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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

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

Correspondence to Luca Maria Sconfienza.

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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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Keywords

  • Interventional radiology
  • Shoulder
  • Ultrasonography
  • Injections
  • Platelet-rich plasma