X-ray of the hand

X-ray examination is considered a fairly common diagnostic method, which is used to determine the condition of the musculoskeletal system, detect violations, injuries and diseases. Among other types of x-ray diagnostics, many patients are prescribed an x-ray of the hand - this is a painless and relatively quick procedure that provides minimal radiation exposure to the human body, and therefore safe. Specialists can prescribe an X-ray of the brush 3-4 times a year, if necessary: it will not bring any harm to health.

Indications for the procedure

According to statistics, most often an x-ray of the hand is carried out in case of injuries, painful processes, as well as other conditions that negatively affect the performance of the upper limb, as well as its configuration (which is usually noticeable from the side).

The basic indications for x-ray are the following:

• pain of varying intensity in the area of the hand, both after motor activity, and in a calm state;
• joint deformities;
• violation of the integrity of the bone, bruises;
• inflammation in the area of the hand, tumor processes (both benign and malignant);
• joint defects - for example, congenital etiology (with Turner syndrome). [1]

With the help of an x-ray of the brush, it is often possible to make the following diagnoses:

• cystic formation (benign abdominal tumor located in the center or in the subchondral part of the pineal gland);
• synovitis (accumulation of effusion in the joint cavity);
• tenosynovitis, tendonitis (inflammatory process in the tendon and synovial tendon sheath);
• calcification (deposition of calcium salts, one of the symptoms of arthritis);
• osteophyte (spine-shaped bone growth of the border of the articular surface); [2]
• osteoporosis (a disease associated with bone loss of calcium). 

According to a 2013 study, DXR analysis (digital radiography) of radiographs of the wrist and hand allows predicting the risk of hip fracture in women and men. [3]

X-ray of the hand on bone age

Speaking about bone age, doctors mean the conditional age period corresponding to the level of development of the skeletal system. Usually it is determined using x-rays, after which they use special calculated indicative schemes: body weight and height, the circumference of the chest and the stage of puberty are taken into account. [4]

Several methods are known for evaluating a bone-age index. These methods take into account the period of the appearance of the epiphyseal departments of the tubular bones, the stages of their development, the stage of connection of the epiphyses and metaphyses with the formation of synostoses. These processes are especially clearly visible in the bones of the hands of the upper extremities, since they have a considerable number of epiphyseal sites and ossification nuclei. 

The level of skeletal maturity, in essence, can be determined on the basis of two characteristics: the level of growth in areas subject to ossification, and the level of calcium accumulation in these areas. From infancy to adulthood, these two characteristics correspond to a specific pattern and timeline. [5] The periods of epiphyseal ossification and bone fusion do not occur evenly throughout the body. In some bones, ossification begins immediately after birth, while in other bones it is from 14 to 17 years old. [6]

Determination of bone age is usually performed with disorders of the physical development of the baby, with slow growth, pathologies of the pituitary gland, hypothalamus and thyroid gland.

Preparation

X-rays of the hands do not require special training, regardless of which hand will be examined - right or left.

Immediately before the procedure, the patient must remove the metal jewelry: you need to get rid of rings, bracelets, watches. The patient should sit on a chair in the X-ray room, putting his hand on a special stand: the position of the limb will be indicated by the specialist who will conduct the diagnosis.

If necessary, the patient may wear special protection in the form of a lead apron or vest.

Technique of the x-ray of hand

X-ray of the hands is as follows. The patient sits on a chair located near the table or couch of the radiological apparatus. Usually, a specialist asks to bend the arm at the elbow joint, while putting the brush on a table or a special stand. The angle of the brush will tell the radiologist. Most often, these types of images are used:

For direct projection, the brush is placed horizontally on the surface of the stand. In this case, X-rays will pass through the arm perpendicularly, which will allow you to consider the entire skeletal system of the wrist, except for the pisiform bone. The metacarpal bones, metacarpal and wrist joints, the finger phalanges, and the wrist are well visualized.

For lateral projection, place the palm of your hand laterally on the surface, and the thumb is pulled forward. This position contributes to a good examination of bone contours, phalanges, metacarpals. Lateral projection is often used to assess the degree of wrist injury, since the displacements of the bone segments are well visualized.

