Embolization of abnormal blood vessels in the thickened shoulder capsule — easing pain and helping physiotherapy work more effectively for adhesive capsulitis.
Frozen shoulder (adhesive capsulitis) develops when the capsule surrounding the shoulder joint becomes inflamed, thickened, and tight, causing progressive pain and a marked reduction in the shoulder's range of movement. It typically progresses through a painful "freezing" stage, a stiffer "frozen" stage, and a gradual "thawing" stage, though the total course can take many months to a couple of years, and pain in particular can be severe and disabling during the earlier stages.
Imaging and pathology studies of the frozen shoulder capsule have shown an increase in small, abnormal blood vessels (neovascularity) within the inflamed tissue, alongside nerve growth that is thought to contribute significantly to the pain experienced. Embolization works by selectively identifying the small arteries feeding this abnormal vascularity — usually branches of the arteries supplying the shoulder region — and injecting tiny embolic particles into them under X-ray guidance. Reducing blood flow to this abnormal tissue is thought to calm the inflammatory and pain-generating process within the capsule, easing pain and, by making movement more comfortable, supporting more effective physiotherapy and functional recovery.
Based on clinical assessment and imaging, with other causes such as a rotator cuff tear reasonably excluded.
Physiotherapy and corticosteroid injections tried without adequate improvement.
Where reducing pain specifically is expected to unlock further improvement in movement.
Clinical assessment and imaging confirm the diagnosis and plan a safe catheter route.
A needle puncture is made at the wrist or groin under local anaesthesia.
Tiny embolic particles are injected into the identified abnormal vessels.
Most patients go home the same day, resuming physiotherapy within a few days.
Frozen shoulder embolization is most useful for patients with the specific combination of factors below, generally reviewed jointly by orthopaedics or rheumatology and interventional radiology:
Based on clinical assessment and imaging, with other causes of shoulder pain (such as a rotator cuff tear or significant osteoarthritis) reasonably excluded.
That has not adequately improved with an appropriate trial of standard treatments, including physiotherapy and corticosteroid injections.
Where reducing pain specifically is expected to help unlock further improvement in movement.
Such as manipulation under anaesthesia or arthroscopic capsular release, particularly where surgical or anaesthesia risk is a consideration.
Frozen shoulder embolization isn't the right choice for every patient with shoulder pain — pain driven predominantly by a structural problem such as a rotator cuff tear, significant glenohumeral osteoarthritis, or shoulder instability generally shifts the diagnostic and treatment approach elsewhere instead, decided on a case-by-case basis after appropriate orthopaedic evaluation.
Clinical assessment and imaging beforehand confirm the diagnosis and help plan a safe catheter route to the shoulder's vascular supply.
Under local anaesthesia with light or no sedation, a needle puncture is made in the radial artery at the wrist or the femoral artery in the groin.
A fine catheter is guided under X-ray guidance into the arteries supplying the shoulder, and contrast dye is injected to identify the abnormal, excess small vessels feeding the inflamed capsule.
Tiny embolic particles are injected through the catheter into the identified abnormal vessels, reducing blood flow to this tissue while preserving normal blood supply to the rest of the shoulder.
Once the targeted vessels have been treated, the catheter is removed and the access site is treated appropriately.
Most patients are observed for a short period after the procedure and go home the same day, generally resuming normal activities, including physiotherapy, within a few days.
Frozen shoulder embolization is generally well tolerated. The most common effects are transient — mild discomfort at the treated shoulder for a few days, and occasionally minor skin discolouration over the area related to the reduced blood supply to superficial tissue. Site-related risks, such as bruising or bleeding at the wrist or groin puncture, are uncommon and usually minor. As with any embolization procedure, there is a small risk of non-target embolization affecting nearby normal tissue, minimised through careful pre-procedure imaging and precise, selective catheter technique.
Improvement is primarily assessed clinically — through pain scores, range-of-motion measurements, and functional questionnaires — at intervals after the procedure, since benefit typically builds gradually over the following weeks as inflammation settles and patients are able to engage more fully with physiotherapy. Continued physiotherapy after the procedure is an important, expected part of aftercare, since embolization is intended to make rehabilitation more effective rather than to replace it.
Getting frozen shoulder embolization right depends on precise identification of the abnormal vessels feeding the inflamed capsule — which are small and can be technically demanding to catheterise selectively — while protecting the normal blood supply to surrounding shoulder structures. Because frozen shoulder sits at the intersection of orthopaedic and rheumatological care, decisions about candidacy and the technical execution of embolization are best made jointly by interventional radiology and the treating orthopaedic or rheumatology specialist, working from the same clinical picture and imaging, alongside a structured physiotherapy plan.
It is used to treat persistent pain from frozen shoulder (adhesive capsulitis) by targeting the abnormal, excess small blood vessels that develop in the inflamed shoulder capsule, particularly when standard treatments such as physiotherapy and steroid injections haven't given adequate relief.
Embolization mainly targets pain by reducing blood flow to the abnormal vessels in the inflamed capsule. It is not a direct treatment for the stiffness itself, but by easing pain, it's intended to help patients engage more effectively with physiotherapy to regain movement over time.
A steroid injection reduces inflammation within the joint itself. Embolization instead targets the abnormal blood vessels that have developed in the thickened capsule, addressing a different aspect of the condition, and is generally considered after standard treatments including steroid injections haven't given adequate relief.
No. It's specifically for confirmed adhesive capsulitis. Shoulder pain from other causes, such as a rotator cuff tear or significant osteoarthritis, needs a different diagnostic and treatment approach, which is why orthopaedic evaluation is part of the assessment.
The procedure is done under local anaesthesia through a single wrist or groin puncture, so there's no surgical incision. Most patients go home the same day and can resume normal activities, including physiotherapy, within a few days.
Improvement is typically gradual, building over the weeks following the procedure as inflammation settles, rather than immediate. Continued physiotherapy afterward plays an important role in regaining movement.
Book a consultation with Dr. Giragani to discuss whether embolization is right for you.