Wrist X-ray: Information, Procedure And When To Get a Scan

If you're experiencing wrist pain, stiffness or discomfort in the wrist joint, an X-ray is a quick and affordable way to check if any bones are broken or whether an underlying issue is causing your symptoms. Here’s what a wrist X-ray can check for, how it is carried out and what you can expect from the results.

What is a Wrist X-ray?

A wrist X-ray is a quick and painless imaging test that helps your doctor check the bones and joints in your wrist. It uses a small dose of radiation to capture detailed images, which can help your doctor identify fractures, dislocations, arthritis and other wrist conditions.

A wrist X-ray captures detailed images of the two forearm bones - the radius and ulna- and the eight small carpal bones forming the wrist joint. These carpal bones are arranged in two rows of four at the base of the hand, creating the structure that allows your wrist to move and flex.

A wrist X-ray is often the first type of scan that your doctor will use in assessing and diagnosing wrist injuries or checking what may be causing ongoing pain in your wrist.

Who Performs a Wrist X-ray?

A radiographer will perform your wrist X-ray. They are a healthcare professional trained in medical imaging. Once the images are taken, your radiologist will review them and provide a report to your referring clinician, who will explain the findings and any next steps.

What a Wrist X-ray Can Diagnose

Doctors use wrist X-rays to diagnose:

Fractures

A wrist x-ray is crucial for detecting broken bones, particularly in the distal radius and scaphoid. Some fractures may not be visible immediately, so your doctor may order additional imaging if your symptoms persist, such as a follow-up X-ray, a CT scan for a more detailed bone assessment, or an MRI to detect bone bruising and hidden fractures.

Dislocations

X-rays can show if your wrist bones have moved out of place, helping your doctor decide if you need treatment, such as bone realignment or surgery.

Arthritis

If you have wrist joint pain, an X-ray can reveal arthritis-related changes, such as narrowing joint space, bone spurs, or cartilage damage.

Osteoporosis

Although an X-ray can't measure bone density, it can show fractures that could be an underlying sign of osteoporosis. This can help your doctor decide if you need further tests for osteoporosis, such as a bone density scan (DEXA scan) to check your bone strength.

Infections

Bone infections, such as osteomyelitis, can sometimes be identified on X-rays if they have caused visible bone damage.

Tumours

Bone tumours or cancer that has spread to the arm and wrist may be detected through abnormal bone growths or changes seen on an X-ray.

Carpal Tunnel Syndrome (Indirect Signs)

X-rays can’t diagnose carpal tunnel syndrome directly, but they can help your doctor rule out conditions that may cause similar symptoms, such as arthritis or fractures.

Ligament Injuries (Indirect Signs)

If your wrist ligament is damaged, the X-ray may show unusual spacing between your bones or a misalignment in the bones. This may be a sign that you have a torn ligament, which is creating instability in your wrist joint.

Growth Plate Abnormalities

The growth plate is an area of tissue near the ends of long bones in children and teens. It determines the eventual length and shape of the fully-grown bone. X-rays can reveal changes in how the bones are spaced at the growth plate, so your doctor could notice an abnormality in an X-ray and recommend further tests, such as an MRI or CT scan, to check the growth plate and identify any issues.

Kienböck’s Disease

This rare condition affects the blood supply to the radius lunate bone, which can lead to the bone collapsing. This can cause chronic wrist pain and stiffness and, eventually, arthritis in the wrist. Doctors can use X-rays to help diagnose Kienböck’s disease because they can reveal changes to the bone structure over time, although MRIs are more helpful in diagnosing the disease at an earlier stage.

Scaphoid Fractures

The scaphoid is one of the eight small carpal bones in your wrist. Scaphoid fractures are one of the most common wrist injuries, but they can be tricky to see on an X-ray. If you continue to have persistent pain in your wrist, your doctor may recommend follow-up imaging, such as MRI or CT scans, to confirm the fracture.

Wrist Sprains

Your doctor won’t always use an X-ray to diagnose a wrist sprain. They’ll usually check for swelling, bruising or tenderness, ask about your symptoms and see how your wrist bends and flexes. However, if your pain persists, they may use an X-ray to see if there are any broken bones or misalignment.

