Common xray views of different joints of body in tabular form mentioning its indications and common interpretations
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Common X-Ray Views of Different Joints - Complete Reference
Below is a joint-by-joint breakdown of standard and supplementary radiographic views, their indications, and key interpretive findings.
1. SHOULDER
| View | Technique/Position | Indications | Common Interpretations |
|---|---|---|---|
| AP (Neutral/Internal/External rotation) | Arm slightly abducted; beam AP through glenohumeral joint | Trauma, pain, dislocation screen | Fracture of humeral head/neck, Hill-Sachs lesion (internal rotation), AC joint space, calcific tendinitis |
| Grashey (True AP) | Patient rotated 35-45° so beam is parallel to glenoid articular surface | Glenohumeral joint space evaluation, OA, instability | True joint space narrowing, subchondral sclerosis, glenoid bone loss |
| Scapular Y (Lateral) | Patient obliqued 60° so scapula is in lateral profile | Dislocation confirmation, scapular fractures | Humeral head position relative to Y - anterior/posterior dislocation; scapular body/spine fractures |
| Axillary View | Arm abducted 70-90°, beam aimed axially through axilla | Anterior/posterior dislocation (most reliable), Hill-Sachs, Bankart bony lesion | Humeral head anterior (anterior dislocation) or posterior (posterior dislocation) to glenoid; bony Bankart |
| Zanca View | 10-15° cephalad tilt, centered on AC joint | AC joint injuries | AC joint widening, CC distance increase (Grade I-VI AC separation), osteolysis |
| Serendipity View | 40° cephalad tilt centered on sternum | SC joint dislocation/injury | Anterior (head rides superior) vs. posterior SC dislocation |
2. ELBOW
| View | Technique/Position | Indications | Common Interpretations |
|---|---|---|---|
| AP | Elbow extended, palm supinated | Trauma, routine evaluation | Distal humerus fractures (supracondylar, lateral/medial condyle), radial head fractures, carrying angle |
| Lateral (90° flexed) | Elbow flexed at 90°, ulnar side down | Any elbow injury | Posterior fat pad sign (effusion = occult fracture), anterior sail sign, radial head alignment (ERCL), olecranon fractures |
| Radial Head View (Greenspan) | AP with 45° cephalad beam tilt | Suspected radial head fracture when AP is normal | Radial head fractures not seen on standard AP |
| Cubital Tunnel / Distal Humerus Axial | Elbow maximally flexed, beam axial | Cubital tunnel syndrome, medial epicondyle fractures | Medial epicondyle avulsion, osteophytes in cubital tunnel |
3. WRIST
| View | Technique/Position | Indications | Common Interpretations |
|---|---|---|---|
| PA (Posteroanterior) | Hand/wrist flat on detector, palm down | Trauma, wrist pain | Distal radius fracture (Colles', Smith's), scaphoid fracture, carpal alignment, Gilula's arcs, DISI/VISI deformity |
| Lateral | Wrist in true lateral | Wrist pain, dislocation | Perilunate/lunate dislocation (spilled teacup sign), distal radius angulation, carpal alignment |
| Scaphoid Views (Ulnar deviation) | Wrist in ulnar deviation with PA beam | Suspected scaphoid fracture | Scaphoid waist fracture (AVN risk), proximal pole fractures |
| Carpal Tunnel View | Wrist hyperextended, beam tangential to carpal tunnel floor | Hook of hamate fracture, calcium deposits | Hook of hamate fracture, calcification in carpal tunnel |
| Clenched-Fist AP | Patient grips tightly, PA view | Scapholunate instability (dynamic) | Scapholunate interval widening (>3mm = Terry Thomas sign) |
4. HAND & FINGERS
| View | Technique/Position | Indications | Common Interpretations |
|---|---|---|---|
| PA (Posteroanterior) | Palm flat on detector | Trauma, RA, OA, foreign body | Metacarpal/phalangeal fractures; juxta-articular erosions (RA); joint space narrowing; subchondral cysts |
