. 2020 Apr;30(4):2220-2230.

doi: 10.1007/s00330-019-06545-6. Epub 2019 Dec 16.

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

Luca Maria Sconfienza^{1

2}, Miraude Adriaensen³, Domenico Albano^{4

5}, Maria Pilar Aparisi Gómez^{6

7}, Alberto Bazzocchi⁸, Ian Beggs⁹, Bianca Bignotti¹⁰, Vito Chianca⁴, Angelo Corazza^{4

11}, Danoob Dalili^{12

13}, Miriam De Dea¹⁴, Jose Luis Del Cura^{15

16}, Francesco Di Pietto¹⁷, Eleni Drakonaki^{18

19}, Fernando Facal de Castro^{20

21}, Dimitrios Filippiadis²², Jan Gielen^{23

24}, Salvatore Gitto²⁵, Harun Gupta²⁶, Andrea S Klauser²⁷, Radhesh Lalam²⁸, Silvia Martin^{29

30}, Carlo Martinoli^{31

10}, Giovanni Mauri³², Catherine McCarthy^{13

33}, Eugene McNally³³, Kalliopi Melaki³⁴, Carmelo Messina^{4

35}, Rebeca Mirón Mombiela^{36

37}, Benedikt Neubauer^{38

39}, Marina Obradov⁴⁰, Cyprian Olchowy⁴¹, Davide Orlandi⁴², Athena Plagou⁴³, Raquel Prada Gonzalez⁴⁴, Saulius Rutkauskas⁴⁵, Ziga Snoj⁴⁶, Alberto Stefano Tagliafico^{31

10}, Alexander Talaska⁴⁷, Violeta Vasilevska-Nikodinovska⁴⁸, Jelena Vucetic^{21

37}, David Wilson^{49

50}, Federico Zaottini³¹, Marcello Zappia^{51

52}, Georgina Allen^{49

50}; Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR)

Affiliations

¹ IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. io@lucasconfienza.it.
² Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20100, Milan, Italy. io@lucasconfienza.it.
³ Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, The Netherlands.
⁴ IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
⁵ Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127, Palermo, Italy.
⁶ Department of Radiology, Auckland City Hospital, Auckland, 1023, New Zealand.
⁷ Department of Radiology, Hospital Vithas Nueve de Octubre, 46015, Valencia, Spain.
⁸ Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy.
⁹ Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.
¹⁰ Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy.
¹¹ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.
¹² The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹³ The Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.
¹⁴ UOC Radiologia, Ospedale di Feltre, AULSS1 Dolomiti, Veneto, Italy.
¹⁵ Department of Radiology, Donostia University Hospital, Begiristain Doktorea Pasealekua, 109, 20014, Donostia/San Sebastian, Spain.
¹⁶ University of the Basque Country (UPV/EHU), Leioa, Spain.
¹⁷ Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, CE, Italy.
¹⁸ Private Institution of Ultrasonography and MSK Radiology, Heraklion, Greece.
¹⁹ Department of Anatomy, Medical School of the European University of Cyprus, Nicosia, Cyprus.
²⁰ IBERORAD 1895 S.L., 08021, Barcelona, Spain.
²¹ Department of Radiology, General University Hospital of Valencia, Valencia, Spain.
²² 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²³ University of Antwerp, Antwerp, Belgium.
²⁴ University of Antwerp Hospital (UZA), Antwerp, Belgium.
²⁵ Università degli Studi di Milano, Milan, Italy.
²⁶ Leeds Teaching Hospitals, Leeds, UK.
²⁷ Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.
²⁸ The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK.
²⁹ Hospital Son Llatzer, Palma de Mallorca, Spain.
³⁰ Medicine, Universidad de las Islas Baleares, Palma de Mallorca, Spain.
³¹ DISSAL Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genova, Italy.
³² Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy.
³³ Oxford Musculoskeletal Radiology, Oxford, UK.
³⁴ Medical School of the National and Kapodistrian University of Athens, Athens, Greece.
³⁵ Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20100, Milan, Italy.
³⁶ Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain.
³⁷ Radiologisk Afdeling, Herlev og Gentofte Hospital, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark.
³⁸ Radiology, Medical University of Vienna, Vienna, Austria.
³⁹ Ordensklinkum Linz, Linz, Austria.
⁴⁰ Sint Maartenskliniek, Nijmegen, The Netherlands.
⁴¹ Department of Oral Surgery, Wroclaw Medical University, Wroclaw, Poland.
⁴² Department of Radiology, Ospedale Evangelico Internazionale Genova, Genova, Italy.
⁴³ Department of Radiology, Private Institution of Ultrasonography, Athens, Greece.
⁴⁴ Department of Radiology, Hospital POVISA, Vigo, Spain.
⁴⁵ Institute of Sport Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania.
⁴⁶ University Medical Centre Ljubljana, Zaloška ul. 7, 1000, Ljubljana, Slovenia.
⁴⁷ Department of Radiology, AUVA Trauma Centre, Vienna, Austria.
⁴⁸ Medical Faculty, University "Ss.Cyril and Methodius", University Surgical Clinic "St.Naum Ohridski", Skopje, North Macedonia.
⁴⁹ St Luke's Radiology Oxford Ltd, Oxford, UK.
⁵⁰ Oxford University, Oxford, UK.
⁵¹ Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
⁵² Varelli Institute, Naples, Italy.

