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  • Radiographs are usually normal in early inflammatory arthritis (JIA). Although plain radiographs may reveal soft tissue swelling around joints or demonstrate bony erosions, radiographs are an insensitive tool for the diagnosis of acute synovitis or erosive joint damage. Ultrasound scanning or Magnetic Resonance Imaging are preferable.
  • Plain radiographs can be used in the initial investigation of children with bone pain or arthritis.
  • The presence of periosteal reaction suggests the possibility of bony infection or malignancy.
  • Radiographs of the knee should include the long bones above and below in the context of persistent knee pain - bone tumours commonly arise in the distal femur or proximal tibia. 
  • An anterior-posterior view of the hand and wrist can be a useful screening tool in the investigation of metabolic bone disease (for example rickets).
  • It is often useful to compare both sides (e.g. hip radiographs) to exclude pathology. Frog views should be requested to detect subtle changes of Slipped Upper [Capital] Femoral Epiphysis.

The Figure below shows an abnormal hip (right) - compare both sides - due to Perthes


The Figure below shows an abnormal hip (right) - compare both sides - due to Slipped Upper [Capital] Femoral Epiphysis 


The radiograph below shows periosteal reaction and soft tissue swelling due to malignant bone tumour in the proximal tibia (arrow). This emphasises the need to include the long bone above and below the knee with knee pain.

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