Is Hand Arthritis Embolization Painful? What to Expect

Quick Answer

In the two studies that describe it, hand embolization was done under local anesthesia through a very thin needle or cannula in a wrist artery, and in the one study that reports discharge, patients went home after 20 minutes of observation. No study reports pain scores during the procedure, so it cannot be called painless.

Most people asking this question want to know two things: how much the procedure itself hurts, and what the day looks like. The published hand studies answer the second question fairly well and the first one only partly. This article walks through what was done, step by step, in those studies. For the bigger picture, see our hand arthritis embolization page.

The honest short answer

Two of the five studies describe local anesthesia at the wrist. The available summaries of the others do not say what anesthesia or sedation was used. In those two, a very thin needle or cannula was placed in a wrist artery. In the one study that reports discharge, patients went home after 20 minutes of observation.

It does not prove the procedure is painless. None of the reports we reviewed gives a pain score for the procedure itself. You should expect at least a needle stick for the numbing medicine, and you should ask what the injection feels like.

Where these details come from

Five small studies of embolization for hand osteoarthritis have been published, covering 204 patients. All are uncontrolled case series, and there is no randomized trial. For four of the five, only a short summary is publicly available, so step-by-step detail comes mainly from one of them: a 2024 pilot study from Taiwan that treated 9 patients and published its full method.

That is a thin base. Treat what follows as a description of what researchers did, not a promise of what your visit will be. Dr. Fox evaluates patients for hand and finger embolization at our Manhattan office, and his own steps may differ from the studies.

Before the procedure: a circulation check

Your hand gets blood from two arteries at the wrist, the radial artery on the thumb side and the ulnar artery on the pinky side. In the 2024 Taiwan study, every patient first had a bedside test (the Barbeau test) to confirm that the hand had adequate backup circulation before a needle went into the radial artery. Patients in that study also received an anti-inflammatory pain medicine through an IV 10 minutes before starting.

Who qualifies in the first place is covered in am I a candidate for hand arthritis embolization.

Step by step, as described in the 2024 study

Numbing the wrist. Local anesthesia was injected into the skin over the artery.
Entering the artery. Using ultrasound to see the vessel, the doctor placed a 24-gauge cannula into the radial artery at the wrist. That is a very thin tube. There was no groin puncture.
Taking pictures. Contrast dye was injected and X-ray images were taken to map the blood vessels of the hand. The team looked for a "blush" of extra vessels around the painful joints.
Delivering the embolic. A mixture of imipenem/cilastatin and contrast dye was slowly infused. Imipenem/cilastatin is an antibiotic that forms tiny crystals, used here off-label as a short-acting embolic. The doctor stopped when blood flow in the abnormal vessels slowed or when a preset maximum dose was reached.
Closing up. The cannula was removed, the spot was pressed by hand, and a band-aid was applied. No stitches are described.
Observation. In the paper's words, "the patient was discharged after 20 min of observation."

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This article is part of our Embolization Guide.

How long it took, and why two studies differ so much

Only two of the five studies report procedure time, and the numbers are far apart.

Study	Technique	Reported time
Inui 2021, Tokyo, 31 patients with thumb base arthritis	Medicine infused directly through a 24-gauge needle placed in the radial artery, with no catheter	Mean 2.9 minutes, counted from the start of local anesthesia to needle removal
Lee 2024, Taiwan, 9 patients with hand arthritis	Ultrasound-guided cannula, then X-ray mapping of the hand arteries with contrast dye, then infusion to a defined stopping point	Mean 15.7 minutes, range 11 to 20 minutes

The two studies used different techniques, which likely explains much of the gap. The Tokyo team used a needle-only method with fewer steps. The Taiwan team added imaging of the hand's arteries before and during the infusion, which takes longer but shows where the medicine is going.

The other three studies do not report a time in their published summaries. The one US series, 14 patients in North Carolina, delivered the embolic through a microcatheter in the radial artery, a different method again. So do not plan around "three minutes." That figure belongs to one technique in one study, and neither number includes check-in, preparation or observation.

What patients were observed to experience

Only the 2024 Taiwan study reports minor events in full, so these observations come from 9 patients.

A pale hand. All 9 patients had a temporary color change in the treated hand. The skin turned pale at first and looked normal again about 30 minutes after the infusion. The paper reports this as a temporary side effect and does not explain it further. It was seen in a study of 9 people, so how often it happens, and how long it can last, is not established.
Artery spasm. In 4 of the 9, the radial artery tightened temporarily during the procedure. It passed without lasting effects. Spasm of small arteries is a recognized issue in this kind of work. A separate 2024 report described 7 musculoskeletal embolization cases in which spasm was treated with nitroglycerin given through the catheter.
What was not seen. The authors reported no skin or tissue damage, tendon rupture, muscle weakness, or numbness and tingling.

For the three largest hand studies, the summaries say only that there were no major or severe adverse events. They do not say how many patients had a pale hand, soreness, bruising or pain during the injection. Our article on risks and side effects covers this gap in detail.

So, is it painful?

Here is what can be said without guessing:

Two of the five studies describe local anesthesia at the wrist. The available summaries of the others do not say what anesthesia or sedation was used.
In three of the Asian studies a 24-gauge needle or cannula, which is thin, was placed in a wrist artery. The fourth describes wrist artery access without further detail.
No hand study reports how the infusion felt to patients, so there is no number to give you.
Soreness afterward has not been measured in the hand. In a 2025 report on 431 patients treated for other conditions, not hand arthritis, increased pain at the treated site lasting more than 7 days occurred in 7.1% of those who received imipenem/cilastatin.

If you are anxious about needles or about being awake, say so at your consultation. Comfort measures are a practice decision, not something the studies settle.

Going home, and the second visit

In the Taiwan study, patients left after 20 minutes of observation with a band-aid on the wrist. None of the published studies gives instructions about driving, typing, lifting or returning to work afterward, so those answers have to come from the doctor treating you.

Plan for the possibility of more than one visit. The largest study, 92 patients in Japan, planned two procedures, with the second 1 to 2 months after the first. The Taiwan study gave every patient two sessions a month apart. What happens to pain over the following weeks and months is covered in the recovery timeline.

Questions to ask before you schedule

Which artery do you use, and do you use a needle or a catheter?
Will I be awake? Is any sedation offered?
What will I feel during the injection?
Which embolic agent do you use, and is that use off-label?
How long should I plan to be at the office in total?
Can I drive myself home, and when can I use the hand normally?
How many sessions do you plan?

To see how this compares with embolization in the knee, shoulder and other joints, visit our embolization guide.

Frequently Asked Questions

Will I be awake during hand embolization?

Two of the five studies describe local anesthesia at the wrist. The available summaries of the others do not say what anesthesia or sedation was used. Whether sedation is offered is a practice decision to ask about.

How long does hand embolization take?

Two studies report it. A Tokyo study of 31 patients using a needle-only technique averaged 2.9 minutes, and a Taiwan study of 9 patients that added artery imaging averaged 15.7 minutes. Neither figure includes preparation or observation time.

Why did the hand turn pale in the study?

In a 2024 study of 9 patients, every treated hand turned pale for a short time, and color returned in about 30 minutes. The paper does not explain the cause. The other studies do not report how often this happened.

Is the needle placed in the groin?

Not in the Asian hand studies. In three of them a 24-gauge needle or cannula was placed in a wrist artery, and the fourth describes wrist artery access without further detail. The one US series used a microcatheter in the radial artery.

Will I need more than one session?

Possibly. The largest study planned two procedures 1 to 2 months apart, and a smaller study gave all 9 patients two sessions a month apart.

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.