X-Ray Interpretation

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 X-Rays are shot from above.

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.

LATERAL VIEW

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

THE ABCDs APPROACH TO INTERPRETING HAND RADIOGRAPHS

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

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