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Imaging techniques for evaluation of the painful joint

Barbara N Weissman, MD
Steven J Baccei, MD
Chun K Kim, MD
Section Editor
Robert H Shmerling, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


Joint pain may be due to a broad array of conditions. Imaging studies of the joint, in combination with clinical and laboratory evaluation, are often helpful in establishing a specific diagnosis. The choice of imaging procedure is based upon the clinical situation, the differential diagnostic considerations, and the availability of specific imaging modalities. Guidelines for the use of musculoskeletal imaging for specific clinical situations are included among the American College of Radiology appropriateness criteria [1].

Sufficient history should be provided to assist the radiologist in study interpretation. Thus, the quality and location of pain, as well as any history of trauma, pertinent medical history, and laboratory data, are invaluable information when interpreting an imaging study [2].

An overview of the use of the diagnostic imaging modalities and techniques to evaluate joint pain is presented here. Detailed discussions of these techniques in specific diseases are presented separately (see appropriate topic reviews), as is the use of musculoskeletal ultrasound. (See "Musculoskeletal ultrasonography: Nomenclature, technical considerations, validation, and standardization" and "Musculoskeletal ultrasonography: Clinical applications" and "Musculoskeletal ultrasonography: Guided injection and aspiration of joints and related structures".)


Radiography remains the initial imaging choice in many, if not most, bone and joint disorders. Radiography utilizes a radiograph tube with a two-dimensional image detector, a sheet of film, or digital detector. In most radiology departments, radiographic images are digital and thus are interpreted on a computer display.

Radiographs have the greatest resolution of all available imaging modalities. Densities that can be distinguished on radiographs are calcium, soft tissue, fat, and air. Radiography is especially useful for detecting and/or evaluating:


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