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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 II, elbow and wrist

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Background

Although image-guided interventional procedures of the elbow and wrist are routinely performed, there is poor evidence in the literature concerning such treatments. Our aim was to perform a Delphi-based consensus on published evidence on image-guided interventional procedures around the elbow and wrist and provide clinical indications on this topic.

Methods

A board of 45 experts in image-guided interventional musculoskeletal procedures from the European Society of Musculoskeletal Radiology were involved in this Delphi-based consensus study. All panelists reviewed and scored published papers on image-guided interventional procedures around the elbow and wrist updated to September 2018 according to the Oxford Centre for Evidence-based Medicine levels of evidence. Consensus on statements drafted by the panelists about clinical indications was considered as “strong” when more than 95% of panelists agreed and as “broad” if more than 80% agreed.

Results

Eighteen statements were drafted, 12 about tendon procedures and 6 about intra-articular procedures. Only statement #15 reached the highest level of evidence (ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement). Seventeen statements received strong consensus (94%), while one received broad consensus (6%).

Conclusions

There is still poor evidence in published papers on image-guided interventional procedures around the elbow and wrist. A strong consensus has been achieved in 17/18 (94%) statements provided by the panel on clinical indications. Large prospective randomized trials are needed to better define the role of these procedures in clinical practice.

Key Points

• The panel provided 18 evidence-based statements on clinical indications of image-guided interventional procedures around the elbow and wrist.

• Only statement #15 reached the highest level of evidence: ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement.

• Seventeen statements received strong consensus (94%), while broad consensus was obtained by 1 statement (6%).

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Abbreviations

CT:

Computed tomography

ESSR:

European Society of Musculoskeletal Radiology

MRI:

Magnetic resonance imaging

PRP:

Platelet-rich plasma

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Acknowledgments

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

Author information

Author notes

  1. Rebeca Mirón Mombiela

    Present address: Radiologisk Afdeling, Herlev og Gentofte Hospital, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark

Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, 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, 20100, Milan, 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. Department of Radiology, Auckland City Hospital, Auckland, 1023, New Zealand

    Maria Pilar Aparisi Gómez

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

    Maria Pilar Aparisi Gómez

  7. Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy

    Alberto Bazzocchi

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

    Ian Beggs

  9. Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy

    Bianca Bignotti

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

    Angelo Corazza

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

    Danoob Dalili

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

    Danoob Dalili & Catherine McCarthy

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

    Miriam De Dea

  14. Department of Radiology, Donostia University Hospital, Begiristain Doktorea Pasealekua, 109, 20014, Donostia/San Sebastian, Spain

    Jose Luis del Cura

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

    Jose Luis del Cura

  16. Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, CE, Italy

    Francesco Di Pietto

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

    Eleni Drakonaki

  18. Department of Anatomy, Medical School of the European University of Cyprus, Nicosia, Cyprus

    Eleni Drakonaki

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

    Fernando Facal de Castro

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

    Fernando Facal de Castro & Jelena Vucetic

  21. 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Dimitrios Filippiadis

  22. University of Antwerp, Antwerp, Belgium

    Jan Gielen

  23. University of Antwerp Hospital (UZA), Antwerp, Belgium

    Jan Gielen

  24. Università degli Studi di Milano, Milan, Italy

    Salvatore Gitto

  25. Leeds Teaching Hospitals, Leeds, UK

    Harun Gupta

  26. Department of Radiology, Medical University Innsbruck, Innsbruck, Austria

    Andrea S. Klauser

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

    Radhesh Lalam

  28. Hospital Son Llatzer, Palma de Mallorca, Spain

    Silvia Martin

  29. Medicine, Universidad de las Islas Baleares, Palma de Mallorca, Spain

    Silvia Martin

  30. DISSAL Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genova, Italy

    Carlo Martinoli, Alberto Stefano Tagliafico & Federico Zaottini

  31. Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy

    Carlo Martinoli & Alberto Stefano Tagliafico

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

    Giovanni Mauri

  33. Oxford Musculoskeletal Radiology, Oxford, UK

    Catherine McCarthy & Eugene McNally

  34. Medical School of the National and Kapodistrian University of Athens, Athens, Greece

    Kalliopi Melaki

  35. Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain

    Rebeca Mirón Mombiela

  36. Radiologisk Afdeling, Herlev og Gentofte Hospital, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark

    Jelena Vucetic

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

    Benedikt Neubauer

  38. Ordensklinkum Linz, Linz, Austria

    Benedikt Neubauer

  39. Sint Maartenskliniek, Nijmegen, The Netherlands

    Marina Obradov

  40. Department of Oral Surgery, Wroclaw Medical University, Wroclaw, Poland

    Cyprian Olchowy

  41. Department of Radiology, Ospedale Evangelico Internazionale Genova, Genova, Italy

    Davide Orlandi

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

    Athena Plagou

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

    Raquel Prada Gonzalez

  44. Institute of Sport Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania

    Saulius Rutkauskas

  45. University Medical Centre Ljubljana, Zaloška ul. 7, 1000, Ljubljana, Slovenia

    Ziga Snoj

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

    Alexander Talaska

  47. Medical Faculty, University “Ss.Cyril and Methodius”, University Surgical Clinic “St.Naum Ohridski”, Skopje, North Macedonia

    Violeta Vasilevska-Nikodinovska

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

    David Wilson & Georgina Allen

  49. Oxford University, Oxford, UK

    David Wilson & Georgina Allen

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

    Marcello Zappia

  51. Varelli Institute, Naples, Italy

    Marcello Zappia

Authors
  1. Luca Maria Sconfienza
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  2. Miraude Adriaensen
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  3. Domenico Albano
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  4. Maria Pilar Aparisi Gómez
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  5. Alberto Bazzocchi
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  6. Ian Beggs
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  7. Bianca Bignotti
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  8. Vito Chianca
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  9. Angelo Corazza
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  10. Danoob Dalili
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  15. Fernando Facal de Castro
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  17. Jan Gielen
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  18. Salvatore Gitto
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  19. Harun Gupta
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  21. Radhesh Lalam
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  22. Silvia Martin
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  23. Carlo Martinoli
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  24. Giovanni Mauri
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  25. Catherine McCarthy
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  26. Eugene McNally
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  27. Kalliopi Melaki
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  28. Carmelo Messina
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  29. Rebeca Mirón Mombiela
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  30. Benedikt Neubauer
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  31. Marina Obradov
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  32. Cyprian Olchowy
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  33. Davide Orlandi
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  34. Athena Plagou
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  35. Raquel Prada Gonzalez
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  36. Saulius Rutkauskas
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  37. Ziga Snoj
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  38. Alberto Stefano Tagliafico
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  39. Alexander Talaska
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  40. Violeta Vasilevska-Nikodinovska
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  41. Jelena Vucetic
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  42. David Wilson
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  43. Federico Zaottini
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  44. Marcello Zappia
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  45. Georgina Allen
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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.

Ethics declarations

Guarantor

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

Conflict of interest

The authors declare that they have no competing interests.

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 this study does not involve patients.

Methodology

• Literature-based Delphi process

Additional information

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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 II, elbow and wrist. Eur Radiol 30, 2220–2230 (2020). https://doi.org/10.1007/s00330-019-06545-6

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  • DOI: https://doi.org/10.1007/s00330-019-06545-6

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