Axial traction in magnetic resonance arthrography of the wrist: How to do?

MR;Arthrography;Wrist;Axial;TractionMagnetic resonance (MR) arthrography is an efficient technique to study both intrinsic andextrinsic ligaments as well as the triangular fibrocartilage complex (TFCC) of the wrist[1,2]. While multidetector computed tomography (MDCT) arthrography is superior in cor-tical bone and articular cartilage analysis because of its higher spatial resolution, MRarthrography is better to assess medullar bone andsoft tissues such as ligaments ten-dons because of its higher contrast resolution [1]. MR arthrography is especially accuratefor detection ofnon-transfixingTFCCrupturewithasensitivity andspecificity 85 76%compared with standard MR imaging (sensitivity and specificity of 17 and 79%) [3,4]. Stressmaneuvers inspired by arthroscopic techniques have previously been developed for shoul-der, hip and knee and even metatarsophalangeal MR arthrography [5—8]. Guntern et al.studied 12 wrist MR arthrographies with and without traction and demonstrated a signifi-cant increase in joint space width at the radiocarpal and lunocapitate spaces resulting inbetter coverage of the articular cartilage by the contrast material with axial traction [5].Cerny et al. investigated 20 MR arthrographies of the wrist and conclude that axial tractionmay enhance both detection and characterization of scapholunate and lunotriquetral lig-ament tears by widening the articular space and increasing the amount of contrast within[6].