PMID: 31844963
DOI: 10.1007/s00330-019-06545-6

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

Luca Maria Sconfienza et al. Eur Radiol. 2020 Apr.

. 2020 Apr;30(4):2220-2230.

doi: 10.1007/s00330-019-06545-6. Epub 2019 Dec 16.

Authors

Affiliations

¹ IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. io@lucasconfienza.it.
² Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20100, Milan, Italy. io@lucasconfienza.it.
³ Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, The Netherlands.
⁴ IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
⁵ Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127, Palermo, Italy.
⁶ Department of Radiology, Auckland City Hospital, Auckland, 1023, New Zealand.
⁷ Department of Radiology, Hospital Vithas Nueve de Octubre, 46015, Valencia, Spain.
⁸ Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy.
⁹ Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.
¹⁰ Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy.
¹¹ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.
¹² The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹³ The Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.
¹⁴ UOC Radiologia, Ospedale di Feltre, AULSS1 Dolomiti, Veneto, Italy.
¹⁵ Department of Radiology, Donostia University Hospital, Begiristain Doktorea Pasealekua, 109, 20014, Donostia/San Sebastian, Spain.
¹⁶ University of the Basque Country (UPV/EHU), Leioa, Spain.
¹⁷ Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, CE, Italy.
¹⁸ Private Institution of Ultrasonography and MSK Radiology, Heraklion, Greece.
¹⁹ Department of Anatomy, Medical School of the European University of Cyprus, Nicosia, Cyprus.
²⁰ IBERORAD 1895 S.L., 08021, Barcelona, Spain.
²¹ Department of Radiology, General University Hospital of Valencia, Valencia, Spain.
²² 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²³ University of Antwerp, Antwerp, Belgium.
²⁴ University of Antwerp Hospital (UZA), Antwerp, Belgium.
²⁵ Università degli Studi di Milano, Milan, Italy.
²⁶ Leeds Teaching Hospitals, Leeds, UK.
²⁷ Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.
²⁸ The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK.
²⁹ Hospital Son Llatzer, Palma de Mallorca, Spain.
³⁰ Medicine, Universidad de las Islas Baleares, Palma de Mallorca, Spain.
³¹ DISSAL Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genova, Italy.
³² Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy.
³³ Oxford Musculoskeletal Radiology, Oxford, UK.
³⁴ Medical School of the National and Kapodistrian University of Athens, Athens, Greece.
³⁵ Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20100, Milan, Italy.
³⁶ Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain.
³⁷ Radiologisk Afdeling, Herlev og Gentofte Hospital, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark.
³⁸ Radiology, Medical University of Vienna, Vienna, Austria.
³⁹ Ordensklinkum Linz, Linz, Austria.
⁴⁰ Sint Maartenskliniek, Nijmegen, The Netherlands.
⁴¹ Department of Oral Surgery, Wroclaw Medical University, Wroclaw, Poland.
⁴² Department of Radiology, Ospedale Evangelico Internazionale Genova, Genova, Italy.
⁴³ Department of Radiology, Private Institution of Ultrasonography, Athens, Greece.
⁴⁴ Department of Radiology, Hospital POVISA, Vigo, Spain.
⁴⁵ Institute of Sport Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania.
⁴⁶ University Medical Centre Ljubljana, Zaloška ul. 7, 1000, Ljubljana, Slovenia.
⁴⁷ Department of Radiology, AUVA Trauma Centre, Vienna, Austria.
⁴⁸ Medical Faculty, University "Ss.Cyril and Methodius", University Surgical Clinic "St.Naum Ohridski", Skopje, North Macedonia.
⁴⁹ St Luke's Radiology Oxford Ltd, Oxford, UK.
⁵⁰ Oxford University, Oxford, UK.
⁵¹ Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
⁵² Varelli Institute, Naples, Italy.

