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



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%).

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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


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


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Correspondence to Luca Maria Sconfienza.

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

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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).

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