Ulnar Variance

X-rays can measure ulnar variance, which refers to the relative length of your ulna bone compared to your radius bone at the wrist joint. A positive variance means the ulna is longer than the radius bone at the wrist, which can lead to increased pressure and pain due to a condition called ulna impaction syndrome. A negative ulnar variance means the ulna is shorter, which can put pressure on the radius lunate bone and increase the risk of developing Kienböck’s disease. Your doctor can use the images from an X-ray to measure the bones and check the variance.

Tendon Injuries

X-rays can sometimes reveal signs of tendon injuries. For example, chronic tendon issues can cause slight changes to the bones where the tendon is attached. These signs can let your doctor know there may be an underlying problem with the tendon.

Types of Wrist X-Rays

Standard Wrist X-Rays

A standard wrist X-ray usually includes three views:

Posteroanterior (PA) View

Taken from above the wrist joint and provides a clear image of the carpal bones.

Lateral View

Taken from the side view and helps your radiologist or doctor check bone alignment and detect dislocations.

Oblique View

Taken at an angle to capture parts of the wrist not clearly visible in the PA or lateral views.

Specialised Wrist X-Rays

If your doctor suspects a specific condition, they may ask for a specialised view to be taken during an X-ray to get a clearer picture of certain bones and structures, including:

Scaphoid View

This view focuses on the scaphoid bone and it's often used if a fracture is suspected.

Clenched Fist View

This view assesses how stable the wrist joint is under pressure, in this case, from a clenched fist.

Carpal Tunnel View

This view looks at the carpal tunnel for any signs of nerve compression.

Ulnar Deviation View

This view provides a better look at the scaphoid and lunate bones by tilting the wrist outwards.

Radial Deviation View

This view highlights the ulnar bone side of the wrist by bending the hand towards the thumb.

Stress Views

These can also include the clenched fist view, or your radiologist may ask you to hold and squeeze a pencil or bend your wrist and hand in a certain way. This helps your doctor look for instability or injury, particularly in the area between the scaphoid and lunate bones.

How an X-ray Works

X-rays use a small amount of ionising radiation to create images of the body. Dense structures like bones absorb more radiation and appear white, while softer tissues appear darker. This contrast helps your radiologist and clinician identify any abnormalities.

What are the benefits of a wrist X-ray?

Having a wrist X-ray is a quick procedure. It usually only takes a few minutes to produce clear images of the bones, so you can get the answers you need without much wait or discomfort.

X-rays effectively diagnose fractures, making them the most reliable first-line test for wrist injuries. Whether you’ve had a fall or are experiencing pain, an X-ray can quickly show if there's any bone damage in your wrist.

Another great benefit is that it’s noninvasive – no needles, incisions, or complex procedures are involved. It's a straightforward way to get the right diagnosis with minimal disruption.

Plus, wrist X-rays are more affordable than other imaging tests, such as MRIs or CT scans, making them a budget-friendly option if you pay privately. Your radiation exposure is also low compared with other imaging techniques, such as CT scans.

Risks & Side Effects

While wrist X-rays only expose you to a low dose of radiation, repeated X-rays may slightly increase the risk of cancer. However, the benefits of a quick and accurate diagnosis and prompt treatment should outweigh any concerns you have about your radiation exposure. If you’re at all worried, ask your clinician, who will be able to reassure you.

How to Prepare for a Wrist X-ray

You don’t need to do anything special before a wrist X-ray; you can eat and drink normally before the procedure. You may be asked to remove clothing and jewellery that could interfere with the image and let the radiologist know if you are, or think you could be, pregnant. This will help them to minimise the risk of any radiation exposure for you and your baby.

The Procedure Explained: What to Expect

Positioning the Wrist

Your radiologist will ask you to sit on an X-ray table or stand near the X-ray machine. They’ll ask you to position your wrist in a certain way, helping you if you have difficulty. This helps to ensure clear images. You may need to adjust your arm and wrist slightly, depending on which views your radiologist needs to take.

Centreing the X-Ray Beam

Once your wrist is positioned correctly, your radiologist will centre the X-ray beam over it and adjust the beam to focus on a particular area, depending on your symptoms.

Taking the Posteroanterior (PA) View

The most common view for a wrist X-ray is the posteroanterior (PA) view. In this position, your palm faces down, and your wrist is straight. This view helps your clinician assess the bones and joints of your wrist from the front.

