MSK Embolisation

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MSK Embolisation

Welcome to MSK Embolisation

Professor Mark Little

Consultant Interventional Radiologist
Royal Berkshire Hospital
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Dr Nimit Goyal

Consultant Interventional Radiologist
The Grange University Hospital
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Musculoskeletal pain continues to be a leading cause of disability among aging patients in the world. Many patients live with chronic pain and others rely on drugs, physical therapy, invasive surgeries, and more to get relief. The increasing preference among patients for minimally invasive procedures coupled with the potential of these techniques is leading to a surge in interest in embolotherapy as a safe and minimally invasive procedure to treat MSK pain.

Osteoarthritis
Sports Elbow
Frozen Shoulder
Wrist Joint

Musculoskeletal (MSK) embolisation is a minimally invasive procedure that treats chronic pain and inflammation in joints and tendons:

How it works

A small nick is made in the skin, and a microcatheter is inserted into the artery that supplies the joint or
tendon. A dye is injected to identify abnormal blood vessels, and then tiny particles are infused to block
them.

MSK embolisation can reduce synovial inflammation, which is the inflammatory cascade that causes chronic joint pain.
The most studied MSK embolisation procedure is genicular artery embolisation (GAE), which targets the abnormal vasculature around the knee joint. MSK embolisation has also been used to treat elbow pain caused by lateral epicondylitis, also for Frozen Shoulder
Possible risks include allergic reaction, bleeding at the catheter site, infection at the catheter site, and failure of the procedure.

Yuji Okuno is an award-winning researcher who has pioneered MSK embolisation research, including developing temporary embolic material to combat pain and inflammation.

Overview of Musculoskeletal Pain and Pain Relief Procedures
Abnormal vessels in inflamed tissues promote nerve cell growth and cause musculoskeletal pain.

Musculoskeletal Pain

Embolisation by targeting abnormal vessels during the MSKE procedure.

Procedure

After abnormal vessels are occluded

Pain Relief

Musculoskeletal Embolisation: A Novel Approach to Chronic Joint Pain Relief
Musculoskeletal embolisation has emerged in recent years as a potential treatment for chronic joint pain, as the inflammatory cascade responsible for such pain has become better understood. Studies have demonstrated a complex interplay between joint inflammation and synovial hypervascularity that causes growth of new unmyelinated nerve fibres responsible for pain. Embolisation 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, intra-articular injections, and finally surgical replacement or release. Genicular artery embolisation (GAE), targeting abnormal vasculature around the knee joint, is the most widely studied musculoskeletal embolisation procedure, reflecting the high worldwide prevalence and increasing incidence of knee osteoarthritis. GAE is now supported by multiple prospective studies, with heterogenous outcome from randomized control trials comparing GAE versus sham treatment. Embolisation has also extended outside of the knee joint to include the shoulder (treatment of adhesive capsulitis or secondary stiff shoulder), elbow (medial/lateral epicondylitis), hip (osteoarthritis, great trochanteric pain syndrome), and ankle (plantar fasciitis).

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