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- Title
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
Sconfienza, Luca Maria; Adriaensen, Miraude; Albano, Domenico; Aparisi Gómez, Maria Pilar; Bazzocchi, Alberto; Beggs, Ian; Bignotti, Bianca; Chianca, Vito; Corazza, Angelo; Dalili, Danoob; De Dea, Miriam; del Cura, Jose Luis; Di Pietto, Francesco; Drakonaki, Eleni; Facal de Castro, Fernando; Filippiadis, Dimitrios; Gielen, Jan; Gitto, Salvatore; Gupta, Harun; Klauser, Andrea S.
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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%).<bold>Conclusions: </bold>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.<bold>Key Points: </bold>• 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%).
- Subjects
MUSCULOSKELETAL system; CLINICAL indications; WRIST; ELBOW; TENOSYNOVITIS; GLUCOCORTICOIDS; PLATELET-rich plasma; ULTRASONIC imaging; TENOTOMY; INJECTIONS; INTERVENTIONAL radiology; RADIOGRAPHY; HYALURONIC acid; FLUOROSCOPY; DE Quervain disease; INTRA-articular injections; SOLUTION (Chemistry); LONGITUDINAL method; DELPHI method
- Publication
European Radiology, 2020, Vol 30, Issue 4, p2220
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-019-06545-6