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
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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.
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.
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%).
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.
• 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%).
KeywordsInterventional radiology Shoulder Ultrasonography Injections Platelet-rich plasma
European Society of Musculoskeletal Radiology
External shockwave therapy
Long head of biceps tendon
Rotator cuff calcific tendinopathy
Triamcinolone acetonide or triamcinolone acetate
Ultrasound-guided percutaneous irrigation of calcific tendinopathy
All authors are members of the Ultrasound and/or Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR).
The authors state that this work has not received any funding.
Compliance with ethical standards
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.
Written informed consent was not required for this study because it does not involve patients.
Institutional Review Board approval was not required because it does not involve patients.
• Literature-based Delphi process
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