Exam category: Procedures → Extremity
Why it matters: The shoulder girdle is where the named views live. Five named views (Grashey, both Lawrence projections, Neer, and the scapular Y) each exist to solve one specific clinical problem, and several of them are actively contraindicated in the trauma patient because they require the injured arm to be rotated or abducted. The registry tests why a view is chosen far more often than it tests the name — and the trauma-safe-vs-not distinction is what most of those questions turn on.
Hand and wrist and Forearm and elbow walked the limb from the fingers to the elbow. This module finishes the walk: humerus → shoulder → clavicle and AC joints → scapula. The pattern changes here. Distally, routine projections do most of the work and the special views are rare. Proximally, the bones sit behind the ribs and on top of each other, so almost every view is a deliberate manoeuvre to get one structure out from behind another — and when the patient is injured, the manoeuvre you'd normally use is often the one you must not perform.
The humerus is the longest and largest bone of the entire upper limb, longer than the forearm bones or any bone of the hand and wrist.
Routine shoulder: AP internal/external rotation (non-trauma) or AP neutral (trauma, no rotation attempted). Rotating the arm swings the two tubercles of the proximal humerus around, and each rotation profiles a different one:
| Rotation | How it's done | Epicondyles | What ends up in profile |
|---|---|---|---|
| External | Arm abducted slightly, hand supinated | Parallel to the IR | Greater tubercle, in full profile on the lateral aspect of the humeral head; the lesser tubercle is superimposed over the head. This is the true AP of the proximal humerus |
| Internal | Arm abducted slightly, hand pronated | Perpendicular to the IR | Lesser tubercle, in full profile on the medial aspect of the head; only an outline of the greater tubercle shows over the head. This is the lateral of the proximal humerus |
| Neutral (trauma) | Arm left at the side "as is" — no rotation attempted | Roughly 45° to the IR | Neither. Both tubercles are usually superimposed by the humeral head, giving an intermediate, oblique-looking appearance |
The AP humerus uses the same external-rotation logic: abduct the arm slightly and gently supinate the hand so the epicondyles are parallel and equidistant from the IR, with the CR to the midpoint of the humerus. It is the same supinated, epicondyles-parallel setup used for the AP forearm.
Why neutral is the trauma answer. If a fracture or dislocation is suspected, do not attempt to rotate the arm at all. AP neutral is the projection used in that situation, because it needs no arm rotation.
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For a non-trauma AP shoulder, the hand is supinated so the epicondyles are parallel to the IR. What ends up in profile?
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