PMID: 31844963
DOI: 10.1007/s00330-019-06545-6

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%).

Keywords: Elbow; Injections; Radiology, interventional; Ultrasonography; Wrist.

PubMed Disclaimer

Cited by

US/CT fusion imaging and virtual navigation to guide lumbar intradiscal oxygen-ozone therapy: a pilot study.
Albano D, Messina C, Gitto S, Fusco S, Sconfienza LM, Bellelli A. Albano D, et al. J Ultrasound. 2024 Jun;27(2):291-296. doi: 10.1007/s40477-023-00835-y. Epub 2023 Dec 15. J Ultrasound. 2024. PMID: 38102520 Free PMC article.
Ultrasound-guided percutaneous irrigation of rotator cuff calcific tendinosis. What radiologist should know.
Chianca V, Pietto FD, Albano D, Corvino A, Del Grande F. Chianca V, et al. Pol J Radiol. 2022 Feb 13;87:e87-e92. doi: 10.5114/pjr.2022.113491. eCollection 2022. Pol J Radiol. 2022. PMID: 35280948 Free PMC article. Review.
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 VII, nerves of the lower limb.
Sconfienza LM, Adriaensen M, Albano D, Alcala-Galiano A, Allen G, Aparisi Gómez MP, Aringhieri G, Bazzocchi A, Beggs I, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gitto S, Grainger AJ, Greenwood S, Gupta H, Ivanoski S, Khanna M, Klauser A, Mansour R, Martin S, Mascarenhas V, Mauri G, McCarthy C, McKean D, McNally E, Melaki K, Messina C, Miron Mombiela R, Moutinho R, Olchowy C, Orlandi D, Prada González R, Prakash M, Posadzy M, Rutkauskas S, Snoj Ž, Tagliafico AS, Talaska A, Tomas X, Vasilevska Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Isaac A. Sconfienza LM, et al. Eur Radiol. 2022 Mar;32(3):1456-1464. doi: 10.1007/s00330-021-08283-0. Epub 2021 Sep 28. Eur Radiol. 2022. PMID: 34581843 Free PMC article.
Ultrasound-guided musculoskeletal interventional procedures around the elbow, hand and wrist excluding carpal tunnel procedures.
Tortora S, Messina C, Albano D, Serpi F, Corazza A, Carrafiello G, Sconfienza LM, Gitto S. Tortora S, et al. J Ultrason. 2021 Jun 7;21(85):e169-e176. doi: 10.15557/JoU.2021.0027. Epub 2021 Jun 18. J Ultrason. 2021. PMID: 34258043 Free PMC article.
CT Arthrography of the Elbow: What Radiologists Should Know.
Folco G, Messina C, Gitto S, Fusco S, Serpi F, Zagarella A, Gallazzi MB, Arrigoni P, Aliprandi A, Porta M, Vitali P, Sconfienza LM, Albano D. Folco G, et al. Tomography. 2024 Mar 11;10(3):415-427. doi: 10.3390/tomography10030032. Tomography. 2024. PMID: 38535774 Free PMC article. Review.

See all "Cited by" articles

References

1. Walsh JP, Farrell TP, Hynes J, Hughes N, O'Byrne C, Eustace SJ Therapeutic intervention in musculoskeletal radiology: current practice and future directions. Semin Musculoskelet Radiol 22:546–563. https://doi.org/10.1055/s-0038-1672193
1. Chianca V, Orlandi D, Messina C et al (2019) Interventional therapeutic procedures to treat degenerative and inflammatory musculoskeletal conditions: state of the art. Radiol Med. https://doi.org/10.1007/s11547-019-01018-8
1. Silvestri E, Barile A, Albano D et al (2017) Interventional therapeutic procedures in the musculoskeletal system: an Italian Survey by the Italian College of Musculoskeletal Radiology. Radiol Med. https://doi.org/10.1007/s11547-017-0842-7
1. Davidson J, Jayaraman S (2011) Guided interventions in musculoskeletal ultrasound: what’s the evidence? Clin Radiol 66:140–152. https://doi.org/10.1016/j.crad.2010.09.006 - DOI - PubMed
1. Albano D, Chianca V, Tormenta S, Migliore A, Sconfienza LM Old and new evidence concerning the crucial role of ultrasound in guiding intra-articular injections. Skeletal Radiol 46:963–964. https://doi.org/10.1007/s00256-017-2644-3

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Springer

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Similar articles

Cited by

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Abstract

Similar articles

Cited by

References

Publication types

MeSH terms

Substances

Related information

LinkOut - more resources

Full Text Sources