Hand XRay

Aka: Hand XRay, Hand Radiograph

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II. Imaging: Standard Hand XRay Views

  1. Posterior-Anterior View (PA)
  2. Oblique View
  3. Lateral View

III. Approach: Musculoskeletal XRay ABCs

  1. Adequacy and Alignment
  2. Bones
  3. Cartilage and Joints
  4. Soft Tissue and Spacing

IV. Findings: Trauma

  1. See Hand Injury
  2. See Hand Fracture
  3. Phalanx Fractures
    1. Distal Phalanx Fracture
    2. Middle Phalanx Fracture
    3. Proximal Phalanx Fracture
  4. Finger Metacarpal Fractures (index to small finger)
    1. Boxer's Fracture
      1. Angulation allowed increases from 1st finger (10 degrees) to 4th finger (40 degrees)
      2. Malrotation is, however, poorly tolerated
    2. Metacarpal head Fractures
      1. Associated with complications (estensor tendon injuries, interosseous Muscle injuries)
    3. Metacarpal shaft Fractures
      1. Risk of malrotation
    4. Metacarpal base Fractures
      1. Risk of nerve injury (e.g. Ulnar Nerve injury with 4th to 5th Finger Fractures)
      2. Often require Hand CT to evaluate carpo-Metacarpal alignment and carpal Fractures
  5. Thumb Proximal Metacarpal Fractures: Thumb intra-articular Fractures at Metacarpal base
    1. Bennett's Fracture (single part)
    2. Rolando fracture (comminuted, T or Y-Shaped)
  6. Finger Avulsion Fractures (Tendon Ruptures)
    1. DIP Extensor Tendon Avulsion (Mallet Finger, Drop Finger, Baseball Finger)
      1. Associated with dorsal distal phalanx avulsion Fracture
    2. DIP Flexor Tendon Avulsion (Jersey Finger, Flexor Digitorum Profundus Avulsion)
      1. Associated with volar distal phalanx avulsion Fracture (75% affect ring finger)
    3. PIP Extensor Tendon Avulsion (Central Slip Extensor Tendon Injury, Boutonniere Deformity)
    4. PIP Flexor Tendon Avulsion (Volar Plate Injury, Jammed Finger, Swan-Neck deformity)
    5. Thumb Ulnar Collateral Ligament Rupture (UCL, Gamekeeper's Thumb, Skier's Thumb)
      1. Associated with proximal avulsion Fractures
  7. Dislocations
    1. Dorsal PIP Dislocation
      1. Associated with a Volar Plate Injury with Proximal Phalanx Fracture (Wilson Fracture, may require ORIF)
    2. Lateral PIP Dislocation
    3. Volar PIP Dislocation
    4. DIP Dislocation
    5. IP Joint Dislocation at Thumb
    6. Metacarpal-Phalangeal Dislocation

V. Findings: Miscellaneous

  1. Infections
    1. See Osteomyelitis XRay
  2. Foreign Bodies
    1. See Radiopaque Foreign Body
    2. See High Pressure Injection Wound

VI. References

  1. Tubbs and Janicki (2025) Hand XRay, Mastering Emergency Imaging, CCME, accessed 3/10/2026

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