Approach to Hand XRays

Hand radiographs are typically done in 3 views.  The ABCDs approach to interpretation is described below.

POSTERIOR-ANTERIOR VIEW

  • This is the most commonly used view for interpretation
  • Finger deformities may not be noticed as patients are required to press their hands down firmly against the plate, while the XRays are shot from above.

XRay hands - PA view

 

BALL-CATCHER’S (NORGAARD’S) VIEW

  • Hands are in a “ball-catching” position
  • This is the best view to look for early erosions at the base corners of the proximal phalanges.

XRay hands - Ballcatcher's view

 

LATERAL VIEW

  • This view is mainly used for assessment of fractures, and is of limited value in rheumatology.

XRay hands - lateral view

 

THE ABCDs APPROACH TO INTERPRETING HAND RADIOGRAPHS

It is best ot have a systematic approach to reading XRays of the hands.  The actual order is less important, but one useful strategy is the ABCDs approach.

  • Alignment
  • Bone
    • Mineralisation, Periarticular Osteopenia
    • New bone formation: osteophytes, syndesmophytes
    • Joint spaces
    • Erosions
    • Fractures
  • Cartilage
    • Joint spaces
    • Calcifications
  • Distribution of any changes
    • Pattern of joint involvement, symmetry
  • Soft Tissues
    • Swelling, calcification