Musculoskeletal X-ray interpretation
A systematic ABCDS read of joint X-rays, the patterns that separate RA, psoriatic arthritis, gout, CPPD, OA, haemochromatosis and axial spondyloarthritis, region-by-region views and findings for hands, knees, hips, shoulders, spine and sacroiliac joints, and when an X-ray won't help.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Plain X-ray is the first imaging test for most chronic joint problems: cheap, available and good for bone. It shows structural damage, not active synovitis.
- Read it systematically with ABCDS: Alignment, Bone, Cartilage, Distribution, Soft tissues.
- Early inflammatory arthritis and early sepsis usually have normal X-rays. Erosions take months to appear. Ultrasound and MRI see synovitis and marrow oedema earlier.
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Sources
- Therapeutic Guidelines: RheumatologyAU/NZTherapeutic Guidelines Limited (eTG complete), current online version, accessed November 2026
- Low Back Pain Clinical Care StandardAU/NZAustralian Commission on Safety and Quality in Health Care, 2022 (no revision as of November 2026)
- InsideRadiology: X-ray and radiation dose informationAU/NZRoyal Australian and New Zealand College of Radiologists, online, accessed November 2026
- ACR Appropriateness Criteria: musculoskeletal topics (chronic extremity joint pain, suspected inflammatory arthritis; chronic hip pain; chronic knee pain; shoulder pain)American College of Radiology, online, accessed November 2026
- van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum 1984;27:361-8Arthritis and Rheumatism, 1984
- Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957;16:494-502Annals of the Rheumatic Diseases, 1957
- Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 1976;119:559-68Radiology, 1976
- Kiely PD et al. EULAR 2025 classification criteria for haemochromatosis arthropathy. Ann Rheum Dis 2026;85:238-45EULAR, 2025 (published 2026)
- Abhishek A et al. The 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease. Ann Rheum Dis 2023;82:1248-57ACR and EULAR, 2023
- Last updated
- 14 November 2026
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