For patients dealing with persistent frozen shoulder, finding the right treatment isn’t always straightforward. Physical therapy, medications, and injections can help, but some patients continue to experience significant pain and stiffness despite these treatments. When that happens, there are several procedures to consider, each working in a different way.
A new study co-authored by Joint & Vascular Institute physicians Dr. Mikin Patel and Dr. Osman Ahmed compared three treatment options for frozen shoulder, including the minimally invasive procedure known as shoulder artery embolization (SAE). The findings suggest that the most effective approach may depend on whether pain or limited shoulder movement is the patient’s primary concern.
What Is Frozen Shoulder?
Frozen shoulder, medically known as adhesive capsulitis, develops when the tissue surrounding the shoulder joint becomes inflamed, thickened, and tight.
Symptoms typically include:
- Persistent shoulder pain
- Increasing stiffness
- Difficulty raising or rotating the arm
- Pain that may become worse at night
- Trouble with everyday activities such as dressing, reaching, or driving
Frozen shoulder often progresses through stages. Pain and inflammation may be especially prominent earlier in the condition, while stiffness and restricted movement can become more significant as the shoulder capsule tightens.
Treatment usually begins conservatively with options such as physical therapy, medications, and injections. When symptoms continue despite these treatments, additional procedures may be considered.
What Did the New Frozen Shoulder Study Compare?
The 2026 study published in CardioVascular and Interventional Radiology analyzed findings from previously published research involving three procedures for frozen shoulder that had not responded to conservative treatment. Rather than directly testing the procedures against one another, researchers compared the available evidence to better understand their effectiveness, safety, and overall costs.
Transarterial embolization (TAE): Also called shoulder artery embolization (SAE), this minimally invasive procedure targets abnormal blood vessels associated with inflammation around the painful shoulder.
Manipulation under anesthesia (MUA): The patient is placed under anesthesia while the shoulder is carefully moved to stretch and release the tightened joint capsule.
Arthroscopic capsular release (ACR): A surgeon uses small instruments inserted into the shoulder to cut and release tight portions of the joint capsule.
Researchers compared outcomes including pain relief, shoulder movement, complications, additional procedures, and overall cost-effectiveness.
The findings differed depending on whether success was measured by pain relief or improved shoulder movement.
Embolization Showed the Greatest Improvement in Pain
When researchers looked specifically at pain, embolization produced the largest average improvement at three months.
On a 10-point pain scale, the average reduction was:
- 5.13 points with embolization
- 4.53 points with arthroscopic capsular release
- 4.25 points with manipulation under anesthesia
Using the available study data, researchers also estimated the percentage of patients who would achieve mild pain levels within three months. Embolization had the highest estimated success rate at 73.3%, compared with 61.4% for arthroscopic capsular release and 55.5% for manipulation under anesthesia.
Based on pain relief, the researchers’ economic model found embolization could be a cost-effective treatment option, particularly when performed in an outpatient setting.
Pain Isn’t the Only Problem With Frozen Shoulder
The findings also highlight an important distinction between treating shoulder pain and restoring movement.
For some people, pain is the biggest problem. For others, the shoulder has become so stiff that limited movement is the primary concern.
When researchers looked specifically at improvement in range of motion, manipulation under anesthesia and arthroscopic capsular release produced greater gains than embolization.
Manipulation and capsular release physically address the tight shoulder capsule responsible for restricted movement. Embolization works differently: it targets abnormal blood flow and inflammation believed to contribute to pain.
In other words, one treatment isn’t necessarily “better” for every person with frozen shoulder. The underlying problem and the patient’s symptoms matter.
How Does Shoulder Artery Embolization Work?
Chronic inflammation around the shoulder can be associated with the development of abnormal microscopic blood vessels. These vessels may contribute to inflammation and persistent pain.
Shoulder artery embolization is designed to reduce this abnormal blood flow.
During the procedure, an interventional radiologist guides a very small catheter through an artery toward the blood vessels supplying the painful area of the shoulder. Using real-time imaging, the physician identifies abnormal blood flow and delivers embolic material to carefully selected vessels.
The goal is to decrease inflammation and pain while preserving normal circulation around the shoulder.
