Hand (lateral view)

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The lateral hand view is an orthogonal view taken along with the PA view of the hand.

Indications

The lateral hand view is requested for diagnosing a variety of clinical indications such as rheumatoid arthritis, osteoarthritis, suspected fracture or dislocation and localizing foreign bodies.

It is particularly useful for visualizing the degree of fracture displacement and the exact location of a foreign body. Spreading the fingers into a fan lateral view is also essential for visualizing each phalange separately, allowing for diagnosis of rheumatoid and osteoarthritis.

Patient position

  • patient is seated alongside the table
  • hand is externally rotated by 90 degrees from the PA position so that the palm is perpendicular to the image receptor
  • fingers are kept extended with thumb abducted
  • fingers should ideally be separated to minimize superimposition and increase diagnostic information contained in the image

Technical factors

  • lateral projection
  • centering point
    • over the head of the second metacarpal
  • collimation
    • anteroposterior to the skin margins
    • distal to the tips of the fingers
    • proximal to include one-third of the distal radius and ulna
  • orientation  
    • portrait
  • detector size
    • 18 cm x 24 cm
  • exposure
    • 50-60 kVp
    • 3-5 mAs
  • SID
    • 100 cm
  • grid
    • no

Image technical evaluation

Fingers should appear equally separated. The third and fourth digits in this image are mostly superimposed so more care should have been taken to separate these. (This, however, is of no concern if that is not the area of interest - e.g. if the patient states no pain in that area.)

Correct lateral positioning is evidenced by the following:

  • interphalangeal joint spaces are open
  • metacarpals are mostly superimposed, with slight over-rotation externally allowing the fracture at the base of the 5th metacarpal to be visualized
  • posterior aspect of the distal radius and ulna are superimposed

Practical points

Lower kVp is used to detect foreign body in the soft tissue; to help identify the region of interest, a radiopaque marker can be placed at cutaneous wound

For follow-up, collimation to the area of interest only can be utilized (e.g. if there is a known fracture of the 5th metacarpal, only include to midshaft of proximal phalanx distally.