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Introduction to imaging: Bone and joint

BMJ 2004; 328 doi: https://doi.org/10.1136/sbmj.0403101 (Published 01 March 2004) Cite this as: BMJ 2004;328:0403101
  1. John Frank, consultant in nuclear medicine and radiology1
  1. 1Charing Cross Hospital, London W6 8RF

In the sixth part of our series, John Frank discusses bone and joint imaging

The best way to consider bone and joint imaging is to think of bone disease as “congenital” or “acquired.” The suitability of the various imaging techniques depends on the type of disease.

Congenital disease

Congenital bone disease can affect a limb, a single bone, or several bones and includes conditions such as the mucopolysaccharidoses, achondroplasia, and other dwarfisms. The abnormalities may be of little consequence or part of a wider syndrome. The best way to image these conditions is using conventional x rays because the anatomy of the skeleton is affected and changes will indicate a diagnosis. However, you may occasionally need to use computed tomography or magnetic resonance imaging; nuclear medicine imaging and ultrasound have no part to play in congenital bone disease.

Figures 1 to 4 show examples of congenital malformations. Consult specialised radiology and paediatric textbooks to see the huge number of congenital abnormalities with bone manifestations.12

Fig 1

(Above) X ray of a child's hands showing small accessory digits attached to the little fingers; of cosmetic importance only

Fig 2

(Above) X ray showing a vertebral developmental defect. Partial fusion leading to a “butterfly” vertebra, which can lead to chronic back pain. Scoliosis centred on the abnormal vertebra which has two pedicles on the right side and one on the left

Fig 3

(Above) X ray of a congenital abnormality known as osteogenesis imperfecta, in which there is abnormal fragility of the bones leading to multiple fractures, often in utero. The tibia has been pinned because of multiple fractures.

Fig 4

(Right) Chest x ray showing small clavicles

In children, care must be taken to differentiate this condition from the multiple fractures seen in non- deliberate injury and abuse. This is such a complex problem that further advice must always …

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