Anterior Circumflex Humeral Artery Research Articles

Quantitative localization of the entry point of the lateral ascending branch of the anterior circumflex humeral artery: a high definition CT-scan radiological study.

To define the localization of the entry point of the lateral ascending branch of the anterior circumflex humeral artery (LACHA) for better surgical management and prevention of injury to this important vessel. The hypothesis is that the insertion point of the artery will be constant in subjects. A retrospective study of 27 tomographic images was conducted to generate a three-dimensional (3D) model and localize the entry point of the LACHA. Using a coordinate system consisting of three axes: the proximal-distal axis (PDA), the anterior-posterior axis (APA) and the medial-lateral axis (MLA), the position of a foramen located in the superior portion of the bicipital groove and representing the entry point of LACHA was measured on each reconstructed model. On average, the foramen was located 10.0mm distal along the PDA from the most proximal point of the greater tuberosity (GT). Along the MLA and with respect to the most medial portion of the GT, the foramen was located 3.4mm medially, on average. No significant differences between men and women or between sides for foramen position measurements were found. Unnecessary procedures to the proximal biceps, aiming to prevent chronic pain, should be avoided in fracture fixation as they would affect a significant source of blood supply to the humeral head. These findings could help surgeons protect the only vascular supply they can during the fixation of proximal humeral fractures, when using the anterior or antero-lateral approaches.

Blood supply in the bicipital groove: A histological analysis.

The vascular anatomy in the closed bicipital groove with the long head of the biceps brachii muscle tendon (LHBT), its mesotenon and the transverse ligament intact has not been analyzed on a histological level yet. An anatomic dissection and histologic study was conducted by using 24 cadaveric formaldehyde fixated shoulders. The bicipital groove including the LHBT and its intact sheath was cut en-bloc, fixated, sliced in 7 μm sections, Azan stained and the vascular anatomy analyzed under light microscopy. Each sideward branch deriving from the main ascending branches of the anterior humeral circumflex artery (ACHA) in the mesotenon of the LHBT was identified and followed through multiple sections to identify its direction and area of supply. Per specimen, a mean of 2.71±1.85 branches could be identified running through the soft tissue of the mesotenon towards the osseous walls of the groove. Of the total 65 arterial branches in all specimens, 22 (33.8%) were running into the medial wall of the groove and 40 (61.5%) into the lateral wall (P<0.01). The results indicate that branches of the ACHA in the mesotenon of the LHBT provide blood supply not only to the tendon but to the osseous bicipital groove as well and here significantly more to the lateral than to the medial osseous wall. In addition, Pacini-like mechanoreceptors could be identified in the mesotenon in 9 (37.5%) of the specimens which has not been described up to now.

Unilateral variation in branching pattern of Right Axillary Artery - A Case Report

The Axillary artery is the continuation of the subclavian artery and is a major artery of the upper limb. During the routine dissection for Undergraduate Ayurvedic Medical Students of Sharada Ayurvedic Medical College, Yadgir, Karnataka, India, in the Department of Anatomy, we come across a variation in branching pattern of second and third part of right axillary artery in male cadaver approximately 55 years of age. The first part of axillary artery was found to be normal. In the second part of axillary artery we observed two branches, first one is thoracoacromial artery arose as usual second branch given common trunk which is further divided into lateral thoracic artery and subscapular artery. Even third part of axillary artery gave one common trunk that terminated by bifurcating into Anterior Circumflex Humeral Artery and Posterior Circumflex Humeral Artery.

Blood supply and vascularity of the glenoid labrum: Its clinical implications.

Tears of the glenoid labrum are common after dislocation of the glenohumeral joint. The outcome for healing or surgical reconstruction of the glenoid labrum relies on the extent of its vascularization. This study aims to evaluate the glenoid labrum blood supply and to determine its regional vascularity. A total of 140 shoulders (30 male and 40 female cadavers) were examined: mean age 81.5 years, range 53-101 years. All blood vessels around the glenohumeral joint were dissected and recorded. Ten specimens with the glenoid labrum and fibrous capsule attached were randomly selected and detached at the glenoid neck and subjected to decalcification. Sections (10-20 μm) were cut through the whole thickness of each specimen from the centre of the glenoid fossa perpendicular to the glenoid labrum at 12 radii corresponding to a clock face superimposed on the glenoid. Sections were stained using haematoxylin and eosin and then examined. The blood supply to the glenoid labrum is by direct branches from the second part of the axillary artery, subscapular, circumflex scapular and anterior circumflex humeral and posterior circumflex humeral arteries, as well as branches of muscular arteries supplying the surrounding muscles. This study shows that the glenoid labrum has a rich blood supply suggesting that, regardless of the types of the glenoid labrum lesions or their management, an excellent outcome for glenoid labrum healing and joint stability is possible. The observations also suggest that the blood supply to the glenoid labrum is sufficient, enabling its reattachment.

