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Purpose: An early-stage, multi-centre, prospective, randomised control trial with five-year follow-up was approved by Health Research Authority to compare the efficacy of a minimally invasive, laterally implanted interspinous fixation device (IFD) to open direct surgical decompression in treating lumbar spinal stenosis (LSS). Two-year results are presented. Patients and Methods: Forty-eight participants were randomly assigned to IFD or decompression. Primary study endpoints included changes from baseline at 8-weeks, 6, 12 and 24-months follow-ups for leg pain (visual analogue scale, VAS), back pain (VAS), disability (Oswestry Disability Index, ODI), LSS physical function (Zurich Claudication Questionnaire), distance walked in five minutes and number of repetitions of sitting-to-standing in one minute. Secondary study endpoints included patient and clinician global impression of change, adverse events, reoperations, operating parameters, and fusion rate. Results: Both treatment groups demonstrated statistically significant improvements in mean leg pain, back pain, ODI disability, LSS physical function, walking distance and sitting-to-standing repetitions compared to baseline over 24 months. Mean reduction of ODI from baseline levels was between 35% and 56% for IFD (p<0.002), and 49% to 55% for decompression (p<0.001) for all follow-up time points. Mean reduction of IFD group leg pain was between 57% and 78% for all time points (p<0.001), with 72% to 94% of participants having at least 30% reduction of leg pain from 8-weeks through 24-months. Walking distance for the IFD group increased from 66% to 94% and sitting-to-standing repetitions increased from 44% to 64% for all follow-up time points. Blood loss was 88% less in the IFD group (p=0.024) and operating time parameters strongly favoured IFD compared to decompression (p<0.001). An 89% fusion rate was assessed in a subset of IFD participants. There were no intraoperative device issues or re-operations in the IFD group, and only one healed and non-symptomatic spinous process fracture observed within 24 months. Conclusion: Despite a low number of participants in the IFD group, the study demonstrated successful two-year safety and clinical outcomes for the IFD with significant operation-related advantages compared to surgical decompression.
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Vascular complications in athletes are common and mimic musculoskeletal injuries such as muscle sprains, fractures, and cartilage abnormalities. They include traumatic vascular injuries and more subtle pathologies like entrapment syndromes, pseudoaneurysms, arterial occlusions, and venous thrombosis. Such vascular complications may be occult on imaging and can be difficult for a musculoskeletal radiologist to diagnose, resulting in a lack of timely diagnosis and potentially limb-threatening consequences. Although the final diagnosis may require multidisciplinary input from orthopaedic, sports and exercise medicine, and vascular and interventional radiology inputs, a musculoskeletal radiologist with prior knowledge of such conditions can be the first to diagnose such conditions aiding the athlete's performance. A musculoskeletal radiologist should pay due attention to anatomical courses of vascular channels and look for potential causes of vascular compression, aberrant myotendinous bands, accessory muscles, etc., before concluding a computed tomography (CT) or magnetic resonance imaging (MRI) as normal. Doppler ultrasound, CT, or MR angiography are commonly employed techniques for primary evaluation, whereas digital subtraction angiography is generally reserved for troubleshooting as advanced dynamic imaging.
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Calcific tendinopathy is characterized by the deposition of calcium hydroxyapatite crystals in various tendons of the body. Terms like calcium tendinitis, tendinosis, and tendinopathy are used interchangeably. Calcific tendinopathy is a common and well-documented ailment in the literature. Although common, the natural history, aetiology, and progression of calcific tendinitis are poorly understood. The treatment options include conservative and interventional measures. However, these measures cannot be applied as a blanket and are often tailored depending on the stage/phase of the disease. Out of the recognized stages of the disease, the resorptive stage causes the utmost symptoms when the calcium is rather soft and unstable. During this stage, the calcium may migrate beyond expected resorption and get deposited in the adjacent tissues contiguous with the calcium focus. The common destinations include bursal migration, intraosseous migration, muscular migration, and other less common migration sites. Such atypical presentations can lead to dilemmas in the diagnosis, prolongation of the diagnostic pathway, unwarranted apprehension, and treatment delay. Radiologists' role in this situation is to correctly recognize the imaging findings of atypical presentations of calcific tendinopathy and prevent unnecessary diagnostic and interventional studies. In this review article, we describe the pathogenic pathway and natural history of calcific tendinopathy from a radiologist's perspective and discuss different migratory patterns of calcium in calcific tendinopathy not only around the shoulder but also in other areas of the body on different imaging modalities. We also show a few examples of mimics and pitfalls on imaging. Finally, we discuss the appropriate management option of this condition.
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Calcinosis , Tendinopatía , Humanos , Tendinopatía/diagnóstico por imagen , Tendinopatía/terapia , Calcinosis/diagnóstico por imagen , Imagen por Resonancia Magnética/métodosRESUMEN
Objective: Compositional-MRI parameters enable the assessment of cartilage ultrastructure. Correlation of these parameters with clinical outcomes is unclear. This systematic review investigated the correlation of various compositional- MRI parameters with clinical outcome measures following cartilage repair or regeneration interventions in the knee. Design: This study was registered with PROSPERO and reported in accordance with PRISMA. PubMed, Institute of Science Index, Scopus, Cochrane Central Register of Controlled Trials, and Embase databases were searched. All studies, regardless of type, that presented correlation of compositional- MRI parameters with clinical outcome measures were included. Two researchers independently performed data extraction and QUADAS-2 analysis. Compositional-MRI parameter change following intervention and correlation with clinical outcome measures were evaluated. Results: 19 studies were included. Risk of bias was generally low. 5 different compositional parameters were observed from the included studies. However, due to the significant variability in the reporting of compositional-MRI parameters across studies, meta-analyses were possible only for T2 values and T2 index values (T2 value of repair cartilage relative to normal cartilage). Correlation of T2 values of repair cartilage with clinical outcome score was r â= â0.33 [0.15, 0.52]. Correlation of T2 index with clinical outcome score was r â= â0.52 [0.32, 0.77]. Conclusions: Correlation between T2 values and clinical outcome scores following knee cartilage repair were found. The heterogeneity of the correlations extracted from the included studies limited the scope for the meta-analysis. Thus, standardised, high-quality studies are required for better assessment of correlation between compositional MRI parameters and clinical outcome measures after cartilage repair. Registration number: PROSPERO CRD42021287364.Study protocol available on PROSPERO website.
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Spondylodiscitis is a common referral to spinal on call services. Identification of the causative organism is vital in order to dictate the appropriate antibiotic treatment. In this context, the surgical and interventional radiology team is often asked to perform a diagnostic biopsy. The aim of the present study was to assess whether the sampling location affects the diagnostic yield. Our results suggest that the overall positive diagnostic yield was 35%. When disc material was included in the sample the diagnostic yield significantly improved to 47%. Bone sampling alone had a positive yield of 15%. Age, pre-biopsy CRP, pre-biopsy use of antibiotics did not seem to affect the likelihood of obtaining a positive yield. These results suggests that when performing image guided biopsies for suspected cases of spondylodiscitis the inclusion of disc material is important.
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Discitis , Disco Intervertebral , Humanos , Discitis/diagnóstico por imagen , Discitis/cirugía , Tomografía Computarizada por Rayos X/métodos , Estudios Retrospectivos , Disco Intervertebral/diagnóstico por imagen , Disco Intervertebral/cirugía , Disco Intervertebral/patología , Biopsia Guiada por Imagen/métodos , Antibacterianos/uso terapéuticoRESUMEN
Magnetic resonance arthrography and 3T magnetic resonance imaging of the hip are a technique commonly performed in young, physically active patients presenting with pain relating to the hip, with the focus on assessing for the presence of labral tears and femoroacetabular impingement. Abnormal signal within the labrum can be misleading, however, as labral tears are a frequent incidental finding and have been identified in a large proportion of the asymptomatic population. A range of extralabral conditions can cause hip-related pain in young patients, including pathology related to the bones, joints, and periarticular soft tissues. It is vital that the radiologist is aware for these pathologies and examines for them even in the presence of a confirmed labral tear. In this article, we review a range of common extralabral pathologies responsible for hip pain and highlight review areas that aid in their diagnosis.