For oblique back projection, the hand is placed on the back surface at an angle of 45 °. This angle will help to consider the state of the I and V metacarpal bones, as well as trihedral, hooked and pea bones.

For oblique palmar projection, the brush is placed with the palmar surface at an angle of 45 °. So it is possible to visualize the trapezoid and scaphoid bones.

Sometimes the location of the brush is adjusted individually, depending on the existing problem.

An x-ray of the right hand is usually performed in two projections, for optimal consideration of the problem. The brush is placed as evenly as possible on the surface of the table, fingers pressed against each other. An x-ray of the left hand is done in the same way, and only in some cases they resort to atypical styling of the limb, which is determined individually.

An x-ray of the fingers helps to give an objective assessment of the structure and condition of the bones, soft and cartilage tissues. The doctor individually indicates the need to obtain images of several or all of the fingers - usually in two projections. The patient's task is to hold his fingers motionless during the procedure. If such immobility is not possible, then additional fixation is used.

Often, along with the study of an injured or pathologically altered limb, an x-ray of a healthy hand is performed for comparison.

X-ray brush child

X-rays of the brush are allowed for children of any age, if there is good evidence. For the smallest patients it is convenient to use a special "X-ray cradle" device, in which it is possible to fix the child to get a clear picture. If there is no such cradle, then the baby should be held by a mother or someone from close people, because in the process of movement you can not get a high-quality image.

If possible, it is advisable to make the child a digital x-ray of the hand: it is safer and more comfortable for the baby.

Diagnosis in childhood can be prescribed:

• with traumatic damage to the upper limb and wrist area;
• with insufficient development of the limbs, as well as to establish bone age;
• with local pain in the hand;
• with tumor processes, abnormalities in the development of bones and the wrist joint.
• to assess the bone age of the child. [7]

X-ray fracture

The hand has a complex structure, as it consists of a large number of small and tiny bones. Therefore, fractures are diverse and often multiple. On an x-ray, fractures can be represented by such varieties:

• open and closed fractures;
• full or partial faults (cracks);
• single or multiple bone damage;
• diaphyseal, periarticular or extraarticular fractures;
• primary or secondary fractures;
• with displacement, or without displacement of fragments.

It is relatively easy to identify a fracture of a brush on an X-ray, if the limb is correctly laid before taking a picture.

X-ray dislocation

Dislocation is a displacement of the articular surfaces of the bones of the hand in relation to each other, which can be caused by trauma or other pathology. X-ray examination with dislocation plays one of the main roles: with its help, you can determine the degree of injury, exclude other damage to the bones. In the image, it is easy to identify the type of dislocation, which is true, perilunar, perilad-lunar, supraclavicular-perilunar, peritriangular-lunar, extracavity-transmulular, depending on the position of the brush during injury and the direction of force.

An X-ray of the hand is prescribed if there is a suspicion of a dislocation, if the victim fell, resting on the hand, or received a direct blow to the wrist band. As a rule, the x-ray is performed in two, and if in doubt, in three projections.

X-ray of hands with rheumatoid arthritis

Hand x-ray is the most valuable imaging technique in rheumatology. Joint disease can be identified by individual signs, such as a narrowing of the joint space, erosion, subluxation and deformation. In diseases such as rheumatoid arthritis, the presence of erosion on x-rays of the hands provides valuable information about the progression of the disease and the response to therapy. [8]

An X-ray examination for a patient with rheumatoid arthritis is especially necessary - first of all, in order to assess the degree of the pathological process and determine its stage.

Edematous soft joint tissues against the background of a slight narrowing of the interarticular gap and visible osteoporosis become the basic radiological signs of the disease. With long-term pathology, bone erosion will be determined - small defects in the edges of the bone articular ends. Epiphyses of the bones of the digital phalanges are usually distinguished by circular enlightenments.

If an x-ray of the hands was carried out with scaling, then the signs will be more extensive: a rupture of the closing plates is detected, and almost at the very beginning of the development of pathology. Over time, the x-ray picture worsens: the joint narrows, erosive lesions form, osteoporosis becomes more distinct. With the destruction of the final articular elements, the development of subluxations is possible.

