Direct traction MR imaging of the wrist: practical experience

Objective: To study the effect of direct wrist traction on patient pain and joint distraction on MRI.

Materials and methods: 291 patients (109 males, 182 females; mean age, 45.8 years) who underwent wrist MRI between November 2019 and September 2024 were studied (152 patients with traction, 139 patients without traction). All patients completed a questionnaire assessing wrist pain scores before, during, and ten minutes after MRI examination. Joint space width and cartilage visibility of the radiocarpal and intercarpal joints were assessed. For patients with arthroscopy within one year after MRI, diagnostic accuracy of intrinsic ligament and triangular fibrocartilage complex tears was assessed.

Results: Fifty-seven (38%) of 152 traction patients had an average increase of 1 point (range, 0 ~ 2) in wrist pain following traction compared to 24 (17%) of 139 non-traction patients (p = 0.085). 44% traction patients and 38% non-traction patients reported non-wrist pain (mainly shoulder, neck), with no inter-group difference in location, prevalence, or pain score (all p values > 0.05). Average joint space width was 0.6 mm wider in the traction group (p < 0.001). On average, eighty-five (60%) of 141 traction patients had 'moderate' or 'good' articular cartilage visibility compared to 22 (17%) of 126 non-traction patients (p < 0.001). Traction tended to increase diagnostic accuracy for intrinsic ligament tear, though it did not reach statistical significance (p = 0.136).

Conclusion: Compared to wrist MRI without traction, traction increases joint space width and improves cartilage visibility, though with a slight increase in wrist pain.