Plain radiography remains the imaging study of choice for most applications in the upper extremity. Far and away, the most common indication for plain radiography in the upper extremity is acute trauma. The shoulder, humerus, elbow, forearm, wrist, and hand are common radiographic series that are useful in diagnosing an acute fracture. Other imaging modalities such as CT, ultrasound, and MRI are not generally indicated in acute trauma, but have an important role in diagnosing soft tissue pathology.

Another common indication for plain radiography of the upper extremity is the search for a foreign body in a wound. Plain films are an excellent modality for the detection of common, dense foreign bodies encountered in wounds, such as glass and rock, but they are much less sensitive in the detection of plastic or organic materials (1). Other imaging modalities such as CT, ultrasound, and MRI are superior for the detection of organic and plastic foreign bodies (2). The principles of using plain films for foreign body detection are similar regardless of the location in the body and are not discussed in further detail here.

In this chapter, the upper extremity is divided into three sections: 1) the shoulder, 2) the elbow and forearm, and 3) the wrist and hand.