Transarterial embolization in the management of chronic shoulder pain: clinical evidence and emerging therapeutic role

Chronic shoulder pain is a prevalent and disabling condition encompassing diverse pathologies such as adhesive capsulitis, tendinopathy, enthesopathy, and trapezius myalgia. These disorders share multifactorial mechanisms involving chronic inflammation, angiogenesis, and neurogenic sensitization, leading to persistent pain and functional limitation. Recent insights into the vascular basis of shoulder pain have highlighted pathological neovascularization as a potential therapeutic target. This narrative review explores the role of transarterial embolization (TAE) as a minimally invasive treatment option for chronic shoulder pain refractory to conservative management. Adhesive capsulitis, characterized by capsular fibrosis and restricted motion, demonstrates significant pain reduction and improved range of motion following TAE, with technical success rates approaching 100% and minimal adverse events. Similarly, rotator cuff tendinopathy and trapezius myalgia have shown marked improvement in pain and function, confirming the role of TAE in disrupting pathological neovascular and neurogenic pathways. Various embolic agents, including imipenem/cilastatin sodium, polyethylene glycol, and calibrated microspheres, have been used with favorable safety profiles, though concerns regarding antibiotic resistance warrant further evaluation. Overall, current evidence supports TAE as a safe, effective, and joint-preserving alternative to surgery for patients with chronic shoulder pain of vascular-inflammatory origin. While the literature demonstrates consistent improvements in pain scores and functional outcomes, large-scale randomized controlled trials remain necessary to validate these findings and establish standardized treatment protocols.