Hand and wrist X-ray: why it is done, what it shows and what to expect

A hand or wrist X-ray is a standard X-ray of the bones of the fingers, hand and wrist. The NHS describes X-rays as a test that takes pictures of the inside of the body using a small amount of radiation, used mainly to check the bones as well as teeth and lungs. For the hand and wrist, several small images are usually taken from different angles so that overlapping bones can be separated.

The wrist contains many small bones, and fractures there can be subtle. For that reason a radiographer may take more than one view and may ask you to position your hand in a particular way, even if it is uncomfortable.

The commonest reason is an injury. The NHS says an X-ray may be used to check your bones for a fracture after an accident, and that after an injury to the arm or wrist it can be hard to tell if a wrist is broken, dislocated or badly sprained, so you will probably need an X-ray.

X-rays are also used for persistent pain, swelling or stiffness without an injury, to look for changes in the joints. The NHS describes osteoarthritis as a condition that causes joints to become painful and stiff, most often in the knees, hips and small joints of the hands, and rheumatoid arthritis as a long-term condition that usually affects the hands, feet and wrists. For osteoarthritis the NHS says X-rays are not usually necessary but may be used to rule out other possible causes such as rheumatoid arthritis or a fractured bone.

Other reasons include checking how a fracture is healing, looking at a joint before or after surgery, or looking for a foreign body.

Do not wait for a routine appointment if you think you have broken a bone. The NHS says to go to A&E or call 999 if the arm or wrist is numb, tingling or has pins and needles, if there is a bad cut bleeding heavily, a bone sticking out of the skin, or the arm or wrist has changed colour, shape or is at an odd angle. It also says not to drive yourself to A&E.

The NHS says to get help from NHS 111 if the injured arm or wrist is very painful or you cannot use it because of pain, there is a large amount of swelling or bruising, or it feels very stiff or is difficult to move. Support the arm gently, apply an ice pack wrapped in a cloth for up to 20 minutes every 2 to 3 hours, remove rings and watches, and avoid eating or drinking in case surgery is needed.

The NHS says most X-rays are done in hospital by a radiographer. You may be asked not to wear anything metal and to remove jewellery, watches or rings from the area. Tell the radiographer if you are or might be pregnant. You can ask for a chaperone.

For the pictures, the machine is lined up with your hand or wrist, and the radiographer moves behind a screen. The NHS says you will be asked to keep very still for a few seconds while one or more X-rays are taken, and you may be asked to move into different positions. You can usually leave as soon as the X-ray is done. No injection or contrast is needed for a standard hand and wrist X-ray.

An X-ray shows bone well. It can show breaks, dislocations, joint space narrowing, bone spurs and some signs of inflammatory arthritis. It cannot show tendons, ligaments, nerves or cartilage directly. A normal X-ray therefore does not rule out a ligament injury or a very small fracture, and a follow-up image or an MRI or ultrasound scan may be advised if symptoms persist.

This is a recognised limitation in wrist injuries, where some fractures only show up days later. If the pain is still significant after a normal X-ray, go back to be reassessed rather than assuming nothing is wrong. The NHS adds that a plaster cast may sometimes be applied a few days after the injury to let swelling go down first.

The NHS says you should be told when you will get your results, and that a healthcare professional should explain them and any next steps. In urgent care they are often available the same day. For a scan requested by your GP, the report is sent to the surgery. If you have not heard anything after a few weeks, contact the doctor who referred you.

X-rays use a small amount of radiation. The NHS says they are usually very safe and serious complications are rare, and that if you have lots of X-rays there is a very small risk that radiation could cause cancer. Your doctor assesses the risk before offering one. Tell staff if you are pregnant, because precautions may be needed.

If a break is found, the NHS says the arm may be placed in a splint, a plaster cast may be used until the bone heals, and in a bad break surgery may be needed. It says recovery from a broken arm or wrist usually takes around 6 to 12 weeks, and the wrist may be stiff and weak when the cast comes off, with physiotherapy helping.

If arthritis is suspected, the next steps are usually blood tests, advice on exercise and joint protection, painkillers or specialist referral. Early diagnosis matters in rheumatoid arthritis, because the NHS says early treatment can prevent it getting worse and reduce the risk of joint damage.