Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus

Luca Maria Sconfienza, Domenico Albano, Georgina Allen, Alberto Bazzocchi, Bianca Bignotti, Vito Chianca, Fernando Facal de Castro, Elena E. Drakonaki, Elena Gallardo, Jan Gielen, Andrea Sabine Klauser, Carlo Martinoli, Giovanni Mauri, Eugene McNally, Carmelo Messina, Rebeca Mirón Mombiela, Davide Orlandi, Athena Plagou, Magdalena Posadzy, Rosa de la PuenteMonique Reijnierse, Federica Rossi, Saulius Rutkauskas, Ziga Snoj, Jelena Vucetic, David Wilson, Alberto Stefano Tagliafico

Research output: Contribution to journalArticlepeer-review


Objectives: To update the 2012 European Society of Musculoskeletal Radiology (ESSR) clinical consensus guidelines for musculoskeletal ultrasound referral in Europe. Methods: Twenty-one musculoskeletal imaging experts from the ESSR participated in a consensus study based on a Delphic process. Two independent (non-voting) authors facilitated the procedure and resolved doubtful issues. Updated musculoskeletal ultrasound literature up to July 2017 was scored for shoulder, elbow, wrist/hand, hip, knee, and ankle/foot. Scoring of ultrasound elastography was included. The strength of the recommendation and level of evidence was scored by consensus greater than 67% or considered uncertain when the consensus was consensus less than 67%. Results: A total of 123 new papers were reviewed. No evidence change was found regarding the shoulder. There were no new relevant articles for the shoulder, 10 new articles for the elbow, 28 for the hand/wrist, 3 for the hip, 7 for the knee, and 4 for the ankle/foot. Four new evidence levels of A were determined, one for the hip (gluteal tendons tears), one for the knee (meniscal cysts), one for the ankle (ankle joint instability), and one for the foot (plantar plate tear). There was no level A evidence for elastography, although for Achilles tendinopathy and lateral epicondylitis evidence level was B with grade 3 indication. Conclusions: Four new areas of level A evidence were included in the guidelines. Elastography did not reach level A evidence. Whilst ultrasound is of increasing importance in musculoskeletal medical practice, the evidence for elastography remains moderate. Key Points: • Evidence and expert consensus shows an increase of musculoskeletal ultrasound indications.• Four new A evidence levels were found for the hip, knee, ankle, and foot.• There was no level A evidence for elastography.

Original languageEnglish
Pages (from-to)5338-5351
Number of pages14
JournalEuropean Radiology
Issue number12
Publication statusE-pub ahead of print - Jun 6 2018


  • Delphi technique
  • Elasticity imaging techniques
  • Guideline
  • Musculoskeletal system
  • Ultrasonography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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