Extremities Radiology Chart
Anomaly/Line
1
ER,
IR,
N
LR
MR
View
Bone
AC spot
AP shoulder
Clavicle,
acromion
Acromioclavicular
Joint Space
AP shoulder
or AP AC jt
Acromion
(scap),
clavicle
Acromioclavicular
Spot
AP shoulder
Clavicle
Acromiohumeral
Interval
AP shoulder
Humerus,
acromiom
(scap)

All
Long

Apophysis
Arcs of carpal
alignment
PA wrist
Carpals
Carpal bones
Any
Carpals
Carpal Coalition
AP wrist
Lunate and
triquetrum
Carpals
PA wrist
Carrying angle
AP elbow
Clavicle
Deltoid tuberosity
variations

AP shoulder
Humerus
Straight or
10-15º
cephalad
None



Humerus,
ulna
Clavicle
None

Carpals
PA clavicle
None



Tube
Tilt

None
None

None

None

None

None

Straight or
10-15º
caudad


None
Measurement/Comment
Top part of jt is wide. Usu viewed bilaterally.
Meassure inf and sup aspects of AC jt and
average. Normal 2-4 mm. Common in weight
lifting. Signifies osteolysis (look for cortex of
clavicle), HPT, rheumatoid arthritis.
Measure sup and inf aspects of jt space and
average. Normal: 2-4 mm (3 mm ave). Diff
b/t both AC jts should not be more than 2-3
mm. ↓ space = DJD; ↑ space = trauma,
osteolysis, HPT, rheumatoid arthritis.
For distal clavicle and AC jt. Turn pts head
away from side being radiographed. See
Clavicle (P to A projection).
Distance b/t inf margin of acromion and sup
aspect of humeral head. Normal: 7-11 mm
(ave 9 mm). < 7 mm = rotator cuff tear
Outgrowth or projection from 2º center of
ossification; bony attaachment site for
ligaments and tendons. Ex: greater tuberosity,
lesser trochanter.
Three arcs are outlined. Arc 1 = proximal
articular surfaces of scaphoid, lunate,
triqueetrum. Arc 2 = distal articular surfaces
of same bones. Arc 3 = prox surfaces of
capitate and hamate. Normal is smooth and
continuous.
Scaphoid, lunate, triquetrum, pisiform,
hamate, capitate, trapezoid, trapezium.
Normal anomaly. Bones can fuse, esp lunate
and triquetrum. Pt may have mechanical
problems or osteoarthritis earlier than usual.
Smaller view is best for viewing carpals.
Scaphoid, lunate, triquetrum, pisiform,
trapezium, trapezoid, capitate, hamate.
Line AB drawn down humerus,  to long
axis. Line CD drawn down center of ulna and
 to long axis. Angle formed ~ 15º.
Significance: may be fx or deformities.
Turn pts head away from side being
radiographed. Tube tilt will get through angle
better. Want to define med to lat edges.
Preferred in anatomic detail and in kyphotic
pts. See AC Spot for A to P projection.
Normal variant. 1/3 way down shaft of
humerus. Irregular bump on deltoid
tuberosity.
Extremities Radiology Chart
Anomaly/Line
2
ER,
IR,
N
LR
MR
View
Bone
All
Long
AP shoulder
Humerus,
scap
All
Long
External
Shoulder
Scap,
humerus

Fat planes
AP shoulder
Humerus,
scap

Flap fracture
AP shoulder
Scapula,
humerus
Diaphysis
Dislocation
Epiphysis
External rotation
Fracture
Fracture
AP elbow,
lat elbow
AP elbow,
lat elbow,
med elbow




Radius
Humerus


Tube
Tilt
None
None


None
None


Measurement/Comment
The shaft of a long bone – longest and
narrowest portion. Provides mechanical
support. Houses bone marrow. Developed
from 1º center of ossification.
Anterior dislocation will go inferior (most
common); post dislocation (rare), usu due to
shocks or seizures, will go superior b/c of
scapula.
End of a long bone developed from 2º center
of ossification; covered w/artic cart; supports
joint movement.
Have pt stand A to P, and turn arm away
from body until palm of hand faces laterally.
(thumb moves in arc from anterior to lateral
to posterior). All adult shoulder views are
done in lat (or ext) rotation.
None
Normal variant. Folds around the shoulder.

None
Flap of bone torn from bone. Sometimes
accompanied with dislocation. Usu from
trauma.

