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: European Radiology

L.M. Sconfienza; M. Adriaensen; D. Albano; M.P. Aparisi Gómez; A. Bazzocchi; I. Beggs; B. Bignotti; V. Chianca; A. Corazza; D. Dalili; M. De Dea; J.L. del Cura; F. Di Pietto; E. Drakonaki; F. Facal de Castro; D. Filippiadis; J. Gielen; S. Gitto; H. Gupta; A.S. Klauser; R. Lalam; S. Martin; C. Martinoli; G. Mauri; C. McCarthy; E. McNally; K. Melaki; C. Messina; R. Mirón Mombiela; B. Neubauer; M. Obradov; C. Olchowy; D. Orlandi; A. Plagou; R. Prada Gonzalez; S. Rutkauskas; Z. Snoj; A.S. Tagliafico; A. Talaska; V. Vasilevska-Nikodinovska; J. Vucetic; D. Wilson; F. Zaottini; M. Zappia; G. Allen; on behalf of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR)

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: European Radiology

L.M. Sconfienza, M. Adriaensen, D. Albano, M.P. Aparisi Gómez, A. Bazzocchi, I. Beggs, B. Bignotti, V. Chianca, A. Corazza, D. Dalili, M. De Dea, J.L. del Cura, F. Di Pietto, E. Drakonaki, F. Facal de Castro, D. Filippiadis, J. Gielen, S. Gitto, H. Gupta, A.S. KlauserR. Lalam, S. Martin, C. Martinoli, G. Mauri, C. McCarthy, E. McNally, K. Melaki, C. Messina, R. Mirón Mombiela, B. Neubauer, M. Obradov, C. Olchowy, D. Orlandi, A. Plagou, R. Prada Gonzalez, S. Rutkauskas, Z. Snoj, A.S. Tagliafico, A. Talaska, V. Vasilevska-Nikodinovska, J. Vucetic, D. Wilson, F. Zaottini, M. Zappia, G. Allen, on behalf of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR)

Research output: Contribution to journal › Article › peer-review

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%). © 2019, European Society of Radiology.

Original language	English
Pages (from-to)	2220-2230
Number of pages	11
Journal	Eur. Radiol.
Volume	30
Issue number	4
DOIs	https://doi.org/10.1007/s00330-019-06545-6
Publication status	Published - 2020

Keywords

Elbow
Injections
Radiology, interventional
Ultrasonography
Wrist
hyaluronic acid
steroid
glucocorticoid
viscosupplement
Article
controlled study
Delphi study
elbow
evidence based medicine
joint function
medical society
metacarpophalangeal joint
musculoskeletal procedure
musculoskeletal system
priority journal
proximal interphalangeal joint
recurrence risk
rheumatoid arthritis
trigger finger
ultrasound
wrist
consensus development
De Quervain tenosynovitis
epicondylitis
fluoroscopy
human
injection
interventional radiology
interventional ultrasonography
intraarticular drug administration
prospective study
radiography
tenotomy
thrombocyte rich plasma
De Quervain Disease
Delphi Technique
Dry Needling
Elbow Joint
Elbow Tendinopathy
Fluoroscopy
Glucocorticoids
Humans
Hyaluronic Acid
Injections, Intra-Articular
Platelet-Rich Plasma
Prospective Studies
Radiography
Radiography, Interventional
Tenotomy
Trigger Finger Disorder
Ultrasonography, Interventional
Viscosupplements
Wrist Joint

