Our study reports new insights into the therapeutic management of EF: (i) CS treatment remains the standard therapy for EF, taken alone or in association with an ISD; (ii) MPPs at initiation of treatment are associated with a better outcome and a lower need of ISD use; (iii) an ISD, usually MTX, might be useful as a second-line therapy, mainly in patients with morphoea-like lesions. Naturally, these practical conclusions should be confirmed by a prospective and multicentre study.

Imaging strategy for wrist injury usually begins with standard radiographs. When a ligamentous disorder is suspected clinically, the next step is arthrographic computed tomography or arthrographic magnetic resonance imaging. When the diagnosis remains unclear, magnetic resonance imaging (MRI) is the preferred examination. Ultrasonography is usually used to assess structures like tendons and bone surface, but thanks to the performances of high-frequency transducers, it can also enable visualization of the main ligaments of the wrist. Ultrasonography could thus replace MRI because of its lower cost, as recently reported in the literature. However, a good knowledge of normal and pathological wrist anatomy is required to avoid false negatives. Wrist ligaments comprise interosseous and capsular ligaments as well as the triangular fibrocartilaginous complex. All these ligaments may be involved in carpal instability. Clinical examination has a major role to play in helping radiologists orient their procedures. A few studies have reported that ultrasonography of the triangular fibrocartilaginous complex is reliable compared with arthrography or MRI, but most of these studies were limited to the radioulnar ligaments. In this article we propose a more extensive protocol.

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