Transarterial Embolization for Musculoskeletal Pain Management: AJR Expert Panel Narrative Review

Musculoskeletal embolization has emerged in recent years as a treatment of chronic joint pain, as the inflammatory cascade responsible for such pain has become better understood. Studies have shown a complex interplay between joint inflammation and synovial hypervascularity that causes growth of new unmyelinated nerve fibers responsible for pain. Embolization targets joint hypervascularity to disrupt the inflammatory cycle and provide pain relief. The standard treatment algorithm for chronic joint pain is well established and entails escalating therapeutic options that include exercise, self-management programs, analgesic medications, intraarticular injections, and finally surgical replacement or release. Genicular artery embolization (GAE), targeting abnormal vasculature around the knee joint, is the most studied musculoskeletal embolization procedure, reflecting the high worldwide prevalence and increasing incidence of knee osteoarthritis (OA). GAE is now supported by multiple prospective studies, including randomized controlled trials comparing GAE versus sham treatment. Embolization has also extended outside of the knee joint to include the shoulder (treatment of adhesive capsulitis or secondary stiff shoulder), elbow (medial or lateral epicondylitis), hip (OA, great trochanteric pain syndrome), and ankle (plantar fasciitis). This AJR Expert Panel Narrative Review discusses the current status of transarterial embolization for musculoskeletal pain management, focusing on treatment of knee OA and chronic shoulder pain.