What is adhesive capsulitis (frozen shoulder)?

Adhesive capsulitis is a condition where the shoulder capsule — the connective tissue surrounding the shoulder joint — becomes thickened, tight, and inflamed. This causes pain and severe restriction of movement.

What causes frozen shoulder?

The exact cause is not fully understood, but risk factors include diabetes, thyroid disorders, hormonal imbalances, and prior shoulder injury or surgery. Frozen shoulder affects an estimated 2–5% of the general population and is far more common in people with diabetes, who have a lifetime prevalence of roughly 10–20%. It most often develops between ages 40 and 60.

How is ACE different from traditional frozen shoulder treatments?

Traditional treatments include physical therapy, steroid injections, anti-inflammatory medications, and in severe cases, manipulation under anesthesia or surgery. ACE targets the blood supply driving inflammation, offering a less invasive option.

How long does the ACE procedure take?

The procedure typically takes 1-2 hours. Most patients return home the same day after a brief monitoring period.

When will I notice improvement after ACE?

Many patients notice reduced pain and improved mobility within the first few weeks, and most return to normal activity within about two to five days after the procedure. Continued improvement typically occurs over roughly one to three months as the inflammation resolves and the shoulder capsule begins to loosen.

Do I need physical therapy after ACE?

Gentle physical therapy or home exercises are typically recommended after the procedure to help restore range of motion. Your specialist will provide guidance based on your specific condition.

Is ACE covered by insurance?

Because adhesive capsulitis embolization is still an emerging, largely off-label procedure, many insurers — including Medicare and Medicaid — do not routinely cover it, and coverage varies by plan. Our team verifies your specific benefits before scheduling.

What is the success rate of ACE for frozen shoulder?

In published clinical studies — mostly small, uncontrolled case series — most patients reported meaningful pain relief and improved shoulder function, and reported technical success has been high (roughly 96–100%), with no severe adverse events described to date. However, these studies are small with short follow-up and randomized controlled trials are still needed, so ACE remains an emerging, off-label option rather than a proven standard of care.

Can frozen shoulder come back after ACE treatment?

While recurrence is possible, most patients experience lasting improvement after ACE. If symptoms do return, the procedure can be repeated.

How do I schedule a consultation for adhesive capsulitis embolization?

Scheduling is simple. Dr. Zagum Bhatti will review your shoulder symptoms, previous treatments, and imaging studies to determine if ACE is right for you.

Joint Pain Relief

Restore Shoulder Mobility with Adhesive Capsulitis Embolization

Patients from Vinton, LA are seen at our Port Arthur office. A minimally invasive treatment for frozen shoulder that reduces inflammation, relieves pain, and improves range of motion without surgery.

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Medically reviewed by Zagum Bhatti, M.D. — Board-Certified Interventional Radiologist

Last reviewed: July 4, 2026

Patients from Vinton, LA are seen at our office located at 3300 Jimmy Johnson Blvd, Suite #130, Port Arthur, TX 77642 — 28 miles away.

What Is Adhesive Capsulitis Embolization?

Adhesive capsulitis, commonly known as frozen shoulder, is a condition where the shoulder capsule becomes thickened and inflamed, causing pain and stiffness. Adhesive capsulitis embolization (ACE) is a minimally invasive procedure that targets abnormal blood vessels in the inflamed shoulder capsule. By blocking these vessels with microscopic embolic microspheres, the procedure reduces inflammation and pain, allowing patients to regain mobility. ACE is offered off-label for refractory frozen shoulder and is being studied in a U.S. investigational device exemption (IDE) trial; no FDA approval or Society of Interventional Radiology guideline currently establishes it as standard care. It offers a minimally invasive alternative for patients who have not found lasting relief with physical therapy, steroid injections, or surgery.

Who It's For

Who Can Benefit from Adhesive Capsulitis Embolization?

Frozen shoulder can significantly limit your ability to perform daily tasks such as dressing, reaching, and sleeping comfortably. Patients who have not found relief with conservative treatments may be candidates for this advanced procedure.

Individuals with Frozen Shoulder

If you have limited range of motion in your shoulder and difficulty with everyday movements, ACE may help by reducing the inflammation that causes the shoulder capsule to tighten.

