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1. Although the system for viewing X-rays of bones and joints varies depending on the anatomy being examined, there are some broad principles which can be applied in a number of situations.A systematic approach involves checking alignment of bone structures, joint spacing, integrity of bone cortex, medullary bone texture, and for abnormalities of any visible surrounding soft tissue structures.
2. Images of the asymptomatic contralateral side to a suspected abnormality are not routinely acquired for assessment of all bones or joints.If an old image of the contralateral side is available, or if the other side is included as standard (for example hip/pelvis), then comparison between symptomatic and asymptomatic appearances can be very helpful.
3. Careful scrutiny of the bone cortex is required because a check that is too brief will lead to incorrect or incomplete diagnosis.In the context of trauma the clinical features of a significant injury may be masked by other injuries.
4. Scrutinizing the soft tissues can often provide helpful information.Not uncommonly an abnormality of soft tissues is more obvious than a bone injury, or may even imply a bone injury that is not visible at all.
5. Very often pain is referred to the symptomatic area and is explained by disease of another system.For example, shoulder pain is usually due to shoulder pathology, but always keep in mind that pain may be referred to the shoulder from the cervical spine, brachial plexus or diaphragm.
6. Occasionally bone injury or disease will result in abnormality of this texture.
7. The skeletal system is symmetrical, so it is particularly important to be sure you are looking at the correct side.
8. Confidence in assessing musculoskeletal system X-rays comes from experience and a knowledge of normal appearances.
9. Not all disease that presents with musculoskeletal symptoms is primarily related to pathology of the bones or joints.
10. Remember to be systematic, and if you spot one abnormality, do not stop until you are sure you have focused on all areas of the anatomy shown.
11. All patients are different, so being sure of the distinction between normal and abnormal is often difficult.Here are some principles that may help you to determine if a finding is normal.
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