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The rotator interval (RI) is a critical but complex anatomical structure for which musculoskeletal ultrasound provides an excellent imaging evaluation. In the patients with restricted and painful movements, the RI may not be visualised optimally as the conventional 'Modified Crass' positions may not be achievable. It can also be difficult to optimally evaluate the anterior supraspinatus and subscapularis tendons in such patients. We describe a simple shoulder position obviating need of pronounced supraspinatus stretch for better evaluation of the rotator interval and adjoining rotator cuff structures.
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Articulación del Hombro , Hombro , Humanos , Manguito de los Rotadores/diagnóstico por imagen , Hombro/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen , Tendones/diagnóstico por imagen , UltrasonografíaRESUMEN
OBJECTIVES: Clarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around foot and ankle in order to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper that was shared with all panel members for final approval. RESULTS: A list of 16 evidence-based statements on clinical indications for image-guided musculoskeletal interventional procedures in the foot and ankle were drafted after a literature review. The highest level of evidence was reported for four statements, all receiving 100% agreement. CONCLUSION: According to this consensus, image-guided interventions should not be considered a first-level approach for treating Achilles tendinopathy, while ultrasonography guidance is strongly recommended to improve the efficacy of interventional procedures for plantar fasciitis and Morton's neuroma, particularly using platelet-rich plasma and corticosteroids, respectively. KEY POINTS: ⢠The expert panel of the ESSR listed 16 evidence-based statements on clinical indications of image-guided musculoskeletal interventional procedures in the foot and ankle. ⢠Strong consensus was obtained for all statements. ⢠The highest level of evidence was reached by four statements concerning the effectiveness of US-guided injections of corticosteroid for Morton's neuroma and PRP for plantar fasciitis.
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Tendón Calcáneo , Sistema Musculoesquelético , Radiología , Tendinopatía , Tobillo/diagnóstico por imagen , Consenso , HumanosRESUMEN
OBJECTIVES: Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications. METHODS: In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications. RESULTS: Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts. CONCLUSIONS: This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip. KEY POINTS: ⢠Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip. ⢠The highest level of evidence was only reached for one statement. ⢠Strong consensus was obtained for all statements.
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Sistema Musculoesquelético , Radiología , Consenso , Humanos , Estudios Prospectivos , Radiografía , Radiología Intervencionista , Ultrasonografía IntervencionalRESUMEN
OBJECTIVES: To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton's neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. RESULTS: Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. CONCLUSION: Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. KEY POINTS: ⢠Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. ⢠US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. ⢠US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area.
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Sistema Musculoesquelético , Radiología , Anestésicos Locales , Consenso , Humanos , Extremidad Inferior/diagnóstico por imagen , Radiografía , Ultrasonografía IntervencionalRESUMEN
OBJECTIVES: Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. METHODS: We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. RESULTS: A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. CONCLUSIONS: Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. KEY POINTS: ⢠A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. ⢠Strong consensus with 100% agreement was obtained for all statements. ⢠Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.
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Radiología , Consenso , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Estudios Prospectivos , Radiografía , Radiología Intervencionista , Ultrasonografía IntervencionalRESUMEN
Musculoskeletal trauma accounts for a large percentage of emergency room visits and is amongst the top causes of unscheduled patient visits to the emergency room. Musculoskeletal trauma results in expenditure of billions of dollars and protracted losses of quality-adjusted life years. New and innovative methods are needed to minimise the impact by ensuring quick and accurate assessment. However, each of the currently utilised radiological procedures, such as radiography, ultrasonography, computed tomography, and magnetic resonance imaging, has resulted in implosion of medical imaging data. Deep learning, a recent advancement in artificial intelligence, has demonstrated the potential to analyse medical images with sensitivity and specificity at par with experts. In this review article, we intend to summarise and showcase the various developments which have occurred in the dynamic field of artificial intelligence and machine learning and how their applicability to different aspects of imaging in trauma can be explored to improvise our existing reporting systems and improvise on patient outcomes.