Patients with Nighttime Shoulder Pain

Frozen shoulder often causes significant discomfort at night, making it difficult to sleep. ACE can help reduce pain and improve sleep quality by addressing inflammation at its source.

Individuals Seeking Non-Surgical Options

Many patients prefer to avoid shoulder surgery and its lengthy recovery. ACE offers a minimally invasive alternative that focuses on reducing inflammation through targeted embolization.

Patients Who Have Not Improved with Physical Therapy

When physical therapy, anti-inflammatory medications, or injections have not provided adequate relief, ACE offers a next-step option that targets the underlying inflammatory process.

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Common Symptoms

Adhesive Capsulitis Embolization for Patients with Frozen Shoulder

Frozen shoulder progresses through three stages: freezing (painful), frozen (stiff), and thawing (recovery). Left untreated, this process commonly runs one to three years, and sometimes longer. ACE is an emerging, minimally invasive option that may help reduce pain and support recovery in appropriately selected patients.

Difficulty moving the shoulder in any direction

Shoulder pain that worsens at night

Pain when reaching overhead or behind

Stiffness that limits daily activities

Gradual onset of shoulder tightness

Pain that persists despite rest

ACE is performed by inserting a tiny catheter into an artery in the wrist or groin and advancing it to the shoulder under X-ray guidance. Microscopic particles are then injected to block the abnormal blood vessels fueling inflammation in the shoulder capsule.

The procedure is typically completed within 1-2 hours, and most patients go home the same day and return to normal activity within about two to five days. Gradual improvement in pain and mobility is often noticed within the first few weeks, with continued improvement over roughly one to three months.

If you're experiencing any of these symptoms, schedule a consultation now →

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What to Expect

Safety, Recovery & What to Expect

Adhesive capsulitis embolization is an outpatient, minimally invasive procedure. Because it is still emerging and offered off-label, being fully informed about recovery, side effects, and the current state of the evidence is part of choosing the right treatment.

Recovery

ACE is performed on an outpatient basis with same-day discharge. Access is a pinhole entry at the wrist or groin under local anesthesia with light (conscious) sedation. Most patients return to normal activity within about two to five days, with gradual pain and range-of-motion improvement over roughly one to three months. Physical therapy remains part of recovery — embolization is intended to reduce the inflammation and pain that limit therapy progress, not to replace it.

Side effects and risks

The most common effects are transient access-site soreness and short-lived post-procedure pain flares, with skin redness or itching over the shoulder. Less commonly, temporary skin discoloration over the treated area can occur and usually resolves on its own. Non-target embolization is a rare risk. In published series to date — which are small with short follow-up — no severe adverse events have been reported. Dr. Bhatti reviews your individual risks at consultation.

Evidence and limitations

Reported technical success is high (roughly 96–100%) and early improvements appear generally sustained, but the evidence base is made up of small, uncontrolled studies with short follow-up, and randomized controlled trials are still needed. ACE is offered off-label for this indication; no FDA approval or Society of Interventional Radiology guideline currently establishes it as standard care.

Surgery-Free Option

How Adhesive Capsulitis Embolization Compares with Shoulder Surgery

For selected patients with refractory frozen shoulder who want to avoid manipulation under anesthesia (MUA) or arthroscopic capsular release, ACE is a minimally invasive alternative. This compares procedure characteristics only — no randomized trial has compared ACE head-to-head against surgery, and ACE is not a proven replacement when surgery is indicated.

Pinhole catheter access — no surgical incision

Local anesthesia with light sedation, not general anesthesia

Same-day, outpatient procedure

Return to normal activity within about two to five days

ACE vs. Shoulder Surgery — Procedure Characteristics

	ACE (Non-Surgical)	Arthroscopic Release / MUA (Surgery)
Incision	Pinhole catheter entry (wrist or groin)	Arthroscopic portals / none for MUA
Anesthesia	Local with light sedation	General or regional anesthesia
Hospital stay	Same-day, outpatient	Usually outpatient; general-anesthesia recovery
Return to activity	About 2–5 days; physical therapy continues	Weeks of rehab; physical therapy continues
U.S. regulatory status	Off-label; studied under an IDE trial; no FDA approval or SIR guideline	Established surgical options
Evidence base	Small uncontrolled studies + one U.S. IDE trial; RCTs pending	Long clinical track record
Insurance coverage	Varies / often limited — many payers consider it investigational	Generally covered when indicated

ACE is an emerging option for appropriately selected patients with refractory frozen shoulder — not a proven replacement for surgery when surgery is indicated, and not a cure. Dr. Zagum Bhatti confirms whether it is a reasonable option based on your symptom history and shoulder imaging.

