Small joints of the hands and feet are frequent sites of musculoskeletal pathology and a common source of patient symptoms driving clinical evaluation. These joints are susceptible to a wide spectrum of conditions, including traumatic injuries, degenerative disorders, inflammatory arthritides, soft tissue, and osseous lesions. The often-subtle imaging findings in these small, complex articulations require a nuanced understanding of anatomy, pathology, and appropriate imaging techniques. This chapter provides a focused overview of diagnostic imaging in the evaluation of small joint pathology, with an emphasis on the use of high-resolution and multiplanar modalities such as MRI, CT, and ultrasound. Detailed attention is given to anatomy, injury patterns, and disease processes.