Wrist series x rays

The wrist series is comprised of a posteroanterior, oblique, and lateral projection. The series examines the carpal bones that are consisting of the scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate and hamate. It also examines the radiocarpal and distal radiocarpal joint along with the distal radius and ulna.

See approach to wrist series for more information.

Indications

Wrist x-rays are indicated for a variety of settings including:

• wrist trauma; see Amsterdam wrist rules
  • suspected fracture
  • obvious deformity
• bony tenderness
• non-traumatic deformity
• non-traumatic wrist pain

Projections

Standard projections

• PA
  • demonstrates the metacarpals, radius and the ulna in the natural anatomical position
  • the best view to inspect the joint spaces of the carpal bones and the distal radio-ulnar joint
• oblique
  • external oblique projection of the wrist
• lateral
  • projection 90° to the PA view
  • demonstrates multiple carpal bones overlapping
  • the essential view to assessing the alignment of the radius, lunate, and capitate in the setting of a suspected dislocation

Modified trauma projections

• horizontal beam lateral wrist
  • modified lateral projection that requires little to no patient movement
  • produces a diagnostic lateral projection without risking patient pain

Additional projections

• carpal tunnel view
• carpal bridge view 
  • used to assess the dorsal aspect of the scaphoid, lunate and the triquetrum
• clenched fist view
  • used for suspected scapholunate dissociation
• radial deviation view 
  • employed to examine the carpal bones at the ulnar aspect of the wrist