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PURPOSE: Greater trochanter (GT) lesions are relatively uncommon. They can be traumatic, infective including tuber-culosis, inflammatory, and neoplastic (primary and metastatic osseous lesions). Although imaging of greater trochanter lesions remains essential for differential diagnoses, an image-guided biopsy is a mainstay for diagnosis and to guide subsequent management. MATERIAL AND METHODS: A retrospective search for the word 'greater trochanter' was performed of a computerised radiology information system (CRIS) of a tertiary referral centre for orthopaedic oncology over a period of 12 years (2007-2019). This revealed 6019 reports with 101 neoplasms. The imaging, histology, and demography were reviewed by a dedicated musculoskeletal radiologist. RESULTS: We identified 101 GT neoplasms with a mean age of 51.5 years (range 6 to 85 years) and a slight female predominance of 1.2 : 1 (46 males and 55 females). Using 30 years of age as a cut-off, we further segregated the patient cohort into 2 groups: 26 (25.74%) lesions in patients less than 30 years age and the remaining 75 (74.26%) lesions in patients over 30 years old. Chondroblastoma was the most common neoplasm in patients below 30 years of age, and metastases were the most common neoplasms in patients over 30 years of age. CONCLUSIONS: Greater trochanter pathologies show a broad spectrum of aetiologies. Imaging including radiographs, computed tomography, magnetic resonance imaging, and nuclear medicine scans help to narrow down the differen-tials diagnosis.
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INTRODUCTION: S1 root block is performed for pain in the lower limbs due to S1 nerve root inflammation at the L5/S1 disc level or compression in the lateral recess. We often note anterior or posterior spread of contrast away from the L5/S1 disc through an anatomically appropriate needle tip placement. We frequently encounter vascular spread when performing S1 root blocks, and the reported incidence varies between 10.4% and 27.8%. There is no clear strategy published to manage these challenges. In such clinical scenarios, we propose a double needle and/or a multilevel needle technique. CASE: A 39-year-old male presented with radicular pain in the left S1 distribution which matched the magnetic resonance imaging (MRI) scan findings and thus he was listed for a left S1 root block. A 22G needle was placed at the S1 level and upon injecting the contrast, vascular spread and anterior and distal spread along the nerve root were noted and the contrast did not reach the site of the pathology, the L5/S1 disc. The contrast continued to spread anteriorly despite withdrawing the needle. A second needle was placed medial and inferior to the first needle and the contrast spread now was adequate, that is, towards the L5/S1 disc and thus the injection was accomplished in a safe and satisfactory manner without needing to reschedule the procedure. CONCLUSION: Double needle technique can assist in overcoming problems encountered when performing an S1 root block. The alternatives could be the multilevel technique or to reschedule the procedure or consider a less optimal technique such as a caudal or a lumbar interlaminar epidural. In this technical report, we have highlighted various intervention options to mitigate such challenges and included a flow diagram to assist in decision-making. We have also discussed the possibility of altering the consent to accommodate the changes to the planned procedure.
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Atraumatic fractures of femur, although not as common as traumatic fractures, are frequently encountered in the clinical practice. They present with non-specific symptoms and can be occult on initial imaging making their diagnosis difficult, sometimes resulting in complications. Overlapping terminologies used to describe these fractures may hamper effective communication between the radiologist and the clinician. In this article, we review various atraumatic fractures of femur, terminologies used to describe them, their imaging findings and differential diagnosis. The article also describes the aetiology, pathophysiology and relevant biomechanics behind these fractures. An approach to atraumatic femoral fractures has been outlined.
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Fracturas del Fémur/diagnóstico por imagen , Fracturas Espontáneas/diagnóstico por imagen , Fracturas por Estrés/diagnóstico por imagen , Terminología como Asunto , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Fracturas del Fémur/etiología , Fracturas del Cuello Femoral/diagnóstico por imagen , Fracturas del Cuello Femoral/etiología , Fracturas por Estrés/etiología , Humanos , Persona de Mediana Edad , Osteoma Osteoide/diagnóstico por imagen , Osteomalacia/diagnóstico por imagen , Osteomielitis/diagnóstico por imagenRESUMEN
Femoral hernia is the protrusion of a peritoneal sac through the femoral ring into the femoral canal lying deep and inferior to the inguinal ligament. The hernia sac usually contains preperitoneal fat, omentum, bowel, or fluid. Ultrasound is recommended as the first-line investigation for diagnosing clinically occult femoral hernias in nonemergency settings, whereas CT is the imaging of choice in emergency settings. High accuracy of the ultrasound in clinically occult femoral hernia is further validated with further CT and MRI. In this article, we propose sonographic detection of the physiological peritoneal fluid herniating through capacious femoral ring manifesting as a "speech bubble/speech box appearance." This is a potentially invaluable sonographic sign for clinically occult femoral hernias, differentiating them from inguinal hernias and cysts of the canal of Nuck in females and preventing inadvertent attempts to aspirate.
