Normal Wrist X-Ray Report Template (3-View)

Normal 3-view wrist radiograph report template: carpal arcs, scaphoid, radiocarpal alignment and ulnar variance, with occult scaphoid fracture notes.

EXAMINATION: Wrist radiograph, [right/left], 3 views.

CLINICAL HISTORY: [indication]

COMPARISON: None available.

TECHNIQUE: PA, oblique and lateral views of the [right/left] wrist.

FINDINGS:
Alignment: Anatomic. The carpal arcs are intact. On the lateral view the
radius, lunate and capitate are colinear. No carpal dislocation.
Bones: No acute fracture. The distal radius, distal ulna, carpal bones
including the scaphoid, and visualized metacarpal bases are intact.
Joints: Radiocarpal, intercarpal and distal radioulnar joint spaces are
preserved. No scapholunate widening. Neutral ulnar variance.
Soft tissues: No significant soft tissue swelling. The pronator fat pad
is normal.

IMPRESSION:
1. No acute fracture or malalignment.

Dictation notes

• Snuffbox tenderness with a normal radiograph is still a scaphoid fracture clinically — recommend immobilization with repeat films or MRI in the impression.
• Check radius-lunate-capitate colinearity on every lateral; lunate and perilunate dislocations are missed on the PA view, not the lateral.
• Scapholunate interval over 3 mm suggests ligamentous injury — compare with the contralateral side or a clenched-fist view before calling it normal variation.

Frequently asked questions

What alignment features are checked on wrist X-rays?

On the PA view the three carpal arcs should form smooth, unbroken curves, and on the lateral view the radius, lunate and capitate should be colinear — the key check for lunate and perilunate dislocation, which is missed on the PA, not the lateral. The report also assesses the scapholunate interval, radiocarpal and distal radioulnar joints, ulnar variance, and the pronator fat pad.

Can a scaphoid fracture be present with normal wrist X-rays?

Yes. Snuffbox tenderness after a fall on the outstretched hand remains a scaphoid fracture clinically even when radiographs are normal, because acute scaphoid fractures are frequently radiographically occult. The report's impression should recommend immobilization with repeat radiographs in 10-14 days or MRI, which detects the fracture immediately. A missed scaphoid fracture risks nonunion and avascular necrosis of the proximal pole.

What does scapholunate widening on a wrist X-ray mean?

A scapholunate interval over 3 mm suggests scapholunate ligament injury — the most common carpal instability — and should not be dismissed as normal variation without comparison with the contralateral wrist or a clenched-fist view, which stresses the interval. Untreated scapholunate dissociation progresses to a predictable pattern of degenerative change (SLAC wrist), so the finding warrants explicit mention and clinical correlation.

← All report templates