In this work the investigators will study the relationship between chronic musculoskeletal pain and abnormal blood flow (neovascularity) around the shoulder, hip and knee. Veterans with as history of chronic shoulder, hip or knee pain and mild/moderate joint degenerative changes will be potential study subjects. Blood flow around joints will be evaluated using perfusion magnetic resonance imaging (MRI). Participants with demonstrably abnormal blood flow around their painful joint will be eligible for enrollment in a pilot study of joint embolization to treat their pain. Participants who choose to not undergo treatment will be re-assessed with MRI after one year to characterize the natural history of joint neovascularity and its relationship to pain.
Participants must be Veterans who receive care in the VA system.
Participants must have a history of chronic pain of the shoulder, hip or knee for at least 1 year.
Participants must have mild to moderate degenerative changes of the painful joint as depicted on prior imaging (X-ray, CT or MRI).
Participants must have undergone at least one failed primary treatment for their chronic pain (e.g. physical therapy, NSAIDs, steroid injection).
Acute injury in the last 12 weeks.
Age under 25.
Severe degenerative changes of painful joint (shoulder, hip or knee).
History of arthroplasty or metallic implant within the painful joint.
Participants will be veterans eligible for care at the VA. Anticipated age range is 25-80. Gender will be predominantly male (approximately 90%), concordant with demographic information of the VA population. Pregnant women, children, vulnerable subjects, study personnel and students will not be eligible for enrollment.
Case-only
Prospective
Shoulder/Hip/Knee Embolization with Embozene Microspheres
DeviceFluoroscopically-guided arterial embolization of synovitis in the painful shoulder, hip or knee.
Primary Clinical Outcome (Hip and Knee, Therapeutic Arm Only)
Composite WOMAC survey score
Primary Clinical Outcome (Shoulder, Therapeutic Arm Only)
Composite WORC survey score
Primary Imaging Outcome (Therapeutic Arm Only)
Quantitative perfusion parameters (Ktrans, mean transit time, fractional extracellular volume, time-to-peak)
Secondary Clinical Outcome (Hip and Knee, Diagnostic Arm Only)
Composite WOMAC survey score
Secondary Clinical Outcome (Shoulder, Diagnostic Arm Only)
Composite WORC survey score
Secondary Imaging Outcome (Diagnostic Arm Only)
Quantitative perfusion parameters (Ktrans, mean transit time, fractional extracellular volume, time-to-peak)
Secondary Imaging Outcome 2 (Diagnostic Arm Only)
Quantitative cartilage mapping parameters (T1rho, T2) in milliseconds averaged over manually segmented cartilage for each joint (shoulder, hip or knee)
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Palo Alto Veterans Institute for Research
Lead sponsor
Varian Medical Systems
Collaborator
