Transarterial Embolization for Refractory Adhesive Capsulitis and Related Tendinopathies: A Systematic Review and Meta-Analysis.

PURPOSE: This study aimed to synthesize evidence on transarterial embolization (TAE) for adhesive capsulitis and related shoulder tendinopathies to quantify pooled changes in pain, range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) scores, and safety outcomes.

MATERIALS AND

METHODS

A systematic review identified eligible cohort studies. PubMed and Scopus were searched through March 30, 2025. Standardized mean change with raw-score standardization (SMCR) was pooled with random-effects models for pain scores. ROM and ASES scores were pooled using raw mean changes. Heterogeneity (I2), influence analyses, and Egger tests quantified robustness and publication bias.

RESULTS

Twelve single-arm studies (329 shoulders; mean age, 54 years [SD ± 10]; 67% women) met the inclusion criteria. Adhesive capsulitis accounted for 84% of cases. For pain, SMCR was -1.48 at 15-30 days, -2.51 at 31-90 days, and -2.59 at 91-180 days (P < .0001). For ROM, the pooled raw external rotation angles increased by +11.67°, +25.78°, and +36.47° at the same intervals (P < .05). ASES scores rose by 22.94, 38.39, and 58.79 points at the 3 time windows (P < .05). Technical success was 100%. Of 94 recorded adverse events, 87 were mild and 7 were moderate; no severe events were reported per the Society of Interventional Radiology (SIR) guidelines.

CONCLUSIONS

TAE yields large improvements in pain, shoulder mobility, and function with an favorable safety profile for refractory adhesive capsulitis and shoulder tendinopathies. Evidence is limited by uncontrolled designs, short follow-ups, and high heterogeneity, highlighting the need for randomized controlled trials.