When to get an X-ray (X-ray) of the left hand?

Indications for X-ray of the Left Hand

X-ray imaging of the left hand is indicated when there is clinical suspicion of fracture, dislocation, or other structural abnormality, requiring at minimum a standard 3-view radiographic examination including posteroanterior (PA), lateral, and oblique views. 1

Standard Radiographic Protocol for Hand Injuries

• A minimum of 3 radiographic views is necessary for adequate evaluation of hand injuries, as recommended by the American College of Radiology. These include posteroanterior (PA), lateral, and oblique views. 1
• For phalangeal injuries specifically, some centers include a PA examination of the entire hand, while others limit the examination to the injured finger. 1
• An internally rotated oblique projection, in addition to the standard externally rotated oblique, increases diagnostic yield for phalangeal fractures. 1
• Relying on only 2 views is considered inadequate for detecting fractures in the fingers. 1

Specific Clinical Indications for Hand X-rays

• Suspected fracture following trauma to the hand or fingers 1
• Suspected dislocation of finger joints 1
• Evaluation of persistent pain following hand injury despite negative initial imaging 1
• Assessment of inflammatory or degenerative conditions affecting the hand 2
• Evaluation of suspected foreign bodies 3

Additional Imaging Considerations

• If initial radiographs are negative but clinical suspicion remains high, options include:
  • Placing the patient in a short arm cast and repeating radiographs in 10-14 days 1
  • Proceeding to MRI without IV contrast for more detailed evaluation 1
• For metacarpal and digital fractures, CT is usually not indicated during acute injury evaluation 1
• In non-traumatic cases, the initial radiographic examination should be a posteroanterior view of both hands for comparison 2

Special Considerations for Pediatric Patients

• In children aged 4-11 years with suspected scaphoid fractures, clinical judgment may be sufficient for initial management without immediate X-rays in some cases 4
• However, this approach should be used cautiously and only in settings where appropriate follow-up can be ensured 4

Common Pitfalls to Avoid

• Failure to obtain adequate radiographic views may lead to missed diagnoses; a minimum of 3 views is necessary 3
• Relying solely on standard views without considering specialized projections when clinically indicated 1
• Not obtaining follow-up imaging when initial radiographs are negative but clinical suspicion remains high 1
• Overlooking the need for comparison views of the uninjured hand in certain cases 2