European Radiology

, Volume 22, Issue 5, pp 1140-1148

First online:

Clinical indications for musculoskeletal ultrasound: A Delphi-based consensus paper of the European society of musculoskeletal radiology

  • Andrea S. KlauserAffiliated withDepartments of Diagnostic Radiology, Medical University Innsbruck
  • , Alberto TagliaficoAffiliated withInstitute of Anatomy—Department of Experimental Medicine—DIMES, Università di Genova Email author 
  • , Gina M. AllenAffiliated withDepartment of Radiology, Oxford Radcliffe Hospitals
  • , Natalie BoutryAffiliated withService de Radiologie Ostéo-articulaire, Hôpital Roger Salengro, CHU de Lille, Boulevard du Pr J Leclercq
  • , Rob CampbellAffiliated withDepartment of Radiology, Royal Liverpool University Hospital
  • , Michel Court-PayenAffiliated withDepartment of Musculoskeletal Radiology, GildhØj Private Hospital
  • , Andrew GraingerAffiliated withLeeds Teaching Hospitals and Leeds MSK Research Unit Leeds
  • , Henry GueriniAffiliated withService de Radiologie B, Hôpital Cochin
  • , Eugene McNallyAffiliated withNuffield Orthopaedic Centre & University of Oxford Old Road Headington
    • , Philip J. O’ConnorAffiliated withDepartment of Clinical Radiology, Leeds Teaching Hospitals Trust, The General Infirmary
    • , Simon OstlereAffiliated withNuffield Orthopaedic Centre
    • , Philippe PetroonsAffiliated withDepartment of Radiology, Hôpitaux Iris Sud (Molière-Longchamp)
    • , Monique ReijnierseAffiliated withLeiden University Medical Center C3Q Albinusdreef 2
    • , Luca Maria SconfienzaAffiliated withUnit of Radiology, IRCCS Policlinico San Donato
    • , Enzo SilvestriAffiliated withOspedale Evangelico Internazionale, Salita Superiore San Rocchino
    • , David J. WilsonAffiliated withNuffield Orthopaedic Centre NHS Trust and University of Oxford
    • , Carlo MartinoliAffiliated withCattedra “R” di Radiologia-DICMI, Università di Genova

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To develop clinical guidelines for musculoskeletal ultrasound (MSKUS) referral in Europe.


Sixteen musculoskeletal radiologists from seven European countries participated in a consensus-based interactive process (Delphi method) using consecutive questionnaires and consensus procedure meetings at several European radiology meetings. The evaluation of musculoskeletal diseases was established by literature reviews, followed by consensus on clinical utility in three consensus meetings. This involved a thorough, transparent, iterative approach which including interview, questionnaire, Delphi and standard setting methodologies. European MSK radiologists with a special interest in MSKUS formed two different expert groups who worked on reaching a consensus in the first two meetings. The third meeting resolved questions that did not achieve a consensus level of 67% using the first two questionnaires.


On expert consensus, the use of MSKUS is indicated to detect joint synovitis, fluid and septic effusion for potential aspiration, and poorly indicated to detect loose bodies. Recommendations for most appropriate use of musculoskeletal ultrasound are reported in six areas relevant to musculoskeletal ultrasound: hand/wrist, elbow, shoulder, hip, knee and ankle/foot.


A comprehensive evidence-based, expert consensus-defined educational framework on clinical ultrsound is presented. This should facilitate referrals for this important imaging technique throughout Europe.

Key Points

Musculoskeletal ultrasound is indicated for detecting joint synovitis, effusions and fluid collections.

Musculoskeletal ultrasound is poor at detecting loose bodies.

Musculoskeletal ultrasound is relevant for most joints.


Ultrasonography Delphi method Musculoskeletal Indications Consensus