Hand Arthritis Embolization vs Injections and Surgery

Quick Answer

No study has compared hand embolization head to head with steroid injections or surgery, so none can be ranked above another. Injections are a conditional guideline option with temporary relief, surgery is for extensive joint damage and takes months to recover from, and embolization rests on five small uncontrolled studies.

If splints, therapy and anti-inflammatory medicines have not settled your hand arthritis, three later options usually come up: a steroid injection, surgery, and, more recently, embolization. This page puts them next to each other using only what has been published. One thing needs saying first, because it shapes everything else on the page.

No study has compared them directly

No published study has compared embolization head to head with a steroid injection, with trapeziectomy, with joint fusion or with joint replacement in the hand. There is also no trial comparing it with a splint or with a sham (placebo) procedure.

So nobody can honestly tell you that one of these works better than another for your hand. What we can do is lay out what is known about each one separately.

Steroid injections: what is known

A steroid injection puts anti-inflammatory medicine, usually mixed with a local anesthetic, directly into the painful joint.

The American Academy of Orthopaedic Surgeons (AAOS) tells patients that these injections can relieve pain for weeks to months. They can be repeated, but only a limited number of times, because of possible side effects: lightening of the skin, weakening of tendons and ligaments, damage to cartilage and infection.

Guidelines support them cautiously. The American College of Rheumatology gave steroid injections for hand osteoarthritis (OA) a conditional recommendation in 2019, noting the lack of evidence specific to the hand, and kept it conditional in its 2026 update. The European EULAR 2018 recommendations say injections are generally not recommended, though they can be considered for painful finger joints.

In short, injections are a guideline-backed option, with relief that is expected to be temporary.

Surgery: what is known

The National Institutes of Health describes surgery as a choice when other treatments are not helping and joint damage is extensive.

Base of the thumb

Trapeziectomy. The surgeon removes the trapezium, the small bone at the base of the thumb, with or without using a tendon for support. AAOS calls it the most commonly performed surgery for this condition in the United States.
Fusion. The joint is fixed in one position. It keeps a strong pinch but gives up some motion.
Joint replacement. An implant takes the place of the joint. AAOS describes promising early results, with less known about the long term.

AAOS states that research has not shown any one of these approaches to be better than the others at relieving pain and improving function. A 2015 Cochrane review of 11 studies with 670 participants reached the same conclusion. It also found more adverse events when a tendon reconstruction was added: about 19 per 100 people, compared with 10 per 100 for trapeziectomy alone, based on low-quality evidence. The review noted that no surgical trial had used a sham comparison.

Finger joints

For finger joints the choices are fusion, which relieves pain but removes motion at that joint, or joint replacement.

Recovery

Thumb-base surgery is outpatient, but recovery is long. AAOS describes a cast or splint for 4 to 8 weeks, full recovery over several months, and grip strength that keeps improving for up to 9 to 12 months. After finger joint surgery, people return to most activities in about 3 months.

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This article is part of our Embolization Guide.

Embolization: what is known

Embolization approaches the problem from the blood supply. In the published studies, a doctor placed a small needle or catheter in an artery at the wrist and delivered a material that slows flow through the abnormal small vessels around painful joints. Nearly all studies used imipenem/cilastatin, an antibiotic used off-label because its particles dissolve quickly. Embolization does not rebuild cartilage.

The evidence is five small studies with 204 patients in total. Every one is an uncontrolled case series, meaning there was no comparison group. Each result below comes from one study and should be read on its own:

Thumb base, Japan, 2021. A prospective series of 31 patients. Average pain fell from 7.2 to 3.1 out of 10 at 2 months and was 2.5 at 24 months, and 77% rated themselves improved at 24 months. This is the longest follow-up published for the hand.
Thumb base, United States, 2026. A prospective series of 14 patients at one private clinic. Average pain went from 8.0 to 2.6 at 6 months, and 79% had at least a 50% improvement. The summary does not name the embolic material.
Finger joints, Japan, 2023. A retrospective series of 92 patients, with two procedures planned 1 to 2 months apart. At 12 months, 77% had a pain drop of at least 2 points. So about one in four did not reach that mark. Average pain went from 7.8 to 4.0, still 4 out of 10.

The most detailed account comes from a 2024 pilot study of 9 patients in Taiwan. It was done under local anesthesia, took an average of 15.7 minutes, and patients went home after 20 minutes of observation with a band-aid at the wrist. Every patient had two sessions a month apart. All 9 had the treated hand turn pale for about 30 minutes, and 4 had a brief spasm of the wrist artery. None had tissue damage, weakness or numbness. Pain partly returned at one month in 4 of the 9 before improving again. Hand function scores were not significantly better at 3 and 6 months, and stiffness did not change.

