nurse places an IV and you are connected to heart, blood pressure and oxygen monitors. You receive moderate sedation so you are relaxed and comfortable.

2. 2
   A pinhole and a map

   The skin over an artery in your wrist or thigh is numbed and a thin tube is placed with ultrasound guidance. A catheter is guided to the arteries around the shoulder, and contrast dye shows them on X-ray.

3. 3
   Embolization

   A microcatheter is placed in each small artery feeding an inflamed area, and tiny particles are slowly released until the abnormal blush fades. You may feel a brief ache in the shoulder.

4. 4
   Closing and going home

   The catheter is removed and the puncture is closed with a wrist band, pressure or a small plug, with no stitches. After a few hours of rest you go home.

On the angiogram, the inflamed shoulder capsule shows up as a cloudy blush of tiny vessels around the joint. After embolization, the blush fades while the main arteries stay open.

1. Day of the procedure
   Rest. No driving, alcohol or important decisions for the rest of the day. If the wrist was used, avoid lifting with that hand for 24 hours.
2. Days 1 to 2
   Return to light daily activities. Gentle shoulder movement is encouraged.
3. Weeks 1 to 4
   If the treatment works for you, night pain often eases first. Restart or continue physical therapy to regain movement.
4. 1 to 6 months
   Movement improves gradually with therapy. We follow up to track your pain and range of motion.