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Sconfienza, L. M., Adriaensen, M., Albano, D., Aparisi Gómez, M. P., Bazzocchi, A., Beggs, I., Bignotti, B., Chianca, V., Corazza, A., Dalili, D., De Dea, M., del Cura, J. L., Di Pietto, F., Drakonaki, E., Facal de Castro, F., Filippiadis, D., Gielen, J., Gitto, S., Gupta, H., ... (ESSR), O. B. O. T. U. A. I. S. O. T. E. S. O. M. R. (2020). 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: European Radiology. Eur. Radiol., 30(4), 2220-2230. https://doi.org/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 : European Radiology. / Sconfienza, L.M.; Adriaensen, M.; Albano, D.; Aparisi Gómez, M.P.; Bazzocchi, A.; Beggs, I.; Bignotti, B.; Chianca, V.; Corazza, A.; Dalili, D.; De Dea, M.; del Cura, J.L.; Di Pietto, F.; Drakonaki, E.; Facal de Castro, F.; Filippiadis, D.; Gielen, J.; Gitto, S.; Gupta, H.; Klauser, A.S.; Lalam, R.; Martin, S.; Martinoli, C.; Mauri, G.; McCarthy, C.; McNally, E.; Melaki, K.; Messina, C.; Mirón Mombiela, R.; Neubauer, B.; Obradov, M.; Olchowy, C.; Orlandi, D.; Plagou, A.; Prada Gonzalez, R.; Rutkauskas, S.; Snoj, Z.; Tagliafico, A.S.; Talaska, A.; Vasilevska-Nikodinovska, V.; Vucetic, J.; Wilson, D.; Zaottini, F.; Zappia, M.; Allen, G.; (ESSR), on behalf of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology.

In: Eur. Radiol., Vol. 30, No. 4, 2020, p. 2220-2230.

Research output: Contribution to journal › Article › peer-review

Sconfienza, LM, Adriaensen, M, Albano, D, Aparisi Gómez, MP, Bazzocchi, A, Beggs, I, Bignotti, B, Chianca, V , Corazza, A, Dalili, D, De Dea, M, del Cura, JL, Di Pietto, F, Drakonaki, E, Facal de Castro, F, Filippiadis, D, Gielen, J, Gitto, S, Gupta, H, Klauser, AS, Lalam, R, Martin, S, Martinoli, C, Mauri, G, McCarthy, C, McNally, E, Melaki, K, Messina, C, Mirón Mombiela, R, Neubauer, B, Obradov, M, Olchowy, C, Orlandi, D, Plagou, A, Prada Gonzalez, R, Rutkauskas, S, Snoj, Z, Tagliafico, AS, Talaska, A, Vasilevska-Nikodinovska, V, Vucetic, J, Wilson, D, Zaottini, F, Zappia, M, Allen, G & (ESSR), OBOTUAISOTESOMR 2020, '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: European Radiology', Eur. Radiol., vol. 30, no. 4, pp. 2220-2230. https://doi.org/10.1007/s00330-019-06545-6

Sconfienza LM, Adriaensen M, Albano D, Aparisi Gómez MP, Bazzocchi A, Beggs I 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: European Radiology. Eur. Radiol. 2020;30(4):2220-2230. https://doi.org/10.1007/s00330-019-06545-6

Sconfienza, L.M. ; Adriaensen, M. ; Albano, D. ; Aparisi Gómez, M.P. ; Bazzocchi, A. ; Beggs, I. ; Bignotti, B. ; Chianca, V. ; Corazza, A. ; Dalili, D. ; De Dea, M. ; del Cura, J.L. ; Di Pietto, F. ; Drakonaki, E. ; Facal de Castro, F. ; Filippiadis, D. ; Gielen, J. ; Gitto, S. ; Gupta, H. ; Klauser, A.S. ; Lalam, R. ; Martin, S. ; Martinoli, C. ; Mauri, G. ; McCarthy, C. ; McNally, E. ; Melaki, K. ; Messina, C. ; Mirón Mombiela, R. ; Neubauer, B. ; Obradov, M. ; Olchowy, C. ; Orlandi, D. ; Plagou, A. ; Prada Gonzalez, R. ; Rutkauskas, S. ; Snoj, Z. ; Tagliafico, A.S. ; Talaska, A. ; Vasilevska-Nikodinovska, V. ; Vucetic, J. ; Wilson, D. ; Zaottini, F. ; Zappia, M. ; Allen, G. ; (ESSR), on behalf of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology. / 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 : European Radiology. In: Eur. Radiol. 2020 ; Vol. 30, No. 4. pp. 2220-2230.

