Gerber 1990
Anterior Circumflex Humeral A
- Supplies main blood supply of humeral head
- Arises from 3rd part of axillary artery
- Passes deep to coracobrachialis & both heads of biceps
- Gives rise to arcuate artery then passes around surgical NOH to anastomose with PCHA
- Arcuate a is the anterolateral branch of the ACHA & passes
- Under long head of biceps tendon
- Along lateral aspect of the tendon
- Enters the head at lateral & superior aspects of intertubercular groove
- Supplies almost entire epiphysis
- 1:9 patients the Arcuate a arises from the PCHA
Posterior Circumflex Humeral Artery
- Supplies posterior portion of the greater tuberosity & small portion of the posteroinferior articular segment
- Arises from 3rd part of axillary artery
- Passes through the quadrilateral space (between subscapularis, teres major, long head triceps, & humerus) with axillary nerve above it
- Anastomoses with profunda brachii & sends branches to shoulder joint
- Some anastomosis within head of the ACHA & PCHA with the recurrent branches of nutrient a of shaft
Doubtful if the rotator cuff vessels vascularise the underlying bone
Good anastomotic network with the
- PCHA