What is Musculoskeletal embolisation (MSK Embolisation)?
MSK embolisation is a minimally invasive interventional radiology procedure used to ease pain and reduce inflammation arising from certain joint and tendon conditions. It works by targeting the abnormal blood vessels thought to contribute to chronic pain, helping to improve symptoms without the need for major surgery.
Musculoskeletal pain is a common cause of disability, particularly in older adults. Many people live with long-standing discomfort, while others depend on medication, physiotherapy, or even surgery to manage their symptoms. As interest grows in safer, less invasive options, embolotherapy is becoming an increasingly popular choice for treating MSK pain.
Conditions that MSK embolisation is used to treat include:
MSK embolisation is used for a range of joint and tendon problems linked with chronic pain and inflammation.
- Knee osteoarthritis: This is the most widely studied use of the technique, especially in mild to moderate disease. The procedure, known as genicular artery embolisation (GAE), targets abnormal blood vessels in the synovial membrane to help relieve pain and improve movement.
- Hand osteoarthritis: MSK embolisation can also be used to treat painful finger joints, as well as arthritis affecting the trapeziometacarpal (TM) joint at the base of the thumb.
- Tendinopathies (chronic tendon pain): MSK embolisation can be used to treat long-standing pain in a number of tendons like:
- Sports-related injuries: The procedure is helpful for conditions such as tennis elbow, patellar tendinopathy (jumper’s knee), and Achilles tendinopathy. By targeting the inflamed areas, it helps reduce pain and supports a quicker return to activity.
- Rotator cuff tendinopathy: In this condition, chronic inflammation leads to the development of abnormal blood vessels and new pain-sensing nerve fibres.
MSK embolisation:
- Identifies these abnormal vessels using detailed imaging and angiography.
- Delivers tiny particles or a temporary embolic agent through a small catheter to block blood flow to the affected area.
- Helps interrupt the inflammatory cycle and limits the formation of new sensory nerves, reducing pain and aiding recovery.
- High hamstring tendinopathy: Here, the technique blocks the small, abnormal vessels that form around a chronic injury and contribute to ongoing pain and inflammation.
- Plantar fasciitis: For persistent plantar fasciitis that has not responded to other treatments, MSK embolisation decreases the abnormal blood supply to the inflamed plantar fascia, helping to relieve pain and promote healing.
Important information
How MSK embolisation works
The procedure begins with a small nick in the skin, through which a microcatheter is inserted into the artery supplying the affected joint or tendon. A dye is then injected to highlight abnormal blood vessels, followed by the infusion of tiny particles to block these vessels and reduce inflammation.
What are the benefits of MSK Embolisation?
MSK embolisation can help relieve chronic pain by reducing synovial inflammation the process that drives long-term joint discomfort.
Other key benefits include:
- Minimally invasive: The procedure avoids major surgery.
- Outpatient procedure: Typically performed without an overnight hospital stay.
- Quick recovery: Most patients return to normal activities rapidly.
- Targeted pain relief: Focuses treatment precisely on the affected area.
Long-lasting results: Can provide sustained improvement in pain and function.
What are the risks of MSK Embolisation?
As with any medical procedure, MSK embolisation carries some risks. These may include:
- Allergic reaction to the dye or materials used
- Bleeding at the catheter insertion site
- Infection at the catheter site
- Lack of improvement or failure of the procedure to relieve pain
Why have the procedure?
Musculoskeletal embolisation has emerged as a treatment for chronic joint pain as understanding of the underlying inflammatory processes has advanced. Research shows that chronic joint pain often involves a cycle of inflammation and increased blood vessel growth (synovial hypervascularity), which stimulates new pain-sensing nerve fibres. Embolisation targets this abnormal blood vessel growth, helping to interrupt the inflammatory cycle and provide pain relief.
The standard approach to chronic joint pain follows a stepwise treatment pathway, including exercise, self-management programmes, medications, injections, and, if necessary, surgery. MSK embolisation offers a minimally invasive alternative before surgical options are considered.
- Genicular artery embolisation (GAE):
GAE, which treats abnormal blood vessels around the knee, is the most widely studied MSK embolisation procedure. This reflects the high global prevalence of knee osteoarthritis. Multiple prospective studies support its use, although results from randomised controlled trials comparing GAE to sham procedures have been mixed.
- Other applications:
Embolisation is increasingly being used beyond the knee, including:
- Shoulder: Adhesive capsulitis or secondary stiff shoulder
- Elbow: Medial or lateral epicondylitis (tennis or golfer’s elbow)
- Hip: Osteoarthritis and greater trochanteric pain syndrome
- Ankle: Chronic plantar fasciitis
This makes MSK embolisation a versatile, minimally invasive option for managing chronic pain in various joints and tendons.