Standard Hand X-ray Coverage of the Thumb
Yes, a standard X-ray of the hand includes the full thumb, from the tip of the distal phalanx through the entire metacarpal and carpometacarpal joint.
Standard Hand Radiographic Protocol
A standard hand X-ray examination encompasses all five digits including the complete thumb ray 1. The American College of Radiology guidelines specify that hand radiographs should include:
- All metacarpals and phalanges of all five digits 1
- The carpometacarpal joints 2
- Standard views include posteroanterior (PA), lateral, and oblique projections 1
Thumb-Specific Imaging Considerations
When evaluating thumb injuries specifically, the imaging protocol may vary slightly:
- Some centers include a PA examination of the entire hand, while others limit the examination to the injured thumb alone 1
- The oblique view is particularly valuable for thumb evaluation, as it uniquely reveals abnormalities and increases diagnostic confidence when interpreted alongside frontal and lateral views 3
- Three-view radiographic examination is necessary to adequately visualize thumb pathology, as relying on only 2 views is inadequate 1
Anatomical Coverage
The standard hand X-ray captures the thumb from:
- Distal phalanx (tip of thumb) through the proximal phalanx and metacarpal down to the trapezium and carpometacarpal joint 4
- This complete visualization allows assessment of the trapezial space and thumb ray length 4
Common Pitfall
Do not assume that a "finger" X-ray will include the thumb—if thumb imaging is specifically needed, ensure the order specifies "hand" or "thumb" to guarantee complete coverage of the first ray 1.