The upper limb radiograph is an extremely common request with trauma. The practising radiographer requires familiarity with normal and abnormal appearances. Recognition of fractures and dislocations is essential and illustrated in this article. This is especially so with the difficult paediatric elbow and suggestions are given for recognising fractures and often subtle dislocations such as the dislocated internal epicondyle. Lines of assessment at the elbow and the value of the elbow fat pad are highlighted.