| Oblique | Hand rotated 45° | Fractures not seen on PA | Metacarpal fractures (especially 4th/5th), phalangeal fractures |
| Lateral | True lateral of individual digit | Fracture displacement, dislocation | PIP/DIP dislocation direction, Mallet finger avulsion, volar plate fracture |
| Ball-Catcher View (Norgaard) | Both hands in 45° supination oblique | Early RA detection | Marginal erosions at radial aspect of MCP/PIP joints (earliest RA sign) |
5. HIP
| View | Technique/Position | Indications | Common Interpretations |
|---|---|---|---|
| AP Pelvis | Supine, hips internally rotated 15-20°, beam centered on pubic symphysis | Hip fracture, AVN, DDH, arthritis, pelvic ring injury | Femoral neck/intertrochanteric fracture; Shenton's line disruption; joint space narrowing (OA); protrusio acetabuli |
| Lateral (Crosstable/Frog-Leg) | Cross-table: uninvolved hip flexed; Frog-leg: bilateral hip flexion-abduction | Hip fractures (avoids moving patient), AVN, SCFE | Posterior displacement of femoral neck fracture; AVN crescent sign; SCFE posterior/inferior slip |
| False Profile View | Patient rotated 65° from plate, beam AP | Anterior acetabular coverage, FAI | Anterior CE angle (anterior coverage); acetabular retroversion |
| Dunn View (45° or 90°) | Hip flexed 45° or 90°, slight abduction | Cam-type FAI | Alpha angle measurement; cam deformity at head-neck junction |
6. KNEE
| View | Technique/Position | Indications | Common Interpretations |
|---|---|---|---|
| AP (Standing/Supine) | Standing preferred for joint space | Trauma, OA, arthritis, masses | Tibial plateau fracture, medial/lateral joint space narrowing (OA), varus/valgus alignment, bone tumors |
| Lateral | True lateral with 30° flexion | Trauma, effusion, OA, patellar height | Fat pad / posterior fat pad signs (effusion), Segond fracture (lateral capsule), patellar height (Insall-Salvati ratio), tibial spine avulsion |
| Merchant/Sunrise (Patellofemoral) | Knee flexed 30-45°, beam tangential to patellofemoral joint | Anterior knee pain, patellar subluxation/tilt, chondromalacia | Patellar tilt angle, sulcus angle, trochlear dysplasia, patellar subluxation |
| Tunnel/Notch View (PA 40° flexed) | Knee flexed 40-45°, PA beam | Osteochondral defects, loose bodies, intercondylar notch OA | Osteochondritis dissecans, notch osteophytes, loose bodies |
| Rosenberg View (PA weight-bearing 45° flexed) | Weight-bearing, knee 45° flexion, PA | Cartilage loss/OA (most sensitive) | Posterior condyle joint space narrowing missed on standard AP |
7. ANKLE
| View | Technique/Position | Indications | Common Interpretations |
|---|---|---|---|
| AP | Foot/ankle dorsiflexed, beam AP | Ankle trauma, arthritis | Tibial plafond/fibular fractures, Maisonneuve (proximal fibula - check!), talar dome OCD, mortise congruence |
| Mortise View (AP with 15-20° internal rotation) | Foot internally rotated 15-20° | Ankle sprain, fracture, instability | Mortise alignment (tibia-fibula-talus); medial clear space >4mm = deltoid injury; tibio-fibular overlap (syndesmosis) |
| Lateral | True lateral of ankle | Trauma, Achilles, os trigonum | Posterior malleolus fracture, calcaneal fractures, talar fractures, os trigonum |
| Stress Views (Varus/Valgus tilt) | Forced inversion or eversion | Ligamentous instability (chronic sprains) | Talar tilt >5-10° = ATFL laxity; tibiotalar widening = deltoid laxity |
8. FOOT
| View | Technique/Position | Indications | Common Interpretations |
|---|---|---|---|
| AP (Dorsoplantar/DP) | Weight-bearing, beam 10° posterior tilt | Forefoot trauma, flat foot, arthritis | Metatarsal fractures, Lisfranc injury (1st-2nd MT base alignment), hallux valgus angle, joint erosions |
