Tip: the lunate can be identified by its moon-shaped appearance and the scaphoid and capitate can be identified by their association. The average volar tilt is approximately 11° and can range from 2°-20°. This is the angle between a line along the distal radial articular surfaces and a line perpendicular to the longitudinal axis of the radial shaft. The volar tilt (palmar tilt) is a measurement made on the lateral view. There should be a volar tilt of between 10°- 25°.The radial surfaces should appear smooth.The palmar/volar cortex of the pisiform bone should lie between the scaphoid and capitate bones.The long axis of the radius, lunate, capitate and the third metacarpal bone should align.pronated wrist (ulnar side of the fifth digit facing down onto the X-ray plate).This view is obtained by positioning the patient as follows: Lateral views of the wrist are technically challenging to interpret due to overlying bony structures. Assess Gilula’s/carpal arcs disruption to any of the arcs may suggest an underlying fracture or ligamentous injury (see Figure 2).įigure 2.Loss of radial length/height may indicate the presence of an impacted radial fracture. Measure the radial length (a.k.a radial height) the distance between two lines drawn perpendicular to the long axis of the radius from the apex of the radial styloid and the level of the ulnar aspect of the articular surface (normal range 8-14mm).A greater than 25° radial inclination may suggest the presence of a fracture. Measure radial inclination this is the angle of the distal radius surface with respect to a line perpendicular to the shaft (normal range is 21-25°).Inspect the distal radial articular surface’s position it should cup the carpal bones.Assess the distal radial contour which should appear smooth (any irregularities in the contour may indicate a fracture).You can confirm that the hand/wrist is in a neutral position by drawing a line through the long axis of the radius, capitate and the third metacarpal (normal axes are within 10° of this line). Hand placed palm down in a neutral position with fingers extended on the X-ray plate.Postero-anterior (PA) viewĪ PA view is typically obtained with the patient seated in the following position: Step 2 – AlignmentĬheck bony alignment on PA and lateral views. AdequacyĬheck the adequacy of the radiograph, it should include the distal radius and ulna with no overlap between the two bones. There are two standard projections produced when a wrist X-ray is performed:Īn oblique view may be obtained to provide additional views of the radial side of the wrist.Īncillary views may be obtained depending on the clinical presentation and potential differential diagnoses. InterpretationĪ structured approach to wrist X-ray interpretation is discussed below. If previous radiographs are available, they should also be reviewed to provide a point of reference. Whether it is a radiograph of the left or right wrist.Patient details (name, date of birth, unique identification number). ![]() ![]() ![]() Confirm the detailsīegin by confirming you have the correct patient and the correct radiograph by assessing the following: The wrist (carpus) is composed of 8 bones as remembered by the mnemonic ‘ Some Lovers Try Positions That They Can’t Handle’:įurther details of the anatomical structure of the hand and wrist can be found in our overview of the bones of the hand. The main bones of the forearm are the ulna (medially, at the side of the little finger) and radius (laterally, at the side of the thumb). The terms volar and palmar are used interchangeably to describe the palmar surface of the hand while the term dorsal is used to describe the back surface of the hand. The intricate anatomy of the wrist makes wrist X-ray interpretation a challenging task. You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation.
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