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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

  • Musculoskeletal
  • Published:
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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

Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, 20161, Milano, Italy

    Luca Maria Sconfienza, Domenico Albano, Vito Chianca, Angelo Corazza & Carmelo Messina

  2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy

    Luca Maria Sconfienza & Carmelo Messina

  3. Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, The Netherlands

    Miraude Adriaensen

  4. Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127, Palermo, Italy

    Domenico Albano

  5. St Luke’s Radiology Oxford Ltd, Oxford, UK

    Georgina Allen & David Wilson

  6. University of Oxford, Oxford, UK

    Georgina Allen & David Wilson

  7. Department of Radiology, Auckland City Hospital, Auckland, 1023, New Zealand

    Maria Pilar Aparisi Gómez

  8. Department of Radiology, Hospital Vithas Nueve de Octubre, 46015, Valencia, Spain

    Maria Pilar Aparisi Gómez

  9. Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy

    Alberto Bazzocchi

  10. Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK

    Ian Beggs

  11. Ospedale Policlinico San Martino, 16132, Genoa, Italy

    Bianca Bignotti, Carlo Martinoli & Alberto Stefano Tagliafico

  12. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy

    Angelo Corazza

  13. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Danoob Dalili

  14. The Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK

    Danoob Dalili & Catherine McCarthy

  15. UOC Radiologia, Ospedale di Feltre, AULSS1 Dolomiti, Veneto, Italy

    Miriam De Dea

  16. Department of Radiology, Donostia University Hospital, 20014, Donostia/San Sebastian, Spain

    Jose Luis del Cura

  17. University of the Basque Country (UPV/EHU), Leioa, Spain

    Jose Luis del Cura

  18. Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, (CE), Italy

    Francesco Di Pietto

  19. Private Institution of Ultrasonography and MSK Radiology, Heraklion, Greece

    Eleni Drakonaki

  20. Department of Anatomy, Medical School of the European University of Cyprus, Engomi, Cyprus

    Eleni Drakonaki

  21. IBERORAD 1895 S.L., 08021, Barcelona, Spain

    Fernando Facal de Castro

  22. Department of Radiology, General University Hospital of Valencia, Valencia, Spain

    Fernando Facal de Castro & Jelena Vucetic

  23. 2nd Department of Radiology, University General Hospital “ATTIKON” Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Dimitrios Filippiadis

  24. University of Antwerp, Antwerp, Belgium

    Jan Gielen

  25. University of Antwerp Hospital (UZA), Edegem, Belgium

    Jan Gielen

  26. Università degli Studi di Milano, Milan, Italy

    Salvatore Gitto

  27. Leeds Teaching Hospitals, Leeds, UK

    Harun Gupta

  28. Medical University Innsbruck, Innsbruck, Austria

    Andrea S. Klauser

  29. Department of Radiology, Innsbruck, Austria

    Andrea S. Klauser

  30. The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK

    Radhesh Lalam

  31. Hospital Son Llatzer, Palma de Mallorca, Spain

    Silvia Martin

  32. Universidad de las Islas Baleares Medicine, Palma, Balearic Islands, Spain

    Silvia Martin

  33. University of Genoa - DISSAL Department of Health Sciences, Genoa, Italy

    Carlo Martinoli & Federico Zaottini

  34. Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy

    Giovanni Mauri

  35. Oxford Musculoskeletal Radiology, Oxford, UK

    Catherine McCarthy & Eugene McNally

  36. Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Kalliopi Melaki

  37. Department of Physiology, Universidad de Valencia/INCLIVA, 46010, Valencia, Spain

    Rebeca Mirón Mombiela & Jelena Vucetic

  38. Herlev og Gentofte Hospital Radiologisk Afdeling, Herlev Ringvej 75, opgang 51, Herlev, Denmark

    Rebeca Mirón Mombiela

  39. Radiology, Medical University of Vienna, Vienna, Austria

    Benedikt Neubauer

  40. Ordensklinikum Linz, Linz, Austria

    Benedikt Neubauer

  41. Sint Maartenskliniek, 9011, Nijmegen, 6500GM, The Netherlands

    Marina Obradov

  42. Department of Oral Surgery, Wroclaw Medical University, Wrocław, Poland

    Cyprian Olchowy

  43. Ospedale Evangelico Internazionale Genova, Genoa, Italy

    Davide Orlandi

  44. Department of Radiology, Hospital POVISA, Vigo, Spain

    Raquel Prada Gonzalez

  45. Radiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania

    Saulius Rutkauskas

  46. Department of Radiology, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, 1000, Slovenia

    Ziga Snoj

  47. Department of Health Sciences, University of Genoa, 16132, Genoa, Italy

    Alberto Stefano Tagliafico

  48. Department of Radiology, AUVA Trauma Centre, Vienna, Austria

    Alexander Talaska

  49. Medical Faculty, University “Ss.Cyril and Methodius”, Skopje, North Macedonia

    Violeta Vasilevska-Nikodinovska

  50. University Surgical Clinic “St.Naum Ohridski”, Skopje, North Macedonia

    Violeta Vasilevska-Nikodinovska

  51. Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy

    Marcello Zappia

  52. Varelli Institute, Naples, Italy

    Marcello Zappia

  53. Department of Radiology, Private Institution of Ultrasonography, Athens, Greece

    Athena Plagou

Authors
  1. Luca Maria Sconfienza
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  2. Miraude Adriaensen
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  3. Domenico Albano
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  4. Georgina Allen
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  5. Maria Pilar Aparisi Gómez
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Consortia

on behalf of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR)

Corresponding author

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.

Ethical approval

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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  • DOI: https://doi.org/10.1007/s00330-019-06479-z

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