Key facts
- What frozen shoulder is: adhesive capsulitis — progressive pain and stiffness from inflammation and fibrosis of the shoulder joint capsule, restricting both active and passive movement.
- Current treatments have real downsides: hydrodilatation can be genuinely painful during and after the injection; manipulation under anaesthesia carries fracture and rotator cuff injury risk; arthroscopic release is major surgery.
- What TAME offers: a day-procedure, image-guided option that targets the abnormal blood vessel growth in the inflamed capsule — without forceful joint manipulation or a general anaesthetic.
- Evidence status: a growing evidence base — including a 2025 cohort of 128 procedures showing significant pain and mobility improvement — but still short of large randomised trials, with one now underway.
Frozen shoulder is one of those conditions where the available treatments can be almost as unpleasant as the condition itself. Hydrodilatation — forcibly stretching an already tight, inflamed joint capsule with fluid under pressure — is often genuinely painful. Manipulation under anaesthesia involves a surgeon physically forcing the joint through its restricted range while the patient is under general anaesthesia. For patients who don't respond to the standard pathway, transcatheter arterial microembolization (TAME) has emerged as a considerably gentler alternative worth understanding — building on the same principle behind TAME for chronic tendinopathy.
What's actually happening in a frozen shoulder
Frozen shoulder — adhesive capsulitis — is a condition of the joint capsule, the fibrous envelope surrounding the shoulder joint, rather than the tendons or bone. In a healthy shoulder, this capsule is loose and elastic, allowing the wide range of motion the joint is known for. In adhesive capsulitis, the capsule becomes progressively thickened, inflamed, and contracted — particularly the rotator interval and coracohumeral ligament at the front of the joint.
At a tissue level, this involves synovial inflammation, fibroblastic proliferation, and increased deposition of type III collagen, which is less organised and less elastic than the mature collagen it replaces. As with chronic tendinopathy, the inflamed capsule also develops abnormal new blood vessel growth (neovascularisation) — and this hypervascularity is thought to carry accompanying sensory nerve fibres into the tissue, contributing directly to pain, particularly the characteristic nighttime pain many patients describe.
Frozen shoulder is more common in people with diabetes — often more severe and slower to resolve in this group — and is also associated with thyroid disease, Dupuytren's contracture, and prolonged shoulder immobilisation (after surgery, a stroke, or a fracture, for example). In many cases, no clear trigger is ever identified.
Clinical features and the three stages
Frozen shoulder classically progresses through three overlapping stages, though the boundaries between them aren't always clear-cut in an individual patient:
| Stage | What's happening |
|---|---|
| Freezing (painful) | Progressive pain, often worse at night, with gradually increasing stiffness. Typically lasts 2–9 months. |
| Frozen (stiff) | Stiffness becomes the dominant problem; pain often lessens somewhat but significant restriction in both active and passive range of motion remains, especially external rotation. Typically lasts 4–12 months. |
| Thawing (recovery) | Gradual, often slow return of movement. Can take a further 12–24 months, and a meaningful proportion of patients don't fully return to their prior range of motion. |
A key clinical distinguishing feature: unlike a rotator cuff tear or subacromial impingement, frozen shoulder restricts both active and passive movement — the shoulder is stiff even when someone else moves it for you, not just when the patient tries to move it themselves. The overall condition has traditionally been described as "self-limiting," typically resolving within one to three years, but more recent reviews of its natural history have questioned how universally true that is — a meaningful proportion of patients are left with some degree of persistent stiffness or discomfort well beyond that window.
Current treatments — and why they can be difficult
Physiotherapy and analgesia
The foundation of treatment throughout all three stages, though aggressive stretching during the acutely painful freezing stage can flare symptoms rather than help, and progress can be frustratingly slow.
Corticosteroid injection
Effective for pain, particularly in the freezing stage, but the effect on stiffness is more limited, and benefits can be temporary. Repeated steroid injections carry the same downsides discussed in our tendinopathy article — including transient blood glucose elevation, relevant for the many frozen shoulder patients who also have diabetes.
Hydrodilatation (distension arthrography)
This is often the most physically uncomfortable of the standard non-surgical options. A relatively large volume of fluid — saline, contrast, local anaesthetic and often a corticosteroid — is injected into the joint under image guidance, deliberately building up pressure within the already-tight, inflamed capsule to stretch or partially rupture it. Because the capsule is contracted and inflamed to begin with, this pressure build-up is frequently painful during the injection itself, and a flare of discomfort in the following day or two is common, even though local anaesthetic is used throughout.
Manipulation under anaesthesia (MUA)
The joint is forcibly moved through its restricted range by the surgeon while the patient is under general anaesthesia, physically tearing through capsular adhesions. It requires a general anaesthetic and hospital admission, and carries a small but real risk of humeral fracture, rotator cuff tear, or dislocation — the joint is still recovering from a genuinely traumatic manipulation once the patient wakes up, even though they weren't conscious for it.
Arthroscopic capsular release
Reserved for the most refractory cases — formal keyhole surgery to surgically divide the contracted portions of the capsule, requiring general anaesthesia and a proper surgical recovery.
Where TAME fits in
Transcatheter arterial microembolization targets the abnormal blood vessel growth within the inflamed shoulder capsule, using the same catheter-based technique and, in much of the published literature, the same imipenem/cilastatin embolic agent described in our article on TAME for tendinopathy. A thin catheter is guided from a small access point at the wrist or groin to the small arteries supplying the affected part of the capsule, and a temporary embolic agent is released to reduce blood flow to that specific hypervascular tissue.
