Building Better MSK Radiograph Reports: A Comprehensive Phrase Reference Guide

Consistency and clarity in musculoskeletal radiograph reporting are essential for effective clinical communication. While each patient's imaging findings are unique, having a robust vocabulary of standardized phrases helps radiologists create reports that are both accurate and efficiently interpreted by referring clinicians. This article presents a comprehensive collection of MSK reporting building blocks that can elevate the quality and consistency of your dictations.

The Foundation: Why Standardized Phrases Matter

Before diving into specific phrases, it's worth understanding why having a repertoire of standardized language matters. First, it ensures consistency across different radiologists within a practice. Second, it helps referring physicians quickly understand findings without deciphering individual reporting styles. Finally, it promotes efficiency in dictation without sacrificing accuracy or completeness.

Joint and Degenerative Changes: The Workhorses of MSK Reporting

Joint Space Assessment

The foundation of arthritis evaluation begins with joint space description:

• "Joint spaces are maintained"
• "Joint spaces are preserved"
• "Marked joint space narrowing"
• "Bone-on-bone articulation"
• "Slight medial compartment joint space narrowing"
• "No significant joint space narrowing"

Describing Arthritis

Arthritis descriptions should be both specific and scalable:

• "Mild/moderate/severe tricompartmental degenerative arthritis"
• "Findings are most advanced within the [location] compartment"
• "Moderate to severe degenerative arthritis of the SI joints"
• "Findings are similar when compared to prior radiographs"
• "Advanced degenerative arthritis with subchondral cystic change"
• "Minimal hypertrophic degenerative change"

Osteophytes and Bone Formation

• "Prominent marginal osteophyte formation"
• "Hypertrophic degenerative endplate spurring"
• "Enthesophyte formation at [insertion site]"
• "Scattered osteocartilaginous bodies"

Trauma Assessment: Precision in Acute Findings

Fracture Terminology

• "No acute osseous abnormalities"
• "No fractures or listhesis"
• "Nondisplaced fracture of [location]"
• "Interval healing with callus formation"
• "Fracture line remains radiolucent"
• "Further obscuration of fracture lines suggesting interval healing"

Alignment Descriptions

• "Unchanged in alignment"
• "No evidence of instability with flexion/extension"
• "Trace retrolisthesis of L4 on L5"
• "Neutral alignment of both knees"
• "[Degrees] of varus/valgus deviation of mechanical axis"

Postoperative Evaluation: Hardware and Healing

Arthroplasty Assessment

• "No radiographic evidence for loosening"
• "Hardware is intact and unchanged in alignment"
• "Bilateral TKAs/THAs"
• "Well-fixed components"
• "Heterotopic ossification about [location]"

Fusion Status

• "Solid bony arthrodesis"
• "Posterior decompression and instrumented fusion"
• "Anterior interbody spacer at [level]"
• "No hardware failure"

Soft Tissue Findings: Beyond the Bones

Effusions and Swelling

• "Trace/small/moderate/large [joint] effusion"
• "No significant joint effusion"
• "Soft tissue swelling overlying [location]"

Tendon and Ligament Pathology

• "Changes of chronic rotator cuff pathology"
• "Calcific tendinitis of [location]"
• "Chronic enthesopathic changes"
• "Soft tissue thickening suggesting tendinosis"
• "Findings compatible with chronic insertional tendinosis"

Spine-Specific Language

Disc Disease

• "Mild/moderate/severe multilevel disc degeneration"
• "Disc degeneration greatest at [levels]"
• "Disc spaces are maintained"
• "Marked disc space narrowing at [level]"

Spinal Alignment

• "No fractures or listhesis in the neutral position"
• "Straightening of usual cervical/lumbar lordosis"
• "Convex left/right thoracolumbar curve"
• "No instability with flexion/extension views"

Temporal Comparisons: Tracking Change

• "Similar to prior examination"
• "Increased in severity since [date]"
• "Findings are unchanged"
• "New since prior study"
• "Interval development of [finding]"
• "Overall stable appearance"

Special Considerations

Bone Quality

Following Society of Skeletal Radiology recommendations:

• "Demineralization" (preferred over osteopenia in most cases)
• "Marked demineralization"
• "Diffuse demineralization"
• "Disuse osteopenia" (acceptable exception when describing postoperative or post-immobilization changes)

Inflammatory Arthritis

• "No marginal erosions"
• "No asymmetric soft tissue swelling to suggest inflammatory process"
• "Findings suggest underlying inflammatory arthritis"
• "Periarticular demineralization"

Avascular Necrosis

• "Findings concerning for developing osteonecrosis"
• "Subchondral lucency concerning for insufficiency fracture"
• "Sclerosis and collapse of [location] compatible with AVN"

Incidental Findings: Maintaining Perspective

• "Arterial calcifications" (preferred over atherosclerotic, as not all arterial calcifications are atherosclerotic in nature)
• "Phleboliths in the pelvis"
• "Remote findings compatible with [prior condition]"
• "Cholecystectomy clips noted"
• "IUD in place"

When Further Imaging Is Needed

• "Could be better evaluated with dedicated MRI"
• "Consider further evaluation with [modality] if clinically indicated"
• "Full length views obtained for orthopedic measurement purposes"
• "Correlation with prior radiographs suggested if available"

The Negative Report

• "Negative [body part] radiographs"
• "No acute findings"
• "[Body part] is otherwise negative"
• "Unremarkable examination"

Essential Modifiers: The Nuance Makers

Severity Scale

• Minimal/trace
• Mild
• Mild-to-moderate
• Moderate
• Moderate-to-severe
• Severe
• Marked
• Advanced
• End-stage

Temporal Descriptors

• Acute
• Subacute
• Chronic
• Age-indeterminate
• Remote
• Developing
• Progressive

Practical Application

These phrases are meant to be combined and modified as needed. For example, a knee report might read: "Moderate to severe tricompartmental degenerative arthritis, most advanced within the medial compartment where there is marked joint space narrowing. Small joint effusion. Findings are increased in severity since prior examination."

Conclusion

This collection of MSK reporting phrases represents the building blocks of clear, consistent radiograph interpretation. By incorporating these standardized terms into your reporting vocabulary, you can create reports that are both comprehensive and easily understood by referring clinicians. Remember, the goal is not rigid adherence to scripts but rather having a robust toolkit of professional language that can be adapted to accurately describe each patient's unique findings.

The art of radiology reporting lies in selecting and combining these phrases to paint an accurate picture of the imaging findings while maintaining efficiency and clarity. With practice, these building blocks become second nature, allowing you to focus on the interpretation itself rather than searching for the right words to convey your findings.