Contraindications to the procedure

X-ray diagnostics has long been the only method that allows you to look "inside" the human body. However, this procedure has a lot of contraindications, so over time, experts have developed new ways to conduct research - in particular, magnetic resonance imaging and ultrasound.

Contraindications to x-rays of the hands are:

• the period of pregnancy (such a contraindication is relative, since with proper protection, research can still be done);

The dose of ionizing radiation necessary to cause specific effects on the fetus depends on the stage of pregnancy. [9] The US National Radiation Protection Council states that the risk of miscarriages or serious congenital malformations in the fetus exposed to doses of 5 rad or less is negligible compared to spontaneous risk among unexposed women. Spontaneous risk includes a 15% chance of spontaneous abortion, a 3% risk of serious malformations, and a 4% risk of fetal growth retardation. [10], [11]

The Radiation Safety Committee of the US Centers for Disease Control and Prevention recommends that unborn lab children not be exposed to more than 0.5 rad from total radiation over the entire pregnancy period. [12] 

• lactation period;
• psychopathology (manic psychoses, schizophrenia, etc.);
• decompensated, serious condition of the patient.

It is better not to carry out an x-ray too often not to exceed an admissible dosage of radiation. It is also not recommended to refer to radiological diagnostics without special indications. [13]

Normal performance

The radiologist performs the description or decryption of the image immediately after receiving the image. This process is an assessment of the relative position of bones, the state of their joints and integrity, structural features and degree of density.

The norm is said when the bones have a homogeneous structure. On the x-ray images, there should be no blackout on a white background, and gaps are required between the bone elements.

In case of traumatic damage to one hand, a picture and the other hand may be needed to conduct a comparative analysis and to more easily determine deviations.

Complications after the procedure

If it is possible to choose an X-ray apparatus for examining hands, then a modern digital device should be preferred: the radiation dose is lower in it than in analogues of earlier generations.

With each diagnostic procedure associated with x-rays, the doctor registers the patient in the dose log, and also makes a note in the individual outpatient card. A few years ago, the radiation dose was calculated according to a special table, in which average indicators were indicated. Today, in any modern X-ray machine or tomograph there is an integrated sensor, which immediately after the procedure demonstrates the level of dose that the patient received. This dose - for example, during an x-ray of the hand - may not be the same for everyone. It depends on the area of study, the stiffness of the rays used, the distance from the emitter, etc.

Usually it takes fractions of a second to take a picture of the hand. During this time, no negative consequences for the body can occur. However, in some cases, additional protection in the form of lead aprons, plates and collars is still required. For example, such protection is necessary if the study is carried out by a pregnant woman or child.

In order to avoid negative consequences, it should also be remembered that the degree of radiation can accumulate, therefore it is not recommended to take one shot after another for a short time: the body must have time for self-healing.

X-rays of the hands during pregnancy, and especially in the first trimester, are not recommended. However, in some cases - for example, in violation of the integrity of the bones - you can’t do without a picture. In order to avoid possible complications for the growing fetus, they use protection: special screens in the form of aprons, which cover the woman's chest and abdomen from radiation.

According to sanitary standards, the maximum permissible dose of radiation for the fetus is determined by an indicator not exceeding 1 mSv. At the same time, the average dose for an x-ray of the hand is usually less than 0.1 mSv, so it can not do much harm.

Experts advise not to panic in vain, but to carry out an x-ray of the hand, if there are indeed indications for this procedure. The radiation load will be minimal, and the diagnostic information that the doctor will receive will be exhaustive: the doctor will be able to establish the correct diagnosis and prescribe the correct treatment. [14]

Care after the procedure

Special care for the patient after the procedure, as a rule, is not required. Immediately after the study, the doctor will decrypt, send the results to the attending specialist, or prescribe treatment on his own. The patient, depending on the circumstances, will be sent home or to the hospital for further treatment.

Some doctors recommend drinking plenty of fluids and consuming dairy products: milk, kefir, and natural yogurt to reduce radiation exposure on the day of the procedure. In addition, it is advisable to take a shower immediately upon arrival. It is better to diversify the diet with fruits and herbs, natural freshly squeezed juices. And we must not forget that the x-ray of the hand is a safe diagnosis, so you should not worry about possible long-term negative consequences.