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The hands act as a mirror in many systemic diseases. Identification of a variety of inflammatory, degenerative, congenital, and hematological diseases can be performed by a single hand radiograph which may help start early intervention and prevent morbidity. Endocrinological and metabolic disorders also may demonstrate signs on a hand radiograph. Granulomatous conditions and systemic connective tissue disorders demonstrate characteristic imaging features which may aid the diagnosis. Radiologists should be familiar with the radiographic imaging findings of common systemic disorders because these may be a problem solving tool to aid in diagnosis.