Hand (oblique view)

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The hand oblique view is part of a two view series metacarpals, phalanges, carpal bones and distal radial ulnar joint.

Indications

The oblique 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 also particularly useful in providing more information regarding the degree and location of any suspected fracture or dislocation.

Patient position

  • patient is seated alongside the table
  • the affected arm if possible is flexed at 90° so the arm and hand can rest on the table
  • the hand is rotated externally by 45 degrees from the basic PA position with fingers kept in extension and parallel to image receptor
  • shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to the central beam
  • the hand and elbow should be at shoulder height which makes radius and ulna parallel (lowering the arm makes radius cross the ulna and thus relative shortening of radius)

Technical factors

  • posteroanterior projection
  • centering point
    • third metacarpal head
  • collimation
    • laterally to the skin margins
    • proximal  to include distal radioulnar joint 
    • distal to the tips of the distal phalanges 
  • orientation  
    • portrait
  • detector size
    • 18 cm x 24 cm
  • exposure
    • 50-60 kVp
    • 1-5 mAs
  • SID
    • 100 cm
  • grid
    • no

Image technical evaluation

Fingers are positioned parallel to image receptor, indicated by open interphalangeal and metacarpophalangeal joint spaces. Correct obliquity is evidenced by the following:

  • midshafts of 3rd to 5th metacarpals do not overlap
  • some overlap of the distal heads of the 3rd to 5th metacarpals
  • no overlap of the distal heads of the 2nd and 3rd metacarpals

Practical points

Patients may not be able to maintain an oblique position, you can assist them via a small 30-degree sponge.

Excessive superimposition of the of the metacarpals indicates the hand is externally elevated too much.

Separation of the metacarpals (almost a PA view) means the hand must be raised slightly.