European Radiology

, Volume 30, Issue 2, pp 903–913 | Cite as

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

  • Luca Maria SconfienzaEmail author
  • Miraude Adriaensen
  • Domenico Albano
  • Georgina Allen
  • Maria Pilar Aparisi Gómez
  • Alberto Bazzocchi
  • Ian Beggs
  • Bianca Bignotti
  • Vito Chianca
  • Angelo Corazza
  • Danoob Dalili
  • Miriam De Dea
  • Jose Luis del Cura
  • Francesco Di Pietto
  • Eleni Drakonaki
  • Fernando Facal de Castro
  • Dimitrios Filippiadis
  • Jan Gielen
  • Salvatore Gitto
  • Harun Gupta
  • Andrea S. Klauser
  • Radhesh Lalam
  • Silvia Martin
  • Carlo Martinoli
  • Giovanni Mauri
  • Catherine McCarthy
  • Eugene McNally
  • Kalliopi Melaki
  • Carmelo Messina
  • Rebeca Mirón Mombiela
  • Benedikt Neubauer
  • Cyprian Olchowy
  • Davide Orlandi
  • Athena Plagou
  • Raquel Prada Gonzalez
  • Saulius Rutkauskas
  • Ziga Snoj
  • Alberto Stefano Tagliafico
  • Alexander Talaska
  • Violeta Vasilevska-Nikodinovska
  • Jelena Vucetic
  • David Wilson
  • Federico Zaottini
  • Marcello Zappia
  • Marina Obradov



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.

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%).


Interventional radiology Shoulder Ultrasonography Injections Platelet-rich plasma 



Acromioclavicular joint


Computed tomography


European Society of Musculoskeletal Radiology


External shockwave therapy


Glenohumeral joint


Long head of biceps tendon


Methylprednisolone acetate


Platelet-rich plasma


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).

Funding information

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.

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.