Across all five studies, no major complications were reported. The three largest did not publish rates of minor side effects, and the numbers are too small to rule out rare serious problems. Our pages on risks and side effects and what the studies show go deeper.

Side by side

	Steroid injection	Surgery	Embolization
What is done	Medicine injected into the joint	Bone removed, joint fused or joint replaced	Short-acting material delivered through a wrist artery (published studies)
Guideline status	Conditional recommendation (ACR 2019 and 2026); generally not recommended by EULAR 2018 except to consider for painful finger joints	Not covered by the 2019 ACR guideline; NIH describes it for extensive damage when other treatments fail	Not mentioned in the American or European hand OA guidelines
Evidence	Limited evidence specific to the hand, per the ACR	Trials comparing one operation with another (Cochrane 2015: 11 studies, 670 people); no sham-controlled trials	Five uncontrolled series, 204 patients; no randomized trial
How long relief lasted in the sources	Weeks to months (AAOS)	Not given as a duration; grip strength improves for up to 9 to 12 months (AAOS)	Most data stop at 6 to 12 months; one 31-patient study reached 24 months
Recovery in the sources	Not described in our sources	Cast or splint 4 to 8 weeks; full recovery several months (thumb base)	Home after 20 minutes of observation in one 9-patient study; two sessions planned in two studies
Reported downsides	Skin lightening, tendon and ligament weakening, cartilage damage, infection; limited number of repeats	Adverse events in 10 to 19 per 100 for thumb-base procedures (low-quality evidence); loss of motion with fusion	Temporary pale skin and artery spasm in one study; no major complications reported, but minor event rates are mostly unpublished
Compared directly with the other two?	Not with embolization	Not with embolization	No

Why the numbers cannot be ranked

It is tempting to read the table and pick a winner. Three things stand in the way.

The embolization figures have no control group. Without one, improvement cannot be separated from the placebo effect or from other treatments patients kept using. The authors of the 2024 pilot study said so themselves and called for sham-controlled trials.

Hand arthritis fluctuates. AAOS notes that some people with thumb arthritis find their symptoms go away over time, with or without treatment. Before-and-after studies can make any treatment look more effective than it is.

The patients are different. Surgery is described for people with extensive joint damage. Three of the embolization studies state that they enrolled people whose pain had not responded to conservative care, and one thumb study enrolled only the middle stages of arthritis (Eaton stage II or III). Nothing has been published on how embolization affects the need for surgery later.

Who was excluded from the embolization studies

These are exclusion criteria from one published study and one registered trial, not formal rules:

Rheumatoid arthritis and other inflammatory arthritis
Raynaud's syndrome, scleroderma and similar circulation disorders of the hands
Narrowed or blocked arm arteries, or a previous clot or tear in the wrist artery
Allergy to contrast dye or to the antibiotic used
Severe kidney disease, pregnancy or breastfeeding
Infection at the site

If any of these apply to you, embolization may not be an option.

Questions that help you choose

How advanced is the arthritis on my X-rays, and would a hand surgeon recommend an operation now?
Have I already had a steroid injection, and how long did it help?
Is my pain at the base of the thumb or in the finger joints? The studies differ by location. See thumb arthritis embolization.
Am I comfortable with a treatment whose evidence is early and uncontrolled?
How much time away from normal hand use can I manage?

Dr. David Fox, a board-certified vascular surgeon, evaluates patients for hand embolization and will tell you if an injection or a surgical opinion makes more sense first. Start with our hand arthritis embolization page, review the non-surgical treatment steps, or see how the procedure is used in other joints in the embolization guide.

Frequently Asked Questions

Does embolization work better than a steroid injection for hand arthritis?

Nobody knows. No study has compared the two in the hand, and the embolization results come from small studies without comparison groups.

Can embolization help me avoid thumb surgery?

That has not been studied. No published research reports how embolization affects the need for later thumb or finger surgery.

How long is recovery after thumb arthritis surgery?

AAOS describes a cast or splint for 4 to 8 weeks, full recovery over several months, and grip strength that can keep improving for 9 to 12 months.

How long do steroid injections last in the hand?

AAOS says relief can last weeks to months. Injections can be repeated only a limited number of times because of possible side effects.

Does embolization repair the joint?

No. It does not rebuild cartilage. In published studies it was used to reduce pain, and function results were inconsistent.

Keep Reading

Sources

Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.

Living with joint or tendon pain that hasn’t improved? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether embolization is right for you. Call (212) 362-3470 or request an appointment online.

Hand Arthritis Embolization vs. Steroid Injections and Surgery