Combined transcatheter arterial embolization and rehabilitative treatment for adhesive capsulitis refractory to conservative treatment

Abstract

Objective: To determine the safety and efficacy of treating adhesive capsulitis refractory to conservative treatment with a combination of TAE(transcatheter arterial embolization) and early physical therapy in our clinical experience. Methods: Observational and prospective study in a single general hospital. A total of 98 patients with adhesive capsulitis were evaluated and 14 of these patients were diagnosed of resistant to conservative treatment. 9 of these patients accepted combined TAE and rehabilitative treatment. Angiogram of the axillary artery was obtained to provide detailed information about the arterial supply to the glenohumeral capsule. A coaxial microcatheter was used for selective catheterization of arteries supplying the hypervascularized area. Small amounts of suspended microparticles formed by diluting 500 mg imipenem and 500 mg cilastatin sodium were injected. Between 72-96 hours after embolization, patients resumed rehabilitation withphysical therapy until their clinical situation stabilized. Results: Significant differences were found in VAS (visual-analogue-scale) and functionality. Comparing VAS measurements at night and during activity showed that pain decreased significantly and progressively with respect to the baseline measurements; moreover, the decrease in pain during activity was evident from the first week after the procedure. Significant improvements in flexion and abduction with respect to the baseline measurements were observed at all timepoints after TAE. Statistically significant improvements in the quickDASH questionnaire were observed at third and sixth months after TAE. No complications were observed. Conclusion: Embolization of arterial branches in the shoulder capsule combined with early rehabilitation was effective combination in adhesive capsulitis refractory to conservatory treatment.