Musculoskeletal x-ray: ABCDE (summary)

Last revised by Francis Deng on 31 Aug 2021

Citation, DOI, disclosures and article data

Citation:

Lustosa L, Deng F, Bell D, Musculoskeletal x-ray: ABCDE (summary). Reference article, Radiopaedia.org (Accessed on 25 Apr 2024) https://doi.org/10.53347/rID-88679

DOI:

https://doi.org/10.53347/rID-88679

Permalink:

https://radiopaedia.org/articles/88679?iframe=true

rID:

88679

Article created:

18 Apr 2021, Leonardo Lustosa ◉

Disclosures:

At the time the article was created Leonardo Lustosa had no recorded disclosures.

View Leonardo Lustosa's current disclosures

Last revised:

31 Aug 2021, Francis Deng ◉

Disclosures:

At the time the article was last revised Francis Deng had no recorded disclosures.

View Francis Deng's current disclosures

Revisions:

3 times, by 3 contributors - see full revision history and disclosures

Systems:

Musculoskeletal

Tags:

medical students, musculoskeletal, abcde, summary, bone

Synonyms:

Musculoskeletal ABCDE
Bone ABCDE

This is a basic article for medical students and other non-radiologists

Musculoskeletal x-ray review is a key competency for medical students, junior doctors, and other allied health professionals. Using A, B, C, D, E is a helpful and systematic method for musculoskeletal x-ray review:

A: anatomy and alignment
B: bone
C: cartilage
D: deformity and density
E: everything else

Reference article

This is a summary article; we do not have a more in-depth reference article.

Summary

Anatomy and alignment

It is fundamental to be familiar with the normal anatomy expected for each radiographic projection. Being used to what is normal allows one to identify what is not and most likely a finding. It is also important to be accustomed to some anatomic variants such as accessory bones.

Alignment should be assessed to search for dislocations or subluxations, as in all further steps, being used to the normal anatomy makes it possible to recognize a dislocated bone.

Bone

Bone assessment is the main step of most musculoskeletal radiographs. Check for any signs of fractures, this can usually be done by following along the bone's cortex and recognizing any interruptions:

follow along the cortex and identify or exclude any interruptions, the cortical should be continuous
check for any lines along the bone, subtle fractures may not interrupt the cortical margin

Cartilage

Cartilage itself is not seen on radiographs, but it is a reminder to evaluate the joints. If the patient is not skeletally mature, in this step we check the growth cartilages as well:

look at the articular spaces, recognize any possible findings, e.g. loss of joint space, erosions
if the patient is skeletally immature, be careful not to mistake a physis for a fracture
if the patient is skeletally immature, verify if the expected ossifications are properly developed for the patient's age. Under- or overdeveloped ossification centers should be noted.

Deformity and density

Evaluate if the proper shape of the bone is preserved if there are no deformities. Deformities can present in many ways, such as displaced fractures, bone tumors, bowing, etc.

Also, look at the bone density, x-ray penetration can vary between radiographs, one way to make up for this is to compare the bone with itself or other bones visualized. Density changes can present in numerous ways, being focal or generalized, lytic or sclerotic.

Everything else

In the final step, review everything else, mostly soft tissues not evaluated on previous steps. Some of the findings that can be present on a musculoskeletal radiograph are: