Wrist embolization is offered after repeated corticosteroid injections have failed. It acts on the underlying pathophysiological mechanism — pathological neovascularisation — and not only on the superficial inflammation, providing more lasting relief.
What are the expected benefits?
- Lasting relief in 65 to 75% of cases at 6 months (e.g. De Quervain tenosynovitis)
- Outpatient treatment under local anaesthesia, discharge the same day
- No mandatory splint, resumption of hand activities within 48-72h
- Acts on the underlying pathophysiological mechanism (neovascularisation), not just on the inflammation
- Repeatable technique in case of partial response
Indications for wrist embolization
- Refractory tenosynovitis: chronic inflammation of the wrist tendon sheaths resistant to injections and physiotherapy (De Quervain tenosynovitis, flexors, extensors)
- Chronic radiocarpal or midcarpal arthritis with synovitis visible on MRI
- Refractory carpal tunnel syndrome with a documented inflammatory synovial component
- Rheumatoid arthritis localised to the wrist during a flare refractory to disease-modifying treatment
- Post-traumatic arthropathy of the wrist with persistent chronic pain
Pathological neovascularisation of the painful wrist
The tendons and synovium of the chronically inflamed wrist develop pathological neovessels (on Doppler ultrasound: intra-tendinous or intra-synovial Doppler signal that is absent in the normal joint). These neovessels, accompanied by sensory nerve fibres, are responsible for chronic pain and local hypersensitivity.
This mechanism, well established in Achilles tendinopathy and tennis elbow, applies successfully to wrist tenosynovitis and synovitis. Embolizing the arteries feeding these neovessels cuts off their blood supply and leads to their progressive regression.
The wrist arteries targeted by embolization
The arterial network of the wrist is complex. Embolization targets the distal branches of the radial and ulnar arteries depending on the location of the synovitis:
- Dorsal branches of the radial artery: for extensor tenosynovitis and dorsal radiocarpal arthritis
- Branches of the palmar arch: for flexor tenosynovitis and palmar radiocarpal arthritis
- Recurrent branches of the ulnar artery: for midcarpal and ulnar synovitis
Catheterisation precision is critical at this level to avoid any risk of digital ischaemia. It requires specific expertise in vascular interventional radiology.
De Quervain tenosynovitis (inflammation of the abductor pollicis longus and extensor pollicis brevis tendons) is one of the most studied indications for wrist embolization. After injections have failed, embolization of the distal radial artery and its tendinous branches provides significant relief in 65 to 75% of cases at 6 months.
Doppler ultrasound of the wrist to document the intra-tendinous or synovial vascular signal. Wrist MRI depending on location. PRWE (Patient-Rated Wrist Evaluation) questionnaire at baseline.
Radial or femoral access. Wrist arteriography. Hyperselective catheterisation of the arterial branches feeding the inflamed area. Injection of calibrated microspheres (75-150 µm). Duration: 45 to 75 minutes.
Monitoring for 2-4h after the procedure. Mild local pain possible for 24-48h. Gradual resumption of hand activities within 48-72h. No mandatory splint.
Follow-up at 6 weeks, then at 3 and 6 months. PRWE and VAS questionnaires. Optional control Doppler ultrasound at 3 months.
What are the possible after-effects and complications?
Les complications sont les suivantes :
| Complication | Description | Fréquence |
|---|---|---|
| Haematoma at the puncture site | Spontaneous resolution | < 3 % |
| Douleur transitoire | 24 to 48h, simple analgesics | Common |
| Digital ischaemia | Exceptional, prevented by the precision of hyperselective catheterisation | Exceptionnelle |
| No improvement | Discussion d'alternatives | 25–35 % |
What are the limits of the treatment?
Improvement is progressive over several weeks. In 25 to 35% of cases, the result is insufficient and other options (a further injection, surgery) may be discussed.
What other techniques and alternatives are possible?
💉 Corticosteroid injections
First-line treatment, with an often transient effect in case of recurrence.
🧤 Splint / rest
Splint immobilisation and activity modification for milder forms.
🏥 Surgery
Surgical release of the tendon sheaths (De Quervain) or synovectomy depending on the indication.
💊 Disease-modifying treatment
For rheumatoid arthritis, optimisation of disease-modifying treatment in coordination with the rheumatologist.
What if I decide not to have the treatment?
You remain entirely free in your decision. Your doctor will discuss the alternatives with you: injections, a splint, surgery, or optimising disease-modifying treatment depending on your situation.
Frequently asked questions
Is wrist embolization suitable for De Quervain tenosynovitis?
What are the risks of wrist embolization?
Is embolization possible for carpal tunnel syndrome?
How long does the benefit of wrist embolization last?
Is wrist embolization reimbursed?
Knee, ankle, wrist, shoulder, epicondyle: complete guide to joint embolization at Cochin AP-HP.