Musculoskeletal Embolization: A Minimally Invasive Option for Chronic Pain

Musculoskeletal embolization (MSKE) is an emerging image-guided technique increasingly recognized for its role in managing chronic pain syndromes related to benign musculoskeletal disorders. By selectively occluding abnormal neovessels associated with chronic inflammation, MSKE aims to reduce pain and the need for pharmacological treatment over a long period of time, improve function and minimize the need for more invasive procedures.

Indications for MSKE include osteoarthritis-related pain, shoulder adhesive capsulitis (AC), chronic tendinopathies, sports injuries such as lateral epicondylitis or jumper’s knee and refractory hemarthrosis. These conditions often involve pathological hypervascularization, which can be effectively targeted using embolic agents.
The procedure is typically performed on an outpatient basis, with a low complication rate and minimal recovery time. An arteriography of the upper or lower limb is performed depending on the joint to be treated. A 3F to 6F catheter is usually employed and the use of small microcatheters, from 1.7F to 1.9F, is recommended. The target of the embolization is the disappearance of the hypervascularized areas called “blush areas” (Figures 1 and 2), for which different types of materials, spheres, imipenem/cilastatin or lipiodol mixed with contrast can be used as embolic agents.

Recent clinical studies have demonstrated promising outcomes, with significant pain reduction in knee osteoarthritis and functional improvement in AC reported in the majority of patients. While long-term data are still being collected, current evidence supports MSKE as a safe and effective adjunct or alternative to surgery in selected patients. Multidisciplinary collaboration, especially with orthopedic and pain specialists, is crucial to identify appropriate candidates, ensure comprehensive and follow-up.

Musculoskeletal embolization represents a significant advancement in the non-surgical treatment of chronic pain, offering targeted relief and improved quality of life for patients. As the field evolves, interventional radiologists have a unique opportunity to offer targeted, minimally invasive solutions for patients suffering from chronic musculoskeletal pain.