@article{6c2272731f9c4b13b3cd0a9d84359e07,

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: European Radiology",

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%). {\textcopyright} 2019, European Society of Radiology.",

keywords = "Elbow, Injections, Radiology, interventional, Ultrasonography, Wrist, hyaluronic acid, steroid, glucocorticoid, viscosupplement, Article, controlled study, Delphi study, elbow, evidence based medicine, joint function, medical society, metacarpophalangeal joint, musculoskeletal procedure, musculoskeletal system, priority journal, proximal interphalangeal joint, recurrence risk, rheumatoid arthritis, trigger finger, ultrasound, wrist, consensus development, De Quervain tenosynovitis, epicondylitis, fluoroscopy, human, injection, interventional radiology, interventional ultrasonography, intraarticular drug administration, prospective study, radiography, tenotomy, thrombocyte rich plasma, De Quervain Disease, Delphi Technique, Dry Needling, Elbow Joint, Elbow Tendinopathy, Fluoroscopy, Glucocorticoids, Humans, Hyaluronic Acid, Injections, Intra-Articular, Platelet-Rich Plasma, Prospective Studies, Radiography, Radiography, Interventional, Tenotomy, Trigger Finger Disorder, Ultrasonography, Interventional, Viscosupplements, Wrist Joint",

author = "L.M. Sconfienza and M. Adriaensen and D. Albano and {Aparisi G{\'o}mez}, M.P. and A. Bazzocchi and I. Beggs and B. Bignotti and V. Chianca and A. Corazza and D. Dalili and {De Dea}, M. and {del Cura}, J.L. and {Di Pietto}, F. and E. Drakonaki and {Facal de Castro}, F. and D. Filippiadis and J. Gielen and S. Gitto and H. Gupta and A.S. Klauser and R. Lalam and S. Martin and C. Martinoli and G. Mauri and C. McCarthy and E. McNally and K. Melaki and C. Messina and {Mir{\'o}n Mombiela}, R. and B. Neubauer and M. Obradov and C. Olchowy and D. Orlandi and A. Plagou and {Prada Gonzalez}, R. and S. Rutkauskas and Z. Snoj and A.S. Tagliafico and A. Talaska and V. Vasilevska-Nikodinovska and J. Vucetic and D. Wilson and F. Zaottini and M. Zappia and G. Allen and (ESSR), {on behalf of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology}",

note = "Cited By :6 Export Date: 5 March 2021 CODEN: EURAE Correspondence Address: Sconfienza, L.M.; Dipartimento di Scienze Biomediche per la Salute, Italy; email: io@lucasconfienza.it Chemicals/CAS: hyaluronic acid, 31799-91-4, 9004-61-9, 9067-32-7; Glucocorticoids; Hyaluronic Acid; Viscosupplements Funding details: European Musculoskeletal Oncology Society, EMSOS Funding text 1: All authors are members of the Ultrasound and/or Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR). 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year = "2020",

doi = "10.1007/s00330-019-06545-6",

language = "English",

volume = "30",

pages = "2220--2230",

journal = "Eur. Radiol.",

issn = "0938-7994",

publisher = "Springer",

number = "4",

}

TY - JOUR

T1 - 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

T2 - European Radiology

AU - Sconfienza, L.M.

AU - Adriaensen, M.

AU - Albano, D.

AU - Aparisi Gómez, M.P.

AU - Bazzocchi, A.

AU - Beggs, I.

AU - Bignotti, B.

AU - Chianca, V.

AU - Corazza, A.

AU - Dalili, D.

AU - De Dea, M.

AU - del Cura, J.L.

AU - Di Pietto, F.

AU - Drakonaki, E.

AU - Facal de Castro, F.

AU - Filippiadis, D.

AU - Gielen, J.

AU - Gitto, S.

AU - Gupta, H.