Taking the Lateral View

Next, your radiographer will ask you to rotate your wrist so that the side of it faces the X-ray machine. This lateral view offers a different angle of the wrist and helps detect fractures or abnormalities that might not be visible in the PA view.

Taking the Oblique View

Sometimes, your doctor may ask for an oblique view to be taken. Your radiologist will ask you to rotate your wrist at a slight angle (usually around 45 degrees) to get a different perspective. This view can reveal injuries or conditions hidden in the PA or lateral images.

Additional Specialized Views if Needed

If your doctor suspects a more complex problem is causing your wrist pain, they may request additional specialised views during the X-ray. These could include angled views or specific positions to highlight areas of concern, such as the carpal bones.

Image Processing and Review

Once all the X-ray images are taken, your radiographer will process them digitally. This usually happens very quickly, and you may be asked to wait a few moments to ensure the images are clear and complete. Sometimes, your radiographer may need to take additional images if they need a clearer picture of your wrist or a different view.

Radiologist Interpretation

Your radiologist will review the X-ray results to look for any signs of fractures, arthritis, bone infections, or other conditions that could be affecting your wrist. They’ll prepare a report and send it to your clinician, who will discuss the results with you.

Normal Wrist X-ray vs Broken

A normal wrist X-ray will show intact bones and structures with no signs of fractures or dislocations. In contrast, a broken wrist will show clear signs of features in the bones, misalignment or other abnormalities that are a sign of injury.

X-ray Equipment

The key equipment of a wrist X-ray include:

X-ray tube: This generates an X-ray beam that passes through the wrist.
Digital detector or film: This captures the X-ray image; many healthcare settings now use digital imaging, which gives faster results and better image quality.
Positioning equipment: This will include standing plates or portable machines for patients who can’t sit or stand up.
Protective equipment: Technicians may wear lead aprons and/or shields to minimise unnecessary exposure, especially if you’re pregnant.

What Happens After a Wrist X-ray?

Depending on the facility you attend, your X-ray results will usually be available within a few hours to a day. Your radiologist will review them and pass them on to your clinician.

Getting the Results & Follow Up

Your clinician will discuss the results of your wrist X-ray in a one-on-one consultation and recommend treatment if necessary. Based on the X-ray results, they may also recommend follow-up imaging, such as an MRI or CT scan.

Costs

Depending on where you live in the UK and where you have your wrist X-ray, you can expect to pay between £100 and £150. X-rays are among the most affordable imaging techniques available.

Get a Wrist X-ray

Booking a wrist X-ray through a trusted medical imaging provider like Scan.com can help you take the first step towards relief from your symptoms. If you’re unsure whether you need a wrist X-ray, our clinicians can guide you based on your specific symptoms in a one-to-one consultation with no obligation to book afterwards.

FAQs

What Does a Sprained Wrist Look Like on an X-Ray?

A sprain involves soft tissues like ligaments that don't appear on X-rays. However, an X-ray can rule out fractures that might cause similar symptoms.

What Does a Broken Wrist Look Like on X-Ray?

A fracture appears as a visible break or a crack in the bone. In some cases, bones may be displaced or misaligned.

What Does Arthritis Look Like on an X-Ray Wrist?

Your doctor may be able to diagnose arthritis from your wrist X-ray through several key signs. These may include narrowing of the joint spaces, which suggests cartilage loss, as well as changes in bone density. You may also see the development of bone spurs (osteophytes) or other signs of joint damage. These changes help your doctor assess the severity of arthritis and plan the best treatment.

Sources:

Distal Radius Fracture (Wrist Fracture). (N.D.) https://www.hopkinsmedicine.org/health/conditions-and-diseases/distal-radius-fracture-wrist-fracture

Fractured wrist. (2021). https://www.imperial.nhs.uk/~/media/website/patient-information-leaflets/orthopaedics/hand-therapy/fractured-wrist.pdf

Wrist radiograph (an approach). (2024). https://radiopaedia.org/articles/wrist-radiograph-an-approach?lang=gb

Wrist series. (2024). https://radiopaedia.org/articles/wrist-series

Wrist X-ray. (2022). https://my.clevelandclinic.org/health/diagnostics/22328-wrist-x-ray