High origin of radial artery from the axillary artery: Case report

The axillary artery is the main artery supplying the shoulder region and is clinically important. In the present case we report an arterial variation of the left upper extremity of a 65 year-old female cadaver. The radial artery arose from the axillary artery 2.5 cm below the anterior humeral circumflex artery and above the teres major muscle. It first coursed along the medial aspect of the arm, then it passed laterally between the biceps brachii and the brachialis muscle. Reaching the upper part of the elbow, it coursed medial to the brachioradialis muscle. It did not give off any branches in either the arm or in the forearm regions. It contributed to the formation of the superficial palmar arch in the palm of the hand. Further, the brachial artery entered the cubital fossa and divided into ulnar and common interosseous arteries. The right upper extremity had a normal arterial branching pattern.Being aware of the variations of the axillary artery may help to prevent diagnostic errors and avoid complications during the surgery of the region.

Blood supply of the subacromial bursa and rotator cuff tendons on the bursal side.

Vascularity of the subacromial bursa and rotator cuff tendons is key factors in the pathogenesis of subacromial bursitis and impingement syndrome, rotator cuff tendinitis, and rotator cuff tears. The purpose of this study was to investigate and describe blood supply to the cranial and caudal parts of the subacromial bursa and the vascularity of the rotator cuff tendons on the bursal side. Fourteen fresh cadaveric shoulders from six females and eight males with a mean age of 71.7 (±10.8) years were studied. Before dissection, an arterial injection of 10% aqueous dispersion of latex was administered. Post-injection, the shoulders were fixed in an alcohol-formalin-glycerol solution. The cranial and caudal bursa of all specimens was mainly supplied by the thoracoacromial, suprascapular, and anterior and posterior circumflex humeral arteries. The cranial part of the bursa was supplied anteriorly by the thoracoacromial artery, and posteriorly and medially by the posterior circumflex humeral artery as far as the medial third. The caudal part received arterial blood anteriorly from the anterior circumflex humeral artery, and posteriorly and medially by the posterior circumflex humeral artery as far as the medial third of the caudal bursa. In addition, the suprascapular artery branched at the upper surface of the coracohumeral ligament, and the subcoracoid artery branched at the under surface of the same ligament. The subacromial bursa appears well vascularized. The results of the present investigation showed that blood supply to the subacromial bursa at the caudal part and rotator cuff tendons on the bursal side was linked to the same arteries. The subcoracoid artery supplied interval rotator structures close to the caudal bursa. It is the wish of the authors that this meticulous anatomical work will help surgeons in their day-to-day clinical work, e.g. to minimize the risk of complications such as perioperative bleeding.

Use of Arm Span as Proxy Indicator of Stature- An Anthropometric Study in Western U.P

Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3 rd part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries and elevates the risk of bleeding.

Clinical and Radiological Evaluation of Healing In Tuberculosis of Spine-A Retrospective and Prospective Study

Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3 rd part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries and elevates the risk of bleeding.

Transdeltoid Approach in Proximal Humerus Fractures: Outcome in 35 Cases and Review of Literature

Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3 rd part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries and elevates the risk of bleeding.

High Origin of Radial Artery- A Cadaveric Case Report

Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3 rd part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries and elevates the risk of bleeding.

Evaluation of Causes of Low Back Pain in Indian Population with Special Reference to Sacroiliitis

Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3 rd part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries and elevates the risk of bleeding.

Morphometric Study on Bicipital Groove among South Indian Population.

The Bicipital Groove (BG) is an indentation between the lesser and greater tubercles of the proximal part of the humerus. It conveys biceps tendon, its synovial sheath and ascending branch of anterior circumflex humeral artery. The knowledge of the morphometry is important for the understanding of the functional aspect of the shoulder region. To study the morphometry of bicipital groove of humerus in south Indian population. In the present study, 100 adult humeri (50 right and 50 left) were examined. The length of the medial wall, lateral wall, width and depth were measured by using vernier calliper. The humeri were examined for the presence of supratubercular ridge. All the parameters were accurately measured and the data were analysed. The mean length of BG on right side was 84.79±5.84 mm and 87.33±6.40mm on the left side. The mean width of BG on right side was 6.84±1.01mm and 7.74±1.96mm on the left side. The mean depth of BG on right side was 4.21±0.58 mm and 5.01±1.05mm on the left side. The mean length of the medial and lateral walls on the right side was 24.22±1.02mm and 32.05±2.21mm respectively and that on the left side was 23.31±2.21mm and 31.12±0.24mm respectively. 17% of humeri on the right side and 14% on the left side showed the presence of supratubercular ridge of Meyer in the present study. Bicipital groove is present in the shoulder region where wide range of movements occurs. Osseous spurs and supratubercular ridge may predispose dislocation of tendon of biceps brachii. Hence morphometric knowledge is obligatory and is significant functionally and clinically for better understanding of this region.

A rare variation in the branching pattern of axillary artery

An unusual variation of the axillary artery was reported in the right side of a 63-year-old female cadaver during routine dissection classes. It was observed that the first part of the axillary artery gave origin to the superior thoracic artery as usual and the second part gave thoracoacromial artery, which showed the normal course and branching pattern. In addition to this branch, the second part also gave a large common trunk from which lateral thoracic artery and subscapular artery arose. The subscapular artery was divided into circumflex scapular and thoracodorsal arteries. The circumflex scapular artery after passing through the upper triangular space of axilla emerged out near the lateral border of scapula on the posterior aspect. The thoracodorsal artery was seen as continuation of the subscapular artery after giving the branch circumflex scapular artery, lies posterior to the lateral thoracic artery. It gave muscular branches to teres major and serratus anterior. The third part of the axillary artery gave anterior and posterior circumflex humeral artery only. The detailed knowledge about anatomy of normal as well as variant axillary artery is very helpful to clinicians in operative and invasive procedures around pectoral and axillary regions, especially in the field of vascular surgeries. This is also useful to radiologists in different Doppler and contrast imaging study of the vessels.

An unusual high bifurcation and variable branching of the axillary artery in a Greek male cadaver.

IntroductionThe axillary artery presents abnormalities in its origin and course and a variable branching.Case descriptionA rare case of axillary artery bifurcation and branching was observed in a 60-years-old European male cadaver of Greek origin. The right axillary artery at the second part was bifurcated into a superficial and a deep brachial artery. The superficial brachial artery anteromedial to the median nerve and lateral to the ulnar nerve gave off the acromio-thoracic artery and two lateral thoracic arteries. The deep brachial artery behind the median nerve, after giving rise to the anterior circumflex humeral artery trifurcated into a branch that coursed distally, the posterior circumflex humeral artery and the subscapular artery. The latter subdivided into the circumflex scapular artery, a muscular branch for the subscapularis and the thoracodorsal artery. The continuation of the deep brachial artery divided laterally into a humeral nutrient artery and medially into a trunk which trifurcated into the profunda brachii artery, a deep muscular branch and a branch to the posterior compartment of the arm. The profunda brachii artery ended as radial and middle collateral arteries.Discussion and evaluationDeviations from the normal arterial pattern are of immense significance for anatomists, plastic, cardiovascular and orthopedic surgeons, vascular radiologists and interventional cardiologists.

The arterial supply of the tendon of the long head of the biceps brachii in the human: A combined anatomical and radiological study

PurposeArthroscopic repair of superior labral anterior to posterior (SLAP) lesions is often associated with a prolonged period of pain during the rehabilitation process. This might possibly be due to hypoxia in the biceps tendon anchor caused by sutures. The purpose of the study was to investigate the arterial supply of the long head of the biceps brachii tendon (LHBT) that may be impaired by surgery in the region of the biceps tendon anchor. MethodsOn 20 human formalin-fixed bodies, the anterior circumflex humeral artery (ACHA) was located and followed into the intertubercular groove until it reached the LHBT. On 10 fresh-frozen anatomic specimens of the upper extremities, contrast medium was injected into the axillary artery, a 3D scan was performed, and multiplanar reconstructed (MPR) slices were generated. A set of maximum intensity projection (MIP) reconstructions from 10 computed tomography angiographies (CTA) of the upper extremities was used to confirm the findings of the 3D scan. ResultsAll anatomical dissections and radiological investigations revealed that the proximal portion of the LHBT was consistently supplied by an ascending branch of the ACHA. No artery was found to supply the biceps tendon anchor from the proximal aspect. ConclusionsAs the arterial supply of the LHBT is mainly provided by the ACHA, which enters the glenohumeral joint from the distal aspect, surgery at the bony origin of the LHBT may not interfere with this specific vessel.

Increased blood flow in the anterior humeral circumflex artery correlates with night pain in patients with rotator cuff tear

Background Night pain is a particularly vexing symptom in patients with rotator cuff tear. It disturbs sleep and decreases quality of life, and there is no consensus regarding its etiology. Based on arthroscopic surgical observations of synovitis around the rotator interval or capsule surface in rotator cuff tear, we hypothesized that blood flow from the artery feeding the capsule increases blood supply to the synovium. This study aimed to investigate the relationship between blood flow and night pain using pulse Doppler ultrasonography.Methods A series of 47 consecutive patients with rotator cuff tear was evaluated. The peak systolic velocity and resistance index of blood flow in the ascending branch of the anterior humeral circumflex artery were evaluated using pulse Doppler ultrasonography. We also investigated 20 normal shoulders in healthy volunteers. The peak systolic velocity and resistance index were compared between affected and unaffected sides in patients and between dominant and nondominant sides in controls.Results Anterior humeral circumflex artery peak systolic velocity and resistance index did not differ between sides in control subjects or in patients with rotator cuff tear without night pain. However, anterior humeral circumflex artery peak systolic velocity and resistance index did differ significantly between sides in patients with rotator cuff tear with night pain.Conclusions This study revealed anterior humeral circumflex artery hemodynamics in patients with rotator cuff tear and normal subjects using Doppler ultrasonography. Night pain, particularly involving aching, appears to be related to the hemodynamics. These findings suggest that investigating the hemodynamics of patients with rotator cuff tear with night pain may lead to greater understanding of the etiology of this symptom.

Anatomical study of simple landmarks for guiding the quick access to humeral circumflex arteries.

BackgroundThe posterior and anterior circumflex humeral artery (PCHA and ACHA) are crucial for the blood supply of humeral head. We aimed to identify simple landmarks for guiding the quick access to PCHA and ACHA, which might help to protect the arteries during the surgical management of proximal humeral fractures.MethodsTwenty fresh cadavers were dissected to measure the distances from the origins of PCHA and ACHA to the landmarks (the acromion, the coracoid, the infraglenoid tubercle, the midclavicular line) using Vernier calipers.ResultsThe mean distances from the origin of PCHA to the infraglenoid tubercle, the coracoid, the acromion and the midclavicular line were 27.7 mm, 50.2 mm, 68.4 mm and 75.8 mm. The mean distances from the origin of ACHA to the above landmarks were 26.9 mm, 49.2 mm, 67.0 mm and 74.9 mm.ConclusionOur study provided a practical method for the intraoperative identification as well as quick access of PCHA and ACHA based on a series of anatomical measurements.

Blood flow changes of the anterior humeral circumflex artery decrease with the scapula in internal rotation.

Poor posture is strongly related to scapular kinematics and shoulder diseases. The purpose of this study was to clarify the blood flow changes of the anterior and posterior humeral circumflex arteries in reference to the scapular position and to clarify anatomical features related to the changes in blood flow. Cadaveric shoulders were dissected to elucidate the anatomical difference between the two arteries. The blood flow of these arteries in healthy volunteers (22-48 years, 113 shoulders) was evaluated by MRI with changing the position of the scapula (internal and external rotation). The anterior humeral circumflex artery was attached to the subscapularis tendon and located beneath the subdeltoid bursa. The posterior humeral circumflex artery was located between the deltoid muscle and the bursa, which allowed free movement during scapular motion. There were no direct extraosseous anastomoses between the two arteries. Compared with the posterior humeral circumflex artery, the anterior humeral circumflex artery decreased blood flow with the scapula in internal rotation. No direct extraosseous anastomoses between the two arteries were observed. Internal rotation of the scapula decreased blood flow of the anterior humeral circumflex artery, which might be related to various pathologies of the shoulder. Diagnostic studies, Level III.

A Rare Anomalous Artery Originating From Axillary Artery

During routine dissections in the Dept. Of anatomy, Sri Venkateswara Medical college, Tirupathi, A.P. we encountered a rare anomaly in an adult male cadaver on the right upper limb. The third part of the axillary artery unilaterally divides into two major arterial stems, named according to their localization as deep brachial artery and superficial brachial artery (brachial artery proper).Deep brachial artery passes at first in between the two roots of median nerve, and later deep to lateral root of median nerve. The deep brachial artery gives off the posterior circumflex humeral artery, anterior circumflex humeral artery, subscapular artery, and profunda brachii artery and lower down in the arm,it terminates by dividing into superior ulnar collateral artery and inferior ulnar collateral artery. This case is a anamoly of the axillary artery that has been rarely documented in the literature(0.12-3.2%). Accurate knowledge of the normal and variant arterial anatomy of the axillary artery is important for surgeons and specialists using radiodiagnostic techniques. The improved knowledge would allow more accurate diagnostic interpretations and surgical treatment.

Anomalous Branching Pattern of the 3rd Part of Axillary Artery

Axillary artery is the principal artery of the upper limb. It is also the axis artery of the upper limb. The present case was found in a male cadaver aged around 70years. During the routine cadaveric dissection of undergraduate students in J.J.M.M.C Davangere we found that 3rd part of axillary artery divided into a larger superficial brachial artery and a narrower deep brachial artery. The superficial brachial artery did not give any branches in the arm and divided into radial and ulnar arteries at the neck of the radius. Whereas the deep brachial artery gave rise to subscapular artery, anterior and posterior circumflex humeral arteries and profunda brachial artery. The knowledge of such type of variation is important for surgeons, orthopedicians and interventional radiologists who operate in this region.