Are You a Candidate for ACE?

If you answer "yes" to any of these questions, you may be a candidate for this treatment.

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Do you have chronic, severe shoulder pain?

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About Your Physician

Zagum Bhatti, M.D.

Board-Certified Interventional Radiologist

Founder & Chief Medical Officer; Interventional Radiologist

Dr. Zagum Bhatti is a board-certified, dual-fellowship-trained interventional radiologist and a former Assistant Professor of Vascular & Interventional Radiology at the University of Texas Health Science Center at Houston (UTHealth). He has dedicated his career to minimally invasive, image-guided procedures that treat serious conditions without open surgery. As Founder and Chief Medical Officer of Seamless Medical Centers, he brings academic-level expertise — including published peer-reviewed research in vascular and interventional radiology — to a community practice in Southeast Texas, making advanced treatments for enlarged prostate, uterine fibroids, knee osteoarthritis, peripheral artery disease, and chronic pain available close to home.

Education & training

B.S., Biochemistry — University of Wisconsin–Milwaukee (2001–2004)
Doctor of Medicine (M.D.) — Medical College of Wisconsin (2004–2008)
Residency, Diagnostic Radiology — Michigan State University College of Human Medicine (2008–2012)
Fellowship, Neuroradiology — Medical College of Wisconsin (2013–2014)
Fellowship, Vascular & Interventional Radiology — Rush University Medical Center (Rush Medical College) (2014–2015)

Board certification & licensure

Board Certified in Interventional Radiology / Diagnostic Radiology, American Board of Radiology — actively maintained in the ABR Continuing Certification (MOC) program
Texas Medical License #Q3852
NPI 1053577890

Selected publications

Portal Venous Interventions: How to Recognize, Avoid, or Get Out of Trouble in Transjugular Intrahepatic Portosystemic Shunt (TIPS), Balloon Occlusion Sclerosis (BRTO), and Portal Vein Embolization (PVE). Techniques in Vascular and Interventional Radiology 2018;21(4):267-287.
Percutaneous Venous Interventions in the Pulmonary Vascular, Central and Peripheral Venous Systems: How to Recognize, Avoid and Treat Complications. Techniques in Vascular and Interventional Radiology 2018;21(4):228-241.
Spontaneous Chyluria Treated with Retrograde Embolization via Direct Thoracic Duct Access at the Left Neck. Journal of Vascular and Interventional Radiology 2019;30(5):772-774.
Management of Vascular Complications of Extra-corporeal Membrane Oxygenation (ECMO). Cardiovascular Diagnosis and Therapy 2018;8(3):372-377.

Read full bio →

Medical Sources

The clinical information on this page is supported by the following peer-reviewed studies and professional medical society guidance.

Allaw S, Khabaz K, Yi Q, Ahmed O — Transarterial embolization for refractory adhesive capsulitis: systematic review and meta-analysis, JVIR (2025) — 329 shoulders; ~100% technical success; no severe adverse events; RCTs needed.
Bagla S et al. — U.S. Investigational Device Study of Adhesive Capsulitis Embolization (ACE Study), JVIR (2022) — PMID 34774930; NCT03676829; U.S. IDE evidence.
Okuno Y et al. — Transcatheter arterial embolization for adhesive capsulitis resistant to conservative treatment, JVIR (2017) — PMID 28007330 — original clinical series.
Adhesive Capsulitis — StatPearls / NIH (NBK532955) — Epidemiology, phases, diabetes association.

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Most major plans accepted, including Medicare/Medicaid — we verify before your visit.