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Hernia Femoral , Hernia Inguinal , Fascia/diagnóstico por imagen , Femenino , Hernia Femoral/diagnóstico por imagen , Hernia Inguinal/diagnóstico por imagen , Humanos , Habla , UltrasonografíaRESUMEN
Indian radiology trainees and radiologists are interested to have FRCR (Fellow of the Royal College of Radiologists) qualification for various reasons including academic career progression, subspecialty interest and other socioeconomic factors. The path for acquiring FRCR qualification is adventurous yet onerous and exhausting. Perseverance, meticulous planning and clarity in the vision are essential prerequisites for an Indian graduate aiming to complete FRCR qualification, and one may require to invest an average of 1.5-2 years even if there is no reattempt in this tripartite examination. Indian doctors including radiologists are considered amongst the finest across global medical fraternities. However, the Indian medical education is skewed and variably distributed over the subcontinent due to organisational inability to provide single radiology curriculum-based education to all radiology training programmes. Parallel educational boards and a variety of institutions such as government, trust-funded and private organisations provide radiology training to further complicate the grand picture of radiology education in India. Conversely, UK radiology education is uniform nationally and rigorously enforced by deaneries based upon state-provided guidelines. UK training opportunities are essentially academically rewarding experience but they require herculean efforts to gain access to one. One should constantly focus on building a resume at par with that of a UK trainee by obtaining experience required to fulfil checklist for such opportunities. Alongwith addressing local (UK) competition thoughtfully, hard work, diligence, and high standards of work ethics are absolute musts to build a great resume, to obtain training opportunity and, in turn, to satisfy the ultimate goal of carrier advancement.
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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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Enfermedad de De Quervain/terapia , Tendinopatía del Codo/terapia , Radiografía Intervencional , Trastorno del Dedo en Gatillo/terapia , Ultrasonografía Intervencional , Técnica Delphi , Punción Seca , Articulación del Codo , Fluoroscopía , Glucocorticoides/administración & dosificación , Humanos , Ácido Hialurónico/administración & dosificación , Inyecciones , Inyecciones Intraarticulares , Plasma Rico en Plaquetas , Estudios Prospectivos , Radiografía , Tenotomía , Viscosuplementos/administración & dosificación , Articulación de la MuñecaRESUMEN
BACKGROUND: Image-guided interventional procedures of the nerves are commonly performed by physicians from different medical specialties, although there is a lack of clinical indications for these types of procedures. This Delphi-based consensus provided a list of indications on image-guided interventional procedures for nerves of the upper limb based on updated published evidence. METHODS: An expert panel of 45 members of the Ultrasound and Interventional Subcommittees of the ESSR participated in this Delphi-based consensus study. After revision of the published papers on image-guided interventional procedures for nerves of the upper limb updated to September 2018, the experts drafted a list of statements according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus on statements regarding clinical indications was considered as strong when more than 95% of experts agreed, and broad if more than 80% agreed. RESULTS: Ten statements were drafted on procedures for nerves of the upper limb. Only two statements reached the highest level of evidence (ultrasound guidance is a safe and effective method for brachial plexus block; ultrasound-guided non-surgical approaches are safe and effective methods to treat carpal tunnel syndrome in the short term, but there is sparse evidence on the mid- and long-term effectiveness of these interventions). Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%). CONCLUSIONS: This Delphi-based consensus study reported poor evidence on image-guided interventional procedures for nerves of the upper limb. Sixty percent of statements on clinical indications provided by the expert board reached a strong consensus. KEY POINTS: ⢠An expert panel of the ESSR provided 10 evidence-based statements on clinical indications for image-guided interventional procedures for nerves of the upper limb ⢠Two statements reached the highest level of evidence ⢠Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%).