AU - Klauser, A.S.

AU - Lalam, R.

AU - Martin, S.

AU - Martinoli, C.

AU - Mauri, G.

AU - McCarthy, C.

AU - McNally, E.

AU - Melaki, K.

AU - Messina, C.

AU - Mirón Mombiela, R.

AU - Neubauer, B.

AU - Obradov, M.

AU - Olchowy, C.

AU - Orlandi, D.

AU - Plagou, A.

AU - Prada Gonzalez, R.

AU - Rutkauskas, S.

AU - Snoj, Z.

AU - Tagliafico, A.S.

AU - Talaska, A.

AU - Vasilevska-Nikodinovska, V.

AU - Vucetic, J.

AU - Wilson, D.

AU - Zaottini, F.

AU - Zappia, M.

AU - Allen, G.

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

N1 - Cited By :6 Export Date: 5 March 2021 CODEN: EURAE Correspondence Address: Sconfienza, L.M.; Dipartimento di Scienze Biomediche per la Salute, Italy; email: io@lucasconfienza.it Chemicals/CAS: hyaluronic acid, 31799-91-4, 9004-61-9, 9067-32-7; Glucocorticoids; Hyaluronic Acid; Viscosupplements Funding details: European Musculoskeletal Oncology Society, EMSOS Funding text 1: All authors are members of the Ultrasound and/or Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR). 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Sibbitt, W.L., Jr., Band, P.A., Chavez-Chiang, N.R., Delea, S.L., Norton, H.E., Bankhurst, A.D., A randomized controlled trial of the cost-effectiveness of ultrasound-guided intraarticular injection of inflammatory arthritis (2011) J Rheumatol, 38, pp. 252-263. , (,),.,:., https://doi.org/10.3899/jrheum.100866; Sibbitt, W.L., Jr., Peisajovich, A., Michael, A.A., Does sonographic needle guidance affect the clinical outcome of intraarticular injections? (2009) J Rheumatol, 36, pp. 1892-1902. , (,),:., https://doi.org/10.3899/jrheum.090013; Smith, J., Brault, J.S., Rizzo, M., Sayeed, Y.A., Finnoff, J.T., Accuracy of sonographically guided and palpation guided scaphotrapeziotrapezoid joint injections (2011) J Ultrasound Med, 30, pp. 1509-1515; Gilliland, C.A., Salazar, L.D., Borchers, J.R., Ultrasound versus anatomic guidance for intra-articular and periarticular injection: a systematic review (2011) Phys Sportsmed, 39, pp. 121-131; Koski, J.M., Hermunen, H., Intra-articular glucocorticoid treatment of the rheumatoid wrist. An ultrasonographic study (2001) Scand J Rheumatol, 30, pp. 268-270; Luz, K.R., Furtado, R.N., Nunes, C.C., Rosenfeld, A., Fernandes, A.R., Natour, J., Ultrasound-guided intra-articular injections in the wrist in patients with rheumatoid arthritis: a double-blind, randomised controlled study (2008) Ann Rheum Dis, 67, pp. 1198-1200. , (,),.,:., https://doi.org/10.1136/ard.2007.084616; Salini, V., de Amicis, D., Abate, M., Natale, M.A., Di Iorio, A., Ultrasound-guided hyaluronic acid injection in carpometacarpal osteoarthritis: Short-term results (2009) Int J Immunopathol Pharmacol, 22, pp. 455-460. , https://doi.org/10.1177/039463200902200222; Di Sante, L., Cacchio, A., Scettri, P., Paoloni, M., Ioppolo, F., Santilli, V., Ultrasound-guided procedure for the treatment of trapeziometacarpal osteoarthritis (2011) Clin Rheumatol, 30, pp. 1195-1200. , (,),.,:., https://doi.org/10.1007/s10067-011-1730-5; Dubreuil, M., Greger, S., LaValley, M., Cunnington, J., Sibbitt, W.L., Jr., Kissin, E.Y., Improvement in wrist pain with ultrasound-guided glucocorticoid injections: a meta-analysis of individual patient data (2013) Semin Arthritis Rheum, 42, pp. 492-497; Zeidenberg, J., Aronowitz, J.G., Landy, D.C., Owens, P.W., Jose, J., Ultrasound-guided aspiration of wrist ganglions: a follow-up survey of patient satisfaction and outcomes (2016) Acta Radiol, 57, pp. 481-486; Wang, G., Jacobson, J.A., Feng, F.Y., Girish, G., Caoili, E.M., Brandon, C., Sonography of wrist ganglion cysts: variable and noncystic appearances (2007) J Ultrasound Med, 26, pp. 1323-1328. , quiz 1330–1; Latif, A., Ansar, A., Butt, M.Q., Treatment of ganglions; a five year experience (2014) J Pak Med Assoc, 64, pp. 1278-1281; Head, L., Allen, M., Boyd, K.U., Long-term outcomes and patient satisfaction following wrist ganglion aspiration (2015) Plast Surg (Oakv), 23, pp. 51-53; Yamamoto, M., Kurimoto, S., Okui, N., Tatebe, M., Shinohara, T., Hirata, H., Sonography-guided arthroscopy for wrist ganglion (2012) J Hand Surg Am, 37, pp. 1411-1415; Ho, P.C., Griffiths, J., Lo, W.N., Yen, C.H., Hung, L.K., Current treatment of ganglion of the wrist (2001) Hand Surg, 6, pp. 49-58; Dias, J.J., Dhukaram, V., Kumar, P., The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention (2007) J Hand Surg Eur Vol, 32, pp. 502-508; Colberg, R.E., Sánchez, C.F., Lugo-Vicente, H., Aspiration and triamcinolone acetonide injection of wrist synovial cysts in children (2008) J Pediatr Surg, 43, pp. 2087-2090; Varley, G.W., Needoff, M., Davis, T.R., Clay, N.R., Conservative management of wrist ganglia. 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PY - 2020