| Lateral (Weight-Bearing) | True lateral | Flatfoot, cavus foot, midfoot OA, plantar fasciitis | Calcaneal pitch angle, talar-first MT angle (Meary's), plantar spur, sinus tarsi |
| Oblique (45° internal rotation) | Foot obliqued 45° | Midfoot trauma, Lisfranc, navicular injuries | Cuboid fractures, Lisfranc ligament gap, navicular fractures |
| Calcaneal Axial (Harris View) | Ankle dorsiflexed, beam 40° from vertical | Calcaneal fractures, coalition | Calcaneal body fracture, subtalar joint, talocalcaneal coalition |
9. SPINE
| Region | View | Indications | Common Interpretations |
|---|---|---|---|
| Cervical | AP + Lateral + Open Mouth (Odontoid) | Trauma, neck pain, myelopathy | Vertebral fracture, C1-C2 alignment (atlantodens interval >3mm = instability), disc space narrowing, osteophytes |
| Cervical | Oblique (AP or PA) | Radiculopathy, foraminal stenosis | Foraminal narrowing due to uncovertebral/facet osteophytes |
| Cervical | Flexion-Extension Laterals | Instability, ligamentous injury | Segmental hypermobility, anterolisthesis (>3.5mm = instability), pseudosubluxation (normal in kids at C2-3) |
| Cervical | Swimmer's View | C6-T1 junction visualization | Fractures or dislocations obscured by shoulders |
| Thoracic | AP + Lateral | Trauma, deformity, OA | Vertebral compression fractures, Cobb angle (scoliosis), kyphosis, Schmorl's nodes |
| Lumbar | AP + Lateral | Back pain, trauma, spondylolisthesis | Disc space narrowing, Meyerding grade of spondylolisthesis, fractures, pedicle erosion (tumor) |
| Lumbar | Oblique (Scotty Dog) | Spondylolysis | Collar on Scotty Dog = pars interarticularis defect (spondylolysis) |
| Lumbar | Ferguson View (AP with 30° cephalad) | Lumbosacral junction, sacroiliac joints | L5-S1 disc space, sacroiliac joint (erosions in ankylosing spondylitis) |
10. SACROILIAC JOINTS & PELVIS
| View | Technique/Position | Indications | Common Interpretations |
|---|---|---|---|
| AP Pelvis | Supine, neutral | Pelvic ring fractures, hip OA, sacral fractures | Iliac wing/pubic rami fractures, SI joint widening (>2.5mm = sacroiliitis), acetabular fractures, pelvic symmetry |
| Outlet View (Tube 35-40° cephalad) | Beam angled superiorly | Sacral fractures, pelvic ring | Sacral fractures, superior/inferior displacement of hemipelvis |
| Inlet View (Tube 40° caudad) | Beam angled inferiorly | Anterior/posterior displacement of hemipelvis | Rotational & AP displacement of hemipelvis, pubic symphysis diastasis |
11. TEMPOROMANDIBULAR JOINT (TMJ)
| View | Indications | Common Interpretations |
|---|---|---|
| AP Axial (Towne's) | TMJ pain, trauma, condylar fractures | Condylar head fractures, intracapsular fractures |
| Axiolateral Oblique (open & closed mouth) | TMJ dysfunction, internal derangement | Condylar translation (open mouth), degenerative changes, condylar hyperplasia |
Key Radiographic Interpretation Principles
| Principle | Details |
|---|---|
| Minimum 2 orthogonal views | Every joint requires at least AP + lateral to avoid missed fractures |
| Weight-bearing vs. non-weight-bearing | Weight-bearing views (knee, ankle, foot, spine) reveal true joint space loss and deformity |
| Stress views | Used when ligamentous instability is suspected clinically but static views are normal |
| Soft tissue signs | Fat pad signs at elbow/knee, capsular distension, and soft tissue swelling are indirect fracture indicators |
| Contralateral comparison | Especially useful in pediatric patients (physeal variants) |
| Joint space measurement | Hip: >2mm; Knee: >3mm; Ankle (medial clear space): ≤4mm are normal thresholds |
Sources: StatPearls - Radiographic Patient Positioning | Radiopaedia - Hand Series | Campbell's Operative Orthopaedics 15th Ed | Rockwood & Green's Fractures in Adults 10th Ed | Miller's Review of Orthopaedics 9th Ed
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