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Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part I, shoulder

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Background

Image-guided interventional procedures around the shoulder are commonly performed in clinical practice, although evidence regarding their effectiveness is scarce. We report the results of a Delphi method review of evidence on literature published on image-guided interventional procedures around the shoulder with a list of clinical indications.

Methods

Forty-five experts in image-guided musculoskeletal procedures from the ESSR participated in a consensus study using the Delphic method. Peer-reviewed papers regarding interventional procedures around the shoulder up to September 2018 were scored according to the Oxford Centre for Evidence-based Medicine levels of evidence. Statements on clinical indications were constructed. Consensus was considered as strong if more than 95% of experts agreed and as broad if more than 80% agreed.

Results

A total of 20 statements were drafted, and 5 reached the highest level of evidence. There were 10 statements about tendon procedures, 6 about intra-articular procedures, and 4 about intrabursal injections. Strong consensus was obtained in 16 of them (80%), while 4 received broad consensus (20%).

Conclusions

Literature evidence on image-guided interventional procedures around the shoulder is limited. A strong consensus has been reached for 80% of statements. The ESSR recommends further research to potentially influence treatment options, patient outcomes, and social impact.

Key Points

• Expert consensus produced a list of 20 evidence-based statements on clinical indications of image-guided interventional procedures around the shoulder.

• The highest level of evidence was reached for five statements.

• Strong consensus was obtained for 16 statements (80%), while 4 received broad consensus (20%).

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Abbreviations

ACJ:

Acromioclavicular joint

CT:

Computed tomography

ESSR:

European Society of Musculoskeletal Radiology

ESWT:

External shockwave therapy

GHJ:

Glenohumeral joint

LHBT:

Long head of biceps tendon

MA:

Methylprednisolone acetate

PRP:

Platelet-rich plasma

RCCT:

Rotator cuff calcific tendinopathy

SASD:

Subacromial–subdeltoid

TA:

Triamcinolone acetonide or triamcinolone acetate

US-PICT:

Ultrasound-guided percutaneous irrigation of calcific tendinopathy

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Acknowledgments

All authors are members of the Ultrasound and/or Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR).

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Rebeca Mirón Mombiela

    Present address: Herlev og Gentofte Hospital Radiologisk Afdeling, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark

Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, 20161, Milan, Italy

    Luca Maria Sconfienza, Domenico Albano, Vito Chianca, Angelo Corazza & Carmelo Messina

  2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy

    Luca Maria Sconfienza & Carmelo Messina

  3. Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, the Netherlands

    Miraude Adriaensen

  4. Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127, Palermo, Italy

    Domenico Albano

  5. St Luke’s Radiology Oxford Ltd, Oxford, UK

    Georgina Allen & David Wilson

  6. University of Oxford, Oxford, UK

    Georgina Allen & David Wilson

  7. Department of Radiology, Auckland City Hospital, Auckland, 1023, New Zealand

    Maria Pilar Aparisi Gómez

  8. Department of Radiology, Hospital Vithas Nueve de Octubre, 46015, Valencia, Spain

    Maria Pilar Aparisi Gómez

  9. Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy

    Alberto Bazzocchi

  10. Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK

    Ian Beggs

  11. Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy

    Bianca Bignotti & Alberto Stefano Tagliafico

  12. Department of Neurosciences, University of Genova, Genoa, Italy

    Angelo Corazza

  13. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Danoob Dalili

  14. Nuffield Orthopaedic Hospital, Oxford, UK

    Danoob Dalili & Catherine McCarthy

  15. UOC Radiologia, Ospedale di Feltre, AULSS 1 Dolomiti, Veneto, Italy

    Miriam De Dea

  16. Department of Radiology, Donostia University Hospital, Begiristain Doktorea Pasealekua, 109, 20014, Donostia/San Sebastian, Spain

    Jose Luis del Cura

  17. University of the Basque Country (UPV/EHU), Leioa, Spain

    Jose Luis del Cura

  18. Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, CE, Italy

    Francesco Di Pietto

  19. Department of Musculoskeletal Radiology, Private Ultrasound Institution, Heraklion, Greece

    Eleni Drakonaki

  20. IBERORAD 1895 S.L., 08021, Barcelona, Spain

    Fernando Facal de Castro

  21. Department of Radiology, General University Hospital of Valencia, Valencia, Spain

    Fernando Facal de Castro & Jelena Vucetic

  22. 2nd Department of Radiology, University General Hospital “ATTIKON” Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Dimitrios Filippiadis

  23. University of Antwerp, University of Antwerp Hospital (UZA), Antwerp, Belgium

    Jan Gielen

  24. Università degli Studi di Milano, Milan, Italy

    Salvatore Gitto

  25. Leeds Teaching Hospitals, Leeds, UK

    Harun Gupta

  26. Department of Radiology, Medical University Innsbruck, Innsbruck, Austria

    Andrea S. Klauser

  27. The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK

    Radhesh Lalam

  28. Hospital Son Llatzer, Palma de Mallorca, Spain

    Silvia Martin

  29. Universidad de las Islas Baleares, Palma, Spain

    Silvia Martin

  30. DISSAL Department of Health Sciences, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy

    Carlo Martinoli

  31. Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy

    Giovanni Mauri

  32. Oxford Musculoskeletal Radiology, Oxford, UK

    Catherine McCarthy & Eugene McNally

  33. Medical School of the National and Kapodistrian University of Athens, Athens, Greece

    Kalliopi Melaki

  34. Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain

    Rebeca Mirón Mombiela

  35. Herlev og Gentofte Hospital Radiologisk Afdeling, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark

    Jelena Vucetic

  36. Radiology, Ordensklinikum, Seilerstätte 4, 4020, Linz, Austria

    Benedikt Neubauer

  37. Department of Oral Dentistry, Wroclaw Medical University, Wroclaw, Poland

    Cyprian Olchowy

  38. Ospedale Evangelico Internazionale Genova, Genoa, Italy

    Davide Orlandi

  39. Department of Radiology, Private Institution of Ultrasonography, Athens, Greece

    Athena Plagou

  40. POVISA Hospital, Vigo, Pontevedra, Spain

    Raquel Prada Gonzalez

  41. Institute of Sport Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania

    Saulius Rutkauskas

  42. Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia

    Ziga Snoj

  43. Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy

    Alberto Stefano Tagliafico

  44. Department of Radiology, AUVA Trauma Centre, Vienna, Austria

    Alexander Talaska

  45. Medical Faculty, University “Ss.Cyril and Methodius”, Skopje, North Macedonia; University Surgical Clinic “St.Naum Ohridski”, Skopje, North Macedonia

    Violeta Vasilevska-Nikodinovska

  46. Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy

    Federico Zaottini

  47. Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy

    Marcello Zappia

  48. Varelli Institute, Naples, Italy

    Marcello Zappia

  49. Sint Maartenskliniek, 6500GM, 9011, Nijmegen, the Netherlands

    Marina Obradov

Authors
  1. Luca Maria Sconfienza
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Corresponding author

Correspondence to Luca Maria Sconfienza.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Luca Maria Sconfienza, MD PhD.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because it does not involve patients.

Ethical approval

Institutional Review Board approval was not required because it does not involve patients.

Methodology

• Literature-based Delphi process

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This paper is published by the authors on behalf of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR).

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Sconfienza, L.M., Adriaensen, M., Albano, D. et al. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part I, shoulder. Eur Radiol 30, 903–913 (2020). https://doi.org/10.1007/s00330-019-06419-x

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