Unlike shoulder surgery, the procedure does not require an incision into the shoulder joint. It can be performed on an outpatient basis, and patients typically return home the same day.
What About Safety?
The study found an important distinction between overall side effects and serious complications.
Embolization had a higher overall rate of reported adverse events, but these were generally minor. Across the embolization studies included in the analysis, no serious adverse events were reported.
Serious adverse events were reported at low rates following both manipulation under anesthesia and arthroscopic capsular release.
As with any medical procedure, shoulder embolization still carries risks, and individual results can vary. The findings should be considered alongside a patient’s overall health, symptoms, and treatment goals.
The Cost-Benefit of Outpatient Treatment
The study didn’t only examine which treatment worked. Researchers also asked whether the benefits justified the costs.
When embolization was modeled in an office-based outpatient setting, its estimated cost-effectiveness improved substantially compared with treatment in a hospital outpatient department.
For patients, this highlights one potential advantage of minimally invasive procedures that can be performed outside the hospital. The treatment setting can influence overall care costs without changing the procedure itself.
At Joint & Vascular Institute, minimally invasive image-guided procedures are performed in a specialized outpatient environment designed to provide advanced care without the complexity of a hospital setting.
What Does This Research Mean for Someone With Frozen Shoulder?
Perhaps the biggest takeaway isn’t that everyone with frozen shoulder should receive the same treatment; it’s that treatment should match the problem.
If pain and inflammation are the dominant symptoms, shoulder artery embolization may offer a minimally invasive way to address the abnormal blood flow associated with that inflammation.
If severe mechanical stiffness and loss of motion have become the primary problem, a treatment that physically releases the tightened shoulder capsule may be more appropriate.
The stage of frozen shoulder may also matter. The study’s authors noted that embolization may be particularly relevant when pain and inflammation predominate, while mechanical treatments may have advantages later when fixed stiffness becomes more prominent.
A careful evaluation can help determine where a patient falls along that spectrum.
JVI Physicians Helped Author the Research
This study is especially meaningful to Joint & Vascular Institute because two of its physicians, Dr. Mikin Patel and Dr. Osman Ahmed, were co-authors.
Their involvement reflects JVI’s broader commitment to advancing research in minimally invasive, image-guided treatments for joint pain.
JVI’s physicians don’t simply offer newer procedures. They participate in research that helps physicians understand which patients are most likely to benefit, how these treatments compare with existing options, and where they fit into patient care.
For people with frozen shoulder, that research is helping move treatment away from a one-size-fits-all approach and toward care based on the symptoms that are actually limiting a patient’s life.
Finding the Right Treatment for Frozen Shoulder
If shoulder pain and stiffness continue despite physical therapy, medications, or injections, there may be additional treatment options worth exploring.
Joint & Vascular Institute offers minimally invasive shoulder artery embolization for select patients with persistent frozen shoulder in the Chicago and Libertyville, IL, area. Our physicians can help determine whether this treatment is appropriate based on your symptoms, medical history, and previous treatments.
Request a consultation to discuss your shoulder symptoms and learn more about your treatment options.
Frequently Asked Questions About Frozen Shoulder and SAE
Is shoulder artery embolization surgery?
No. Shoulder artery embolization is a minimally invasive, catheter-based procedure. It does not require an incision into the shoulder joint or surgical removal of tissue.
Can shoulder embolization improve both pain and movement?
Research has found improvements in both pain and shoulder function following embolization. However, this study found a larger advantage for embolization when success was based on pain relief. Manipulation under anesthesia and arthroscopic capsular release produced greater improvements when success was based specifically on range of motion.
Who may be a candidate for shoulder artery embolization?
SAE may be considered for select patients with persistent frozen shoulder symptoms that have not improved sufficiently with conservative treatments. An evaluation is necessary to confirm the cause of shoulder pain and determine whether inflammation, mechanical stiffness, or another problem is primarily responsible.
Does everyone with frozen shoulder need a procedure?
No. Many people improve with conservative treatments such as physical therapy, medications, activity modification, and injections. Procedures are generally considered when symptoms persist despite appropriate conservative care.