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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 III, nerves of the upper limb

Abstract

Background

Image-guided interventional procedures of the nerves are commonly performed by physicians from different medical specialties, although there is a lack of clinical indications for these types of procedures. This Delphi-based consensus provided a list of indications on image-guided interventional procedures for nerves of the upper limb based on updated published evidence.

Methods

An expert panel of 45 members of the Ultrasound and Interventional Subcommittees of the ESSR participated in this Delphi-based consensus study. After revision of the published papers on image-guided interventional procedures for nerves of the upper limb updated to September 2018, the experts drafted a list of statements according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus on statements regarding clinical indications was considered as strong when more than 95% of experts agreed, and broad if more than 80% agreed.

Results

Ten statements were drafted on procedures for nerves of the upper limb. Only two statements reached the highest level of evidence (ultrasound guidance is a safe and effective method for brachial plexus block; ultrasound-guided non-surgical approaches are safe and effective methods to treat carpal tunnel syndrome in the short term, but there is sparse evidence on the mid- and long-term effectiveness of these interventions). Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%).

Conclusions

This Delphi-based consensus study reported poor evidence on image-guided interventional procedures for nerves of the upper limb. Sixty percent of statements on clinical indications provided by the expert board reached a strong consensus.

Key Points

• An expert panel of the ESSR provided 10 evidence-based statements on clinical indications for image-guided interventional procedures for nerves of the upper limb

• Two statements reached the highest level of evidence

• Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%)

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Abbreviations

ESSR:

European Society of Musculoskeletal Radiology

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Acknowledgements

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 of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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.

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

Methodology

• Literature-based Delphi process

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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 III, nerves of the upper limb. Eur Radiol 30, 1498–1506 (2020). https://doi.org/10.1007/s00330-019-06479-z

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Keywords

  • Radiology, interventional
  • Ultrasonography
  • Peripheral nerves
  • Injections; Steroids