23 - Frozen Shoulder, Warm Results: Trends & Outcomes for Adhesive Capsulitis Embolization

Purpose: Adhesive capsulitis embolization (ACE) has recently emerged as a novel image-guided therapy for frozen shoulder. We evaluated real-world clinical outcomes of ACE and temporal utilization trends across a large federated electronic health record (EHR) network.

Materials and Methods: The TriNetX Research Network was queried for patients diagnosed with adhesive capsulitis of the shoulder (ICD-10-CM: M75.0). ACE was defined as M75.0 followed by arterial embolization procedures, requiring CPT 37242 (vascular embolization or occlusion, arterial, non-hemorrhage, non-tumor) and CPT 75774 (selective angiography, each additional vessel studied), in combination with at least one of the following codes: CPT 36216 (selective catheter placement, second-order thoracic or brachiocephalic branch), CPT 36217 (third-order or more thoracic/brachiocephalic branch), CPT 36218 (additional second/third-order thoracic/brachiocephalic branch), or CPT 75710 (unilateral extremity angiography). Among adhesive capsulitis patients, ACE annual incidence proportion and prevalence were calculated from 2015 to 2024. Furthermore, ACE patients were evaluated for one-year post-procedural outcomes, including repeat embolization, arthroscopy (29806/29825), manipulation under anesthesia (23700), and joint injections (20610/20611). Risk analyses were conducted.

Results: Of 433,078 patients with adhesive capsulitis, ACE incidence proportions were < 0.05% annually, peaking at 0.037% during 2015–2020 and stabilizing at 0.009–0.016% during 2021–2024. Prevalence increased from 0.039% (2015–2020) to 0.074% (2024). Among 111 ACE patients (mean age 66.1 years, 54% male, 46% female, 16% Black, 9% Hispanic, 72% White), prior interventions included intra-articular injection (53%), manipulation under anesthesia (9%), and arthroscopic capsular release (9%). At 1-year, no patients required arthroscopy or manipulation under anesthesia. Fourteen patients (12.6%) underwent a composite repeat intervention (including embolization, injection, or related procedures).

Conclusion: Adoption of ACE demonstrated modest growth over the past decade with zero surgical conversions including manipulation under anesthesia or capsular release. Re-intervention was required in 12.6% of patients within one year. These findings confirm ACE remains an emerging treatment for adhesive capsulitis and has potential as a surgery-sparing therapy. Further prospective studies are warranted to demonstrate long-term efficacy, durability, and optimal patient selection.