None
Radial head/neck fx most common in adults.
None
Supracondylar most common fx in children.
Most common fx in adult or child. Artery is
different for scaphoid bone; artery enters
distal end. If fx is not treated, proximal part
dies b/c of malnourishment. Cause: falling on
extended hand


Fracture
AP, lat, lat
oblique wrist
Scaphoid

None
Fracture
Lat wrist
Triquetrum

None
2nd most common fx. Can see piece of
floating bone. Cause: landing on dorsal hand
Fracture of clavicle
Bilateral AP
clavicle
Clavicle

15º
cephalad
Important to compare sides. Protect thyroid
from X-rays, if possible. Separate views can
protect thyroid more.
Fracture, Barroom
Med oblique
hand
MCP

None
Fracture, Boxer’s
Med oblique
hand
MCP

None
AP shoulder
Humerus,
scap
Glenohumeral Joint
Space
Internal rotation
Internal
Shoulder
Scap,
humerus

None

None
5th metacarpal fx of head. Compare with
“boxer’s fx”. (MCPs = knuckles).
2nd or 3rd MCP head fx. Compare with
‘barroom fx”. (MCPs = knuckles)
Sup, inf and middle aspects of joint space
measurements are averaged. Normal: 4-5
mm.
< 4mm = arthritis (usu DJD). > 5 mm =
acromegaly or posterior dislocation.
Have pt stand A to P, and turn arm towards
body until palm faces laterally. (thumb
moves in arc from anterior to medial to
posterior). Internal rotation pts tend to raise
shoulder. Looks like humerus on top of
acromiom.
Extremities Radiology Chart
Anomaly/Line
Longitudinal axial
alignment of wrist
Metacarpal sign
3
View
Bone
Lat wrist
Radius and
hand bones
ER,
IR,
N
LR
MR


Tube
Tilt
Measurement/Comment
none
Draw line through center of radius in
extended wrist and hand. Radius, lunate, and
3rd metacarpal shouls be aligned along long
axis. Deviation = fracture or dislocation.
PA hand
Metacarpals
All
Long
Lat hand, PA
hand, med
oblique hand
Phalanges
Optional view
Axial
shoulder
Glenoid
fossa (scap),
humerus
Optional view
Abduction
“Baby Arm”
shoulder
Clavicle,
scapula

None
Optional view
Y- (outlet)
oblique
shoulder
Humerus,
scap

None
Optional view
Spot hand
Indiv hand
bones

None
Optional view
stress
Indiv hand
bone

None
Ossicles
Any hand
Carpals

None
Ossification centers
PA hand
MCPs

None
All
Metacarpals,
usually
Metaphysis
Normal variants
Osteophyte


None


None
Draw line along heads of 4th and 5th
metacarpal heads. Normal: 3rd MCP head
shoud be at or prox to line. Deviation: 4th
MCP is too short. Signifies Turner’s
Syndrome or fx
Zone b/t physis and diaphysis; expanded area
that tapers into the shaft. Greatest metabolic
region of bone. Responsible for forming of
long bone shape.

None
Bifid phalanx, extra phalanx, esp in thumb

Pointing
straight up
through
axilla
Sees glenohumeral jt and space. Pts arm is
held flexed abducted 90º to floor in front of
them, Tube is aimed up through axillary
space.


None
Periosteum
All
Long



None
Physis
All
Long



None
Position pt A to P, with arm abducted to 90º,
elbow flexed to 90º, plam of hand faces tube.
For AC jt, proximal humerus, clavicle, lung
apex, coracoid and acromium. Have pt
breathe in, breathe out and hold.
Positon pt w/ shoulder against bucky. Beam
goes through scap. Look for big, open space
at supraspinatus.
Either lat or PA view. Close up of one
specific area—easier to locate problem
Pushes problem region in same direction of
injury. Especially helpful for hairline fx and
ligament tears.
Bones in carpals; look identicle to sesamoids.
Located at proximal end of digit 1 (thumb),
and distal end of digits 2-5.
Bone spurs. Signifies osteoarthritis. Joint is
degenerating, and bone develops osteophytes
to protect against bone-on-bone rubbing.
Soft tissue enveloping around long bone;
attached by sharpey’s fibers. Maintains
caliber, integrity of bone. Appositional bone
growth. Not radiographically visible when
normal.
In growing bones; contributes to enchondral
growth. Located b/t epipysis and metaphysis;
seen as a radiolucent band on radiographs.
Extremities Radiology Chart
Anomaly/Line
4
ER,
IR,
N
LR
MR
Tube
Tilt
View
Bone
Physis mimicking
fracture
AP shoulder
Humerus



