Hand X-Ray Anatomy and Interpretation Checklist
1. Soft tissues - Look carefully at the soft tissue over all the bones for any swelling or foreign body. The swelling should prompt a careful search of the underlying bone or joint.⠀
2. Bones - All the bones of the hand should be examined carefully and systematically. I start from the phalanges and move inwards into the hand and wrist joint and then I move from lateral to medial. The cortex should be carefully evaluated followed by the trabecular pattern. ⠀
3. Joints - The area in between the bones are very important. In case of a fracture, articular involvement should carefully be looked for while in non-traumatic indications, joint evaluation is very important to look for signs of arthritis. Normally, 1-2mm joint space is seen.⠀
4. Alignment - Although this falls under bones and joints, this should be kept in mind because often the deviation from normal alignment is subtle. Incorrect alignment of bones across a joint or even the joints as a whole almost always signifies underlying pathology.⠀
5. Other areas - Last but not the least, look at everything else in the radiograph - the radius and ulna is also seen proximal to the carpal bones.⠀
6. Other hand - In case of a non-traumatic indication, always compare both the hands. Both hand views are typically ordered for rheumatological diseases.

Dr. Devpriyo Pal @drdevrad

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