Finger X-ray (both hands)

What it is

This is a targeted study of one or more fingers rather than the whole hand — fewer bones, but each of them shown properly. Two things are being read. The first is alignment: a finger whose bones have united at an angle or a rotation no longer folds into the palm alongside its neighbours, and that costs far more function than the original break did. The second is the joint surface. A fracture line that runs into the smooth cartilage-covered end of a bone leaves a step in a joint that has to work thousands of times a day, and those are the breaks most likely to stiffen or go on to arthritis. Views are taken from the front, the side, and often an angle, because a finger photographed only face-on hides the joint surfaces behind each other.

Why it is done

• To find a fracture in a finger after a jam, a crush, a twist, or a blow, and to show which bone and which segment
• To show whether the fracture has entered a joint, which changes how urgently and how precisely it must be fixed
• To measure angulation and rotation, the two things that decide between a splint and an operation
• To find a chip of bone pulled off by a tendon or ligament at the moment of injury
• To assess the pattern of joint damage across the fingers of both hands in arthritis, where symmetry is part of the diagnosis

What to expect

The hand is laid palm-down with the finger of interest flat and extended, then rolled onto its side and angled; foam blocks hold a painful finger in position. It takes a few minutes and requires no preparation. Straightening an acutely injured finger is the uncomfortable part, and the technologist will get what is achievable rather than force it. Rings come off first, and it is easier to remove them before swelling sets in. A radiologist reads the films, though hand surgeons and emergency clinicians routinely read them first themselves.

Questions worth asking

• Was a finger code or a hand code used? A hand study covers more bones and costs more, and the bill should reflect the body part actually imaged.
• If the finger was splinted or put back into place during the same visit, is the check film afterwards a separate charge?
• If fingers on both hands were imaged, is that billed once or twice?
• If a hand surgeon is seen a few days later, will the office accept these images rather than repeating them, and how do I get a copy to take?
• When arthritis is the question and films of both hands are taken as a baseline to repeat in future years, how often is that repeat billed?