Direct magnetic resonance arthrography of the wrist with axial traction: A feasibility study to assess joint cartilage

Abstract

Purpose: To assess the impact of axial traction during acquisition of direct magnetic resonance (MR) arthrography of the wrist with regard to joint space width and amount of contrast material between the opposing cartilage surfaces. Materials and Methods:Fifteen consecutive patients (12 male, mean age 38.1 years) were included in this Institutional Review Board-approved prospective study. Threecompartment wrist MR arthrographies were performed between October and December 2009 on a 3 T unit using a fat-suppressed T1-weighted isotropic high-resolution volumetric interpolated breathhold examination (VIBE) sequence in the coronal plane, with and without axial traction (3 kg). Two radiologists measured radiocarpal (radioscaphoid, radiolunate) and midcarpal (lunocapitate, hamatolunate) joint space widths, with and without traction, and assessed the amount of contrast material between the opposing cartilage surfaces using a threepoint scale: 0 ¼ absence, 1 ¼ partial, 2 ¼ complete.Results: With traction, joint space width increased significantly at the radioscaphoid (D ¼ 0.78 mm, P < 0.01), radiolunate (D ¼ 0.18 mm, P < 0.01), and lunocapitate (D ¼ 0.45 mm, P < 0.01) spaces, and both observers detected significantly more contrast material between the cartilage surfaces. At the hamatolunate space, the differences in joint space width (D ¼ 0.14 mm, P ¼ 0.54) and amount of contrast material were not significant. Conclusion:Direct wrist MR arthrography with axial traction of 3 kg increases joint space width at the radiocarpal and lunocapitate spaces, and prompts better coverage of the articular cartilage by the contrast material.

Elbow MR arthrography with traction

“…The finger traps were then clipped to the freely hanging traction weight using a non-elastic cord routed over the edge of the MR gantry table (Figure 2). 24,25 The traction weight used was 7 kg for males and 5 kg for females. MR examination of the elbow was then repeated (Table 1).…”

“…MRA with axial traction has been evaluated with success in the shoulder, [11][12][13] hip, [14][15][16][17][18][19][20][21] knee, 22 wrist, [23][24][25][26][27][28][29][30] ankle 31,32 and metatarsophalangeal 33 and metacarpophalangeal joints. 34 To the best of our knowledge, there is no study comparing MRA of the elbow with and without traction.…”

Effect of traction on wrist joint space and cartilage visibility with and without MR arthrography

“…Traction performed during MR arthrography distracts the wrist joint and separates opposing articular surfaces, allowing contrast to disperse more widely within the joint, which helps improve visibility of the articular cartilage surfaces. [1][2][3] MR arthrography of the wrist with traction has an accuracy close to 100% for tears of the TFCC as well as the ulnotriquetral and scapholunate ligaments. 3 The main limitation of MR arthrography is that it involves an intra-articular contrast injection which requires technical expertise, lengthens overall examination time, increases patient discomfort and has a minimal risk of infection.…”

“…MR arthrography of the wrist with traction is a safe and well-tolerated technique known to increase visibility of cartilage surface defects, ligament tears and triangular fibrocartilage complex (TFCC) tears when compared with MR arthrography without traction. [1][2][3] Traction involves applying a distraction force via a fixed weight to the limb under examination. Traction performed during MR arthrography distracts the wrist joint and separates opposing articular surfaces, allowing contrast to disperse more widely within the joint, which helps improve visibility of the articular cartilage surfaces.…”

Verification of the rehabilitation effect for wrist contracture by dynamic analysis of carpals

“…．例えば，手根中央関節を効果的に他動運動させるリハビリテーション として，ダーツを投じるように手関節を橈背屈から掌尺屈へ運動させる，ダーツスロー運動の応用が検討されて いる (Werner, et al, 2004) (Guntern, et al, 2011) ( Leventhal, et al, 2010)．野中らは牽引により関節骨間の開大が骨折部への 負荷を軽減しているのではないかと推測しているが，詳細は明らかにされていない(野中他，2010)． 牽引による手関節の拘縮改善効果を検討するためには，手関節骨間の距離だけでなく，牽引下における各関節 の運動を明らかにする必要がある．しかし，牽引した状態における手関節の動態を測定し，その運動を考察した 例はきわめて少ない．Ishikawa らは屍体を用いた実験により，牽引が手関節の掌背屈運動に与える影響について 調査し，牽引を加えた場合，手関節骨部は非牽引時とは異なる挙動を示すことを確認した (Ishikawa, et al, 1999) Tanaka, Ikegami, Tsuchida, Sanada, Nishimura, Tada, Kawashima and Horie, Transactions of the JSME (in Japanese), Vol.81, No.824 (2015) は前腕側によって 2 種類に分類され， 手先側の 1：大菱形骨(Trapezium)， 2：小菱形骨(Trapezoid)， 3：有頭骨(Capitate) および 4：有鈎骨(Hamate)の 4 つを遠位列手根骨，前腕側の 5：舟状骨(Scaphoid)，6：月状骨(Lunate)，7：三角骨 (Triquetrum)および 8：豆状骨(Pisiform)の 4 つを近位列手根骨と呼ぶ．…”