X-rays - Neutral position

The neutral position is crucial for correct image interpretation of wrist radiographs in two planes. See how the neutral views are correctly acquired and checked with characteristics.

Neutral position implies that no rotation of the forearm in the radioulnar joints is allowed during acquisition of the dorsopalmar and lateral images. Functionally, the neutral position corresponds to the middle distance between maximum pronation and supination. The joint surfaces of the ulnar incisura radii and the ulnar head then have the greatest possible contact. The correct radiographs of the wrist are obtained as follows:

For the dorsopalmar projection, the arm of the seated patient is positioned at shoulder height (abduction in the shoulder joint of 90 degrees). Simultaneously, the elbow is flexed by 90 degrees. The arm is positioned either with the support of a positioning block on the Bucky table or directly on the height-adjustable Bucky table with tracking control (constant tube-detector distance). The exposure is correctly performed when the dorsopalmar radiograph displays the ulnar styloid process outwards in profile.
For the lateral projection, the seated patient adducts the upper arm to the upper body. The elbow is flexed so that the forearm and hand come to rest with the ulnar sides on the Bucky table. It is also important to ensure that the dorsal sides of the forearm and hand are aligned in one plane (no extension of the wrist). A positioning block is helpful for this. The lateral radiogram is correctly exposed when the pisiform is being projected between the distal scaphoid pole and the palmar side of the capitate.

Note: Do not be confused by textbook descriptions to the contrary, as these are often incorrect!
Neutral position of the wrist