None
Pseudotumor of the
humerus
AP shoulder
Humerus



None
Radiocapitellar line
Lateral
elbow
Humerus,
radius
Sail sign
Secondary
ossification centers
Lat elbow
Humerus

None

None
Any
Humerus,
radius, ulna
Any hand
MCPs,
phalanges
AP shoulder
Scap,
humerus,
clavicle
Standard view
AP elbow
Humerus,
radius, ulna
Standard view
Oblique,
elbow
Humerus,
radius,ulna
Standard view
Lateral
elbow
Humerus,
ulna, radius

None
Standard view
Medial
oblique
elbow
Humerus,
ulna

None
Standard view
PA wrist

None
Sesamoids
Standard view
Carpals



None





None

None
None
None
Measurement/Comment
Normal variant. Jagged radiolucent line,
which is posterior physis . Looks like
fracture, esp in children. Edge depends on 
of film and pt, how shoulder is positioned.
Normal variant. Large lucent region. Looks
like a tumor, but it is not. Due to greater
tuberosity in rotation.
Line drawn down center of radius and
parallel ot long axis. Should pass through
center of capitellum. Significance: radial
head subluxation or dislocation.
Ant fat pad more radiolucent than rest of
tissue. Usu in shape of triangle. Significance:
fx in jt somewhere, which swelling or
bleeding ‘lifted’ fat pad up.
Age of appearance: capitellum → 1 yr; radial
head → 4 yrs; med epicondyle → 7 yrs;
trochlea → 10 yrs; olecranon → 10 yrs;
lateral epicondyle → 11 yrs.
Bones in tendons or ligaments, especially
around joints. Looks identicle to ossicles.
Pisiform is a sesamoid.
Demonstrates proximal humerus, scapula,
clavicle, rib cage. Want to see some lung (for
disease – can refer px to shoulder), and some
muscle tissue. Look for physis to determine if
child.
Viewed, elbow in extension. Elbow extended
on bucky, hand in supinated position. Radius
and ulna overlap proximally. Olecranon
process should be in the middle; condyles
level with each other.
Viewed, elbow in extension. Olecranon
process is in lat or medial position, depending
on angle. Ulna and radius tend to separate out
w/lat oblique; rad and ulna cross in med
oblique.
Elbow is flexed at 90º. Arm resting on bucky,
thumb up. Humerus as flat as possible to
bucky to prevent distortion of humerus.
Views radioulnar jt, distal humerus, prox rad
and ulna.
Arm in extended position. Hand is pronated
on bucky.Views medial aspect of elbow.
Allows carpal bones and joints to be viewed,
also distal radius and ulna. Greater detail than
PA hand view.
Extremities Radiology Chart
5
View
Bone
ER,
IR,
N
LR
MR
Tube
Tilt
Standard view
Lateral wrist
Carpals,
distal radius
and ulna

None
Standard view
Medial
oblique wrist

None
Hand is semipronated (finger and index from
an “O”).
Standard view
PA hand

None
Thumb is in oblique view. Other digits in PA
Standard view
Medial
oblique hand
Hand bones,
distal radius
and ulna

None
Thumb is in lat view. Hand in 35º-40º  All
digits spread out as far as possible. Don’t
mistake flexed finger for problem.
Standard view
Lateral hand
Hand bones,
distal radius
and ulna

None.
Supernumary
AP wrist
Carpals

None
Supracondylar
process
Lat elbow
Humerus
Anomaly/Line
Ulnar variance
PA wrist
Vacuum sign
lat elbow
Carpals,
distal radius
and ulna
Hand bones,
distal radius
and ulna
Ulna, radius



None

None

None
Measurement/Comment
Thumb is ant, out of the way. Views
relationships of carpals (esp lunate) and distal
radius.
Thumb in PA. Difficult to see individual
carpals. Should have full “ray” (spread of
fingers) on view.
Normal anomaly. Too many carpal bones.
Need to count carpals. Pt may have
mechanical problems or osteoarthritis earlier
than usual.
Normal variant. Struther’s ligament attaches
process to humerus, forms foramen. Median
N, brachial art, sometimes ulnar N, radial art
can become ‘entrapped’
Draw line A at distal ulna at Radioulnar jt,
and line B at the level of distal radial styloid
process ( to line A). Normal = line B 9-12
mm distal to line A. > 12 mm = negative
ulnar variance (ulna to short); < 9 mm =
positive ulnar variance (ulna is too long)
Viewed in flexion. Normal anomaly. Thin
line b/t humerus and glenohumeral jt. If in
any other joint, signifies DJD (osteoarthritis).