It's performed under local anaesthetic as a day procedure — no general anaesthetic, no forceful manipulation of an already painful joint, and none of the pressure-related discomfort of hydrodilatation. It doesn't physically break down the contracted capsule the way MUA or arthroscopic release does; instead, it targets the abnormal vascular and inflammatory process that's thought to be driving both the pain and, potentially, the ongoing fibrotic process itself.
What's genuinely interesting here: a 2023 study using FDG-PET/CT imaging — which measures metabolic activity, a marker of inflammation — found that TAE reduced chronic inflammatory activity within the shoulder joint after treatment, not just the patient's reported pain score. That's a step beyond simply masking symptoms, and supports the underlying rationale that embolization is doing something to the inflammatory process itself.
What the outcome data shows: a 2025 retrospective study of 128 procedures in 118 patients with adhesive capsulitis resistant to conventional treatment (using an imipenem/cilastatin suspension) found significant pain reduction at 6 months (VAS improving from 7.8 to 2.2) alongside improved shoulder flexion and abduction. A 2025 systematic review and meta-analysis pooling 12 studies and 329 shoulders found sustained pain improvement from 15 days out to beyond 90 days post-procedure.
What's still developing: an earlier 2021 review found only three full-text studies meeting inclusion criteria and explicitly noted a lack of clear guidance on patient selection — the evidence base has grown substantially since then, but remains short of large randomised controlled trials. A randomised feasibility trial is now underway to help close that gap.
Who tends to be a candidate
TAME for frozen shoulder is generally considered for patients who:
- Have a confirmed diagnosis of adhesive capsulitis with persistent pain, particularly nighttime pain, despite an adequate trial of physiotherapy and at least one corticosteroid injection
- Want to avoid, or have already tried without success, hydrodilatation or manipulation under anaesthesia
- Are looking for an option that doesn't require a general anaesthetic
As with tendinopathy embolization, suitability depends on individual imaging and clinical assessment — this is a genuinely emerging technique, and appropriate patient selection matters more here than with better-established procedures.
In plain terms — a guide for patients
Here's the same information without the medical detail, plus what's worth asking about.
What's actually going on
A frozen shoulder isn't just painful — the lining of the joint has thickened and tightened up, like a jacket that's shrunk. That's why it's genuinely stiff, not just sore: even if someone else tries to move your arm for you, it won't go. Alongside that tightening, the joint lining develops extra, abnormal blood vessels — and these seem to carry pain fibres with them, which is a big part of why frozen shoulder can be so painful, especially at night.
Why the usual treatments can be rough
It's worth knowing this upfront: some of the standard treatments for frozen shoulder are uncomfortable by design. Hydrodilatation involves pumping fluid into an already tight joint to stretch it open, which is often painful at the time. Manipulation under anaesthesia means a surgeon forcibly moves your stiff shoulder while you're asleep — you won't feel it happen, but your shoulder has still been through something forceful, and it can be sore and swollen afterwards.
What TAME does differently
TAME is a day procedure done under local anaesthetic — you're awake, but the area is numbed. A thin tube is guided through the blood vessels, usually starting at the wrist or groin, up to the small arteries feeding the inflamed part of the shoulder capsule. A tiny amount of material calms down that abnormal blood supply. There's no forceful stretching or manipulation of the joint involved, and no general anaesthetic.
What it's realistically used for right now
It's an option worth discussing if you've had ongoing shoulder pain and stiffness despite physio and at least one steroid injection, particularly if you're keen to avoid a general anaesthetic or a forceful manipulation. The evidence for it is growing — recent studies have shown real improvement in pain and movement — but it's still a newer technique than hydrodilatation or manipulation, so it's usually considered once those more established options haven't worked, rather than as a first step.
Questions worth asking your doctor
- Which stage of frozen shoulder am I likely in, and does that change what's worth trying next?
- Have I had an adequate trial of physiotherapy and at least one steroid injection already?
- What would hydrodilatation or manipulation under anaesthesia actually involve for me, including the recovery?
- Would TAME be a reasonable option before those, or only if they don't work?
- How much evidence is there for TAME in frozen shoulder specifically, compared with the more established options?
- What would recovery from TAME look like, and how soon would I know if it's helped?
Next step
Dealing with a frozen shoulder that won't budge?
Ask your GP about a referral, or get in touch directly to discuss whether TAME applies to your situation.
Get in touch- Okuno Y, Yasumoto T, Koganemaru M, et al. Clinical outcomes of transcatheter arterial embolization for adhesive capsulitis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28:161-167.
- Shintaku T, Inui S, Ikegami H, et al. Transarterial embolization of neovascularity for refractory nighttime shoulder pain: a multicenter, open-label, feasibility trial. J Vasc Interv Radiol. 2022;33:1468-1475.
- Shintaku T, Inui S, Ikegami H, et al. Alteration of chronic inflammatory status by transarterial embolization in frozen shoulder evaluated by fluorine-18 fluorodeoxyglucose positron-emission tomography/computed tomography. J Shoulder Elbow Surg. 2023;32:e227-e234.
- Clinical Outcomes of Shoulder Artery Embolization for Adhesive Capsulitis. Cardiovasc Intervent Radiol. 2025.
- Allaw S, Khabaz K, Yu Q, Ahmed O. Transarterial embolization for refractory adhesive capsulitis and related tendinopathies: a systematic review and meta-analysis. J Vasc Interv Radiol. 2025.
- Okuno Y, Matsumura N, Oguro S. Transcatheter arterial embolization using imipenem/cilastatin sodium for tendinopathy and enthesopathy refractory to nonsurgical management. J Vasc Interv Radiol. 2013;24:787-792.
- Wong CK, Levine WN, Deo K, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017;103:40-47.