Y1 - 2020

N2 - 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%). © 2019, European Society of Radiology.

AB - 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%). © 2019, European Society of Radiology.

KW - Elbow

KW - Injections

KW - Radiology, interventional

KW - Ultrasonography

KW - Wrist

KW - hyaluronic acid

KW - steroid

KW - glucocorticoid

KW - viscosupplement

KW - Article

KW - controlled study

KW - Delphi study

KW - elbow

KW - evidence based medicine

KW - joint function

KW - medical society

KW - metacarpophalangeal joint

KW - musculoskeletal procedure

KW - musculoskeletal system

KW - priority journal

KW - proximal interphalangeal joint

KW - recurrence risk

KW - rheumatoid arthritis

KW - trigger finger

KW - ultrasound

KW - wrist

KW - consensus development

KW - De Quervain tenosynovitis

KW - epicondylitis

KW - fluoroscopy

KW - human

KW - injection

KW - interventional radiology

KW - interventional ultrasonography

KW - intraarticular drug administration

KW - prospective study

KW - radiography

KW - tenotomy

KW - thrombocyte rich plasma

KW - De Quervain Disease

KW - Delphi Technique

KW - Dry Needling

KW - Elbow Joint

KW - Elbow Tendinopathy

KW - Fluoroscopy

KW - Glucocorticoids

KW - Humans

KW - Hyaluronic Acid

KW - Injections, Intra-Articular

KW - Platelet-Rich Plasma

KW - Prospective Studies

KW - Radiography

KW - Radiography, Interventional

KW - Tenotomy

KW - Trigger Finger Disorder

KW - Ultrasonography, Interventional

KW - Viscosupplements

KW - Wrist Joint

U2 - 10.1007/s00330-019-06545-6

DO - 10.1007/s00330-019-06545-6

M3 - Article

VL - 30

SP - 2220

EP - 2230

JO - Eur. Radiol.

JF - Eur. Radiol.

SN - 0938-7994

IS - 4

ER -