• Literature-based Delphi process

Supplementary material

330_2019_6419_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 20 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Luca Maria Sconfienza
    • 1
    • 2
    Email author
  • Miraude Adriaensen
    • 3
  • Domenico Albano
    • 1
    • 4
  • Georgina Allen
    • 5
    • 6
  • Maria Pilar Aparisi Gómez
    • 7
    • 8
  • Alberto Bazzocchi
    • 9
  • Ian Beggs
    • 10
  • Bianca Bignotti
    • 11
  • Vito Chianca
    • 1
  • Angelo Corazza
    • 1
    • 12
  • Danoob Dalili
    • 13
    • 14
  • Miriam De Dea
    • 15
  • Jose Luis del Cura
    • 16
    • 17
  • Francesco Di Pietto
    • 18
  • Eleni Drakonaki
    • 19
  • Fernando Facal de Castro
    • 20
    • 21
  • Dimitrios Filippiadis
    • 22
  • Jan Gielen
    • 23
  • Salvatore Gitto
    • 24
  • Harun Gupta
    • 25
  • Andrea S. Klauser
    • 26
  • Radhesh Lalam
    • 27
  • Silvia Martin
    • 28
    • 29
  • Carlo Martinoli
    • 30
  • Giovanni Mauri
    • 31
  • Catherine McCarthy
    • 14
    • 32
  • Eugene McNally
    • 32
  • Kalliopi Melaki
    • 33
  • Carmelo Messina
    • 1
    • 2
  • Rebeca Mirón Mombiela
    • 34
    • 35
  • Benedikt Neubauer
    • 36
  • Cyprian Olchowy
    • 37
  • Davide Orlandi
    • 38
  • Athena Plagou
    • 39
  • Raquel Prada Gonzalez
    • 40
  • Saulius Rutkauskas
    • 41
  • Ziga Snoj
    • 42
  • Alberto Stefano Tagliafico
    • 11
    • 43
  • Alexander Talaska
    • 44
  • Violeta Vasilevska-Nikodinovska
    • 45
  • Jelena Vucetic
    • 21
    • 35
  • David Wilson
    • 5
    • 6
  • Federico Zaottini
    • 46
  • Marcello Zappia
    • 47
    • 48
  • Marina Obradov
    • 49
  1. 1.IRCCS Istituto Ortopedico GaleazziUnità Operativa di Radiologia Diagnostica ed InterventisticaMilanItaly
  2. 2.Dipartimento di Scienze Biomediche per la SaluteUniversità degli Studi di MilanoMilanItaly
  3. 3.Department of Medical ImagingZuyderland Medical CenterKerkradethe Netherlands
  4. 4.Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica AvanzataUniversità degli Studi di PalermoPalermoItaly
  5. 5.St Luke’s Radiology Oxford LtdOxfordUK
  6. 6.University of OxfordOxfordUK
  7. 7.Department of RadiologyAuckland City HospitalAucklandNew Zealand
  8. 8.Department of RadiologyHospital Vithas Nueve de OctubreValenciaSpain
  9. 9.Diagnostic and Interventional RadiologyIRCCS Istituto Ortopedico RizzoliBolognaItaly
  10. 10.Department of RadiologyRoyal Infirmary of Edinburgh, NHS LothianEdinburghUK
  11. 11.Ospedale Policlinico San MartinoGenoaItaly
  12. 12.Department of NeurosciencesUniversity of GenovaGenoaItaly
  13. 13.The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA
  14. 14.Nuffield Orthopaedic HospitalOxfordUK
  15. 15.UOC Radiologia, Ospedale di FeltreAULSS 1 DolomitiVenetoItaly
  16. 16.Department of RadiologyDonostia University HospitalDonostia/San SebastianSpain
  17. 17.University of the Basque Country (UPV/EHU)LeioaSpain
  18. 18.Dipartimento di Diagnostica per ImmaginiPineta Grande HospitalCastel VolturnoItaly
  19. 19.Department of Musculoskeletal RadiologyPrivate Ultrasound InstitutionHeraklionGreece
  20. 20.IBERORAD 1895 S.L.BarcelonaSpain
  21. 21.Department of RadiologyGeneral University Hospital of ValenciaValenciaSpain
  22. 22.2nd Department of Radiology, University General Hospital “ATTIKON” Medical SchoolNational and Kapodistrian University of AthensAthensGreece
  23. 23.University of Antwerp, University of Antwerp Hospital (UZA)AntwerpBelgium
  24. 24.Università degli Studi di MilanoMilanItaly
  25. 25.Leeds Teaching HospitalsLeedsUK
  26. 26.Department of RadiologyMedical University InnsbruckInnsbruckAustria
  27. 27.The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestryUK
  28. 28.Hospital Son LlatzerPalma de MallorcaSpain
  29. 29.Universidad de las Islas BalearesPalmaSpain
  30. 30.DISSAL Department of Health Sciences, Ospedale Policlinico San MartinoUniversity of GenoaGenoaItaly
  31. 31.Division of Interventional RadiologyEuropean Institute of Oncology, IRCCSMilanItaly
  32. 32.Oxford Musculoskeletal RadiologyOxfordUK
  33. 33.Medical School of the National and Kapodistrian University of AthensAthensGreece
  34. 34.Department of PhysiologyUniversidad de Valencia/INCLIVAValenciaSpain
  35. 35.Herlev og Gentofte Hospital Radiologisk AfdelingHerlevDenmark
  36. 36.RadiologyOrdensklinikumLinzAustria
  37. 37.Department of Oral DentistryWroclaw Medical UniversityWroclawPoland
  38. 38.Ospedale Evangelico Internazionale GenovaGenoaItaly
  39. 39.Department of RadiologyPrivate Institution of UltrasonographyAthensGreece
  40. 40.POVISA HospitalPontevedraSpain
  41. 41.Institute of Sport Science and InnovationLithuanian Sports UniversityKaunasLithuania
  42. 42.Institute of RadiologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
  43. 43.Department of Health SciencesUniversity of GenoaGenoaItaly
  44. 44.Department of RadiologyAUVA Trauma CentreViennaAustria
  45. 45.Medical FacultyUniversity “Ss.Cyril and Methodius”, Skopje, North Macedonia; University Surgical Clinic “St.Naum Ohridski”SkopjeNorth Macedonia
  46. 46.Department of Health Sciences (DISSAL)University of GenoaGenovaItaly
  47. 47.Department of Medicine and Health SciencesUniversity of MoliseCampobassoItaly
  48. 48.Varelli InstituteNaplesItaly
  49. 49.Sint MaartenskliniekNijmegenthe Netherlands

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