Perfusion MRI-targeted Joint Embolization to Diagnose and Treat Neovascularity Associated With Chronic Musculoskeletal Pain of the Shoulder, Hip and Knee: A Prospective Cohort Study
Palo Alto Veterans Institute for Research
Summary
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.
Description
1. Joint MRI (shoulder, hip, knee) is ordered by a clinical provider due to ongoing/chronic joint pain. At the time of MR exam protocoling, investigators review prior imaging and determine that the patient has mild-moderate osteoarthritis. Patient is identified as a potential participant and is sent a letter by physical mail or e-mail (signed by PIs) discussing the research project. Subsequently, the clinical research coordinator reaches out to the potential participant by phone 7-14 days before the date of the MR exam to assess interest in the study. 2. Participant is interested and enrolls i…
Eligibility
- Age range
- 25–80 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria (Both Arms): 1. Participants must be Veterans who receive care in the VA system. 2. Participants must have a history of chronic pain of the shoulder, hip or knee for at least 1 year. 3. Participants must have mild to moderate degenerative changes of the painful joint as depicted on prior imaging (X-ray, CT or MRI). 4. Participants must have undergone at least one failed primary treatment for their chronic pain (e.g. physical therapy, NSAIDs, steroid injection). 5. Participants must have an MRI of their painful joint (shoulder, hip or knee) ordered by a clinical provider. I…
Interventions
- DeviceShoulder/Hip/Knee Embolization with Embozene Microspheres
Fluoroscopically-guided arterial embolization of synovitis in the painful shoulder, hip or knee.
Location
- VA Palo Alto Healthcare SystemPalo Alto, California