Anterior Circumflex Humeral Artery Research Articles

Blood flow velocity in the anterior humeral circumflex artery and tear size can predict synovitis severity in patients with rotator cuff tears.

Rotator cuff tears are often associated with synovitis, but the ability of noninvasive ultrasonography to predict the severity of synovitis remains unclear. We investigated whether ultrasound parameters, namely peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, reflect synovitis severity. A total of 54 patients undergoing arthroscopic rotator cuff repair were selected. Doppler ultrasound was used to measure peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, and these values were compared with the intraoperative synovitis score in univariate and multivariate analyses. Univariate analyses revealed that tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the glenohumeral joint were associated with synovitis in the glenohumeral joint (P=0.02, P<0.001, P=0.02, respectively). In the subacromial space, tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the subacromial space were associated with synovitis severity (P=0.02, P<0.001, P=0.02, respectively). Multivariate analyses indicated that tear size and peak systolic velocity in the anterior humeral circumflex artery were independently associated with synovitis scores in both the glenohumeral joint and the subacromial space (all P<0.05). These findings demonstrate that tear size and peak systolic velocity in the anterior humeral circumflex artery, which can both be measured noninvasively, are useful indicators of synovitis severity. Level of evidence: IV.

High bifurcation of the unilateral brachial artery: an unusual variation.

It is common to observe a high bifurcation of the brachial artery, with some variations being quite rare. During routine dissection for medical teaching purposes, a unilateral high bifurcation of the brachial artery was noted on the left side of a female cadaver. On the left arm, two branches of different sizes originate from the axillary artery, one on the radial side and the other on the ulnar side. These branches run down the arm, crossing each other, eventually becoming the forearm's radial and ulnar arteries. We also observed branches such as the posterior circumflex humeral artery, anterior circumflex humeral artery, and deep brachial artery. This case report adds to the existing body of knowledge about the variation of the brachial artery, which is of anatomical and clinical value. We report this case to highlight the unique variation in the arterial anatomy of the upper limb.

Rapidly destructive osteonecrosis of the humeral head after arthroscopic rotator cuff repair: a case report

BackgroundCases of rapidly destructive osteonecrosis (RDON) of the humeral head after arthroscopic rotator cuff repair (RCR) have rarely been reported, which has prevented a clear consensus on the cause of osteonecrosis.Case presentationA 63-year-old woman without a history of trauma underwent arthroscopic RCR after being diagnosed with a medium-sized full-thickness rotator cuff tear for symptoms of left shoulder pain for six months. The patient had no medical history other than hypertension, and no other potential cause was found for osteonecrosis of the left shoulder prior to surgery. Four months after surgery, pain and range of motion improved. Six months after surgery, the patient complained of an increase in shoulder pain. While follow-up ultrasonography did not show a re-tear of the repaired tendon, osteonecrosis of the humeral head could not be confirmed as plain radiography was not performed. Follow up MRI performed a year after surgery revealed RDON of the humeral head. Despite mild improvement in the shoulder pain, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA) and Constant score were poor at 23 and 69, respectively. In the present case, the arthroscopic RCR was performed using two anchors; for the repair of the anterior of the supraspinatus and the rotator interval, a 2.8-mm all-suture anchor was inserted into the upper part of the intertubercular groove. The cause of RDON is presumed to be the damage to the anterolateral and intraosseous branches of the anterior humeral circumflex artery (AHCA) for anchor positioning and insertion.ConclusionsA poor outcome was obtained in the case of RDON, despite the integrity of the repaired rotator cuff tendon after arthroscopic RCR was intact. Although the cause of RDON has not been clearly established, care should be taken not to damage the anterolateral and intraosseous branches of the AHCA regarding the insertion location of the suture anchor, and to prepare the anchor in the vicinity of the intertubercular groove.

Blood flow in the anterior humeral circumflex artery reflects synovial inflammation of the shoulder joint in rotator cuff tears.

BackgroundAn association has been reported between rotator cuff tear and inflammation. We hypothesized that blood flow in the anterior humeral circumflex artery would reflect synovial inflammation in the shoulder. This study aimed to clarify the association of blood flow in the anterior humeral circumflex artery with synovial inflammation and shoulder pain in patients with rotator cuff tears.MethodsIn this prospective, cross-sectional study, tissue samples from the synovium in the rotator interval were obtained from 33 patients undergoing arthroscopic rotator cuff repair. Reverse transcription-polymerase chain reaction and real-time polymerase chain reaction were performed to determine the messenger RNA expression of inflammatory mediators, growth factors, and matrix metalloproteinases. Additional tissue samples were fixed for histologic evaluation. Before surgery, we measured the peak systolic velocity in the anterior humeral circumflex artery using pulse Doppler ultrasonography.ResultsThe peak systolic velocity in the anterior humeral circumflex artery was positively correlated with the messenger RNA expression of interleukin 1β, interleukin 8, and matrix metalloproteinase 3 genes (r = 0.49, P = .004; r = 0.55, P = .001; and r = 0.39, P = .026, respectively), as well as histologic synovitis scores (r = 0.48, P = .005). Additionally, it was significantly higher in patients with resting pain than in those without resting pain (P = .048).ConclusionThe peak systolic velocity in the anterior humeral circumflex artery is associated with the severity of synovial inflammation. Our results suggest that assessing the peak systolic velocity in the anterior humeral circumflex artery is useful for evaluating the severity of synovial inflammation.

Anatomical study for the treatment of proximal humeral fracture through the medial approach

BackgroundThe treatment of complex 3- and 4-part proximal humeral fractures has been controversial due to numerous postoperative complications. With the further study of medial support and blood supply of humeral head, new techniques and conception are developing. The study aims to illustrate the medial approach of the proximal humeral fracture through cadaver autopsy.MethodUpper limbs from 19 cadavers have been dissected to expose the shoulder joint. We selected the coracoid process as the bony reference. Vernier caliper will be used to measure the following data, including distance from coracoid process to circumflex brachial artery, distance between anterior humeral circumflex artery (ACHA) and posterior circumflex brachial artery (PCHA) and their diameters. Assessment included the characteristics of the vascular supply around the humeral head, identification of the structures at risk, quality of exposure of the bony structures, and feasibility of fixation.ResultsThe medial approach is appropriate in 86.84% anatomical patterns. Between the lower part of the shoulder capsule and the insertion of conjoined tendon, the bony surface exposed was limited by the interval between ACHA and PCHA. An interval of 2 to 3 cm (24.29 ± 3.42 mm) was available for medial plate. ACHA (49.35 ± 8.13 mm, 35.14–68.53 mm) and PCHA (49.62 ± 7.82 mm, 37.67–66.76 mm) were about 5 cm away from the coracoid process. Risk structures including ACHA and PCHA originate in common, PCHA originated from the deep brachial artery (DBA), the presence of perforator vessels, musculocutaneous nerve intersects with ACHA, the diameter of PCHA: ACHA < 1.5. In 13.15% anatomical patterns, this risk structure should be taken seriously.ConclusionThe medial approach opens a new perspective in the optimal management of complex fractures of proximal humerus. Anatomical research proves that the medial approach is feasible. The interval between ACHA and PCHA is suitable for placement. Anatomical pattern and indication have been discussed, and we hypothesized that ACHA has been destroyed in complex PHFs. With further studies on the anatomy and mechanism of injury, the development of more clinical cases will be an important work of our institution in the future.

Variable Origin of Axillary Artery Branches in Indian Male Cadaver- A Case Report

In clinical and surgical procedures, the variable origins of the axillary artery branches are significant for identifying uncommon symptoms and signs. The present case report documents an unusual origin of the axillary artery branches during dissection of a male cadaver in the anatomy department of an undergraduate and postgraduate teaching medical college in India. Normally, the superior thoracic artery arises from the first part of the axillary artery. In the present case, the second part of the axillary artery gave rise to a common trunk, from which the thoracoacromial, lateral thoracic, and subscapular arteries originated. Further, the thoracodorsal, circumflex humeral, and posterior circumflex humeral arteries originate from the subscapular artery whereas the anterior circumflex humeral artery only originates from the third part of the axillary artery. During surgical procedures performed in the region of the axilla, anatomists, radiologists, and cardiologists need to be aware of variations in the origin of axillary artery branches. During surgical procedures performed in the region of the axilla, anatomists, radiologists, and cardiologists need to be aware of variations in the origin of axillary artery branches.

Unilateral Double Subscapular Artery: A Case Report

Variations in the Subscapular Artery (SA) are among the most common variations in the Axillary Artery (AA) and its branches. However, the occurrence of a common trunk from the third division is unusual. Hereby, authors report an atypical variation in the distal division of the axillary artery found during routine dissection of an elderly female cadaver. In this donor, the third portion of the AA gave rise to an SA, a common trunk, and the anterior circumflex humeral artery. In addition, the common trunk gave rise to a second SA, the posterior circumflex humeral artery, the scapular circumflex artery, and the thoracodorsal artery. Both SA branches appeared to irrigate the subscapularis muscles. Comprehension of the diverse anatomical variations of the subscapular artery is critically important in surgical procedures and therapeutic interventions for the upper limb.

Unusual Multiple Arterial Variations of the Upper Limb

During routine dissection of a 64-year-old male cadaver, multiple variations were observed in the arteries of the upper extremities. The first part of the axillary artery did not give any branches. The second part, after giving superior thoracic and thoracoacromial arteries divided into deep and superficial brachial arteries. Superficial brachial artery gave lateral thoracic artery and continued into the arm. After giving anterior circumflex humeral artery, the deep brachial artery trifurcated into the subscapular artery, posterior circumflex humeral artery, and profunda brachii artery. Understanding upper limb arterial variations are important for performing safer clinical procedures.

Variations of the branches arising from the third part of the axillary artery: a cadaveric study

Objectives: This study aims to describe variations of the third part of the axillary artery branches with respect to their diameter, origin, subsequent branches, and gender. Methods: One-hundred and forty cadaveric shoulders were examined bilaterally in the Centre for Anatomy and Human Identification, University of Dundee, which is regulated by Human Tissue Act (Scotland) 2006. Branches arising from the third part of the axillary artery were dissected and the diameter, origin, subsequent branching patterns of each branch were documented, as well as gender. T-tests and chi-square tests were used to determine the association between the variables. Results: The most common variations were associated with the posterior circumflex humeral artery (48.3%), followed by the anterior circumflex humeral (25%) and subscapular arteries (16.7%). Variations of the anterior circumflex humeral artery were more common in females than males (p&lt;0.05). A significant association between the origin of posterior circumflex humeral artery and its subsequent branching pattern was observed. In females, the anterior circumflex humeral artery was more likely to give rise to the profunda brachii when it originated from the posterior circumflex humeral artery. Conclusion: Branches of the third part of the axillary artery vary in diameter, origin and subsequent branching patterns and the gender. An understanding of these variations is essential for accurate radiological diagnostic interpretation and therapeutic intervention. The difference in the variations observed and those reported in the literature suggest the need for further large scale studies.

The humeral head: A review of the blood supply and possible link to osteonecrosis following rotator cuff repair.

Trauma, corticosteroid therapy and metabolic diseases are well established aetiologies of humeral head osteonecrosis; however, there is increasing evidence that arthroscopic rotator cuff surgery may be another possible cause. One of the reasons is that there may be inadvertent damage to the arterial blood supply to the humeral head during surgical intervention. The blood supply to the humeral head displays large amounts of variation with regard to origin, course and distribution. Therefore, to shed light on the pathogenesis, the blood supply of the humeral head is reviewed together with a summary of all reported cases of osteonecrosis of the humeral head that occurred following rotator cuff repair. Inconsistencies with regard to terminologies used and contradictions concerning arterial contributions from the anterior circumflex humeral artery and the posterior circumflex humeral artery towards humeral head supply are addressed. Moreover, variations in the course of the anterior circumflex humeral artery and its branches are summarized. The vascular anatomy of the humeral head is clinically relevant due to the close relationship of these blood vessels with the surgical repair sites for rotator cuff surgery and biceps tenotomies or tenodesis procedures. Potential sites of disruption of blood supply following arthroscopic rotator cuff surgery are discussed. Detailed knowledge of the course of the arteries supplying the humeral head may help to minimize the risk of vascular injury and subsequent osteonecrosis. Given the great interindividual variations of vascular anatomy, imaging procedures preceding arthroscopic rotator cuff surgery may be advisable.

BILATERAL VARIATION IN THE BRANCHING PATTERN OF THE AXILLARY ARTERY - A CASE REPORT

During routine dissection of a male cadaver for I year MBBS students in the department of Anatomy bilateral variations in the branching pattern of Axillary artery were observed. In the present study it was observed that, on the left side, the subscapular artery which usually arises from the third part of Axillary artery was found to be originating from the second part along with the lateral thoracic artery and thoraco-acromial artery whereas anterior circumflex humeral artery and posterior circumflex humeral artery originated from the third part as usual. On the right side, the circumflex scapular artery and the Thoracodorsal artery were arising as a common trunk from the third part which is not the usual pattern. Knowing such variations is of utmost significance in performing various clinical procedures by Vascular surgeons, Radiologists, Clinical anatomists and in interventional and diagnostic procedures in cardiovascular diseases.

A unique lpsilateral axillary artery variation

In an 87-year-old male cadaver received through the Gift Body Program at Saint Louis University School of Medicine, a common arterial trunk arose from the third part of the left axillary artery (AA) that divided into the subscapular artery (SA) and a common stem for the deep brachial artery (DBA), the anterior humeral circumflex artery (AHCA), and the posterior humeral circumflex artery (PHCA). Both the SA and AHCA appeared normal. The PHCA traveled through the quadrangular space and gave off the radial collateral artery (RCA) in the posterior arm which anastomosed with the radial recurrent artery. The DBA traveled through the triangular interval and continued as the middle collateral artery (MCA) in the posterior arm to anastomose with the interosseous recurrent artery. Lastly, the medial and lateral cord contributions to the median nerve formed posteriorly to the AA. Knowing anatomical variation of the AA has clinical and embryological significance.

Variations of the circumflex humeral arteries: a cadaveric study

Objectives: Surgery is the main treatment option of both anatomical and surgical neck humeral fractures, which could result in damage to the circumflex humeral vessels. Current research studies have found that vascular supply to the shoulder is variable. However, the incidence of these variations and how they can affect the blood supply to the shoulder region is still under investigation. The aim of this study is to identify possible variation patterns of the circumflex humeral vessels. Methods: A total of 10 shoulders (3 males, 2 females; average age of 68.8 years) were dissected in Anatomy, University of Edinburgh, under the regulation of the Human Tissue (Scotland) Act 2006. Each shoulder was dissected, and tissues were removed to identify the axillary artery and its branches. Results: The anterior and posterior circumflex humeral arteries were observed to arise as single branches from the 3rd part of the axillary artery in 70% (n=7) and 80% (n=8), respectively. In one cadaver, the posterior circumflex humeral artery (PCHA) arose from the subscapular artery in one side (10%, n=1) and from the profunda brachii artery on the contralateral side (10%, n=1). In the remaining 10% (n=1), the anterior circumflex humeral artery (ACHA) was found as a branch from the PCHA, with the latter being a direct branch from the 3rd part of the axillary artery. Conclusion: Knowledge and awareness of these variations is essential to not only suspect, diagnose and treat possible complications of common fractures and dislocations in the region, but also to prevent iatrogenic injury.

Operative Control of Avulsion of the Anterior Humeral Circumflex Artery After Hyperabduction Injury to the Shoulder.

Operative Control of Avulsion of the Anterior Humeral Circumflex Artery After Hyperabduction Injury to the Shoulder.

Morphometric Analysis of Bicipital Groove in Haryanvi Population

Introduction:Bicipital groove (BG) in the proximal part of humerus is an indentation formed between the lesser and greater tubercle forms the lateral edge of lesser tubercle forms the medial border of bicipital groove. It contains the long head of the biceps brachii muscle, its synovial sheath and an ascending branch of the anterior circumflex humeral artery. The depth and width are very important in retention of tendon of biceps. Several authors reported greater incidence of sublaxation and dislocation of tendon of biceps when the BG is shallow. Morphometry of bicipital groove may influence the functions of surrounding structure leading to various pathological condition. BG is important landmark for replacement of prosthesis of shoulder. Thus knowledge of BG is highly useful in prosthetic sizing, positioning and designing. Aim and objectives – To study the morphometry of bicipital groove (BG).Subjects and Methods:Present study was done on 50 humeri in PGIMS Rohtak in which 25 were of right side and 25 left side. The length, width, depth of BG and the length of the medial and lateral wall of intertubercular sulcus were measured using digital Vernier caliper. Data was recorded separately for right and left humeri then it was analyzed statistically using independent t test, p value &lt;0.05 were considered significant. The data was presented as mean ±SD.Results:In present study above stated parameters were measured which came out to be statistically insignificant except the width of BG, which showed the statistical difference. The p value for the width of BG was &lt; 0.05. Conclusion:Knowledge of BG is highly useful in prosthetic sizing, positioning and designing. The present study is an attempt to determine the morphometric parameters of BG in terms of length of medial wall, lateral wall, length of BG, width and depth of BG. The data on morphometry of BG will be of utmost use for radiologists, orthopedic surgeons and physiotherapists.

Quantitative Localization of the Entry Point of the Lateral Ascending Branch of the Anterior Circumflex Humeral Artery: A High Definition CT Scan Radiological Study

Purpose 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.

"Hourglass" Biceps Tendon: An Ultrasound "Mime" of Frozen Shoulder?

Supplemental Figure 1. Panoramic, long-axis view of the hourglass biceps tendon (white arrowheads) with associated effusion (yellow asterisks) inside the synovial sheath. Red arrowhead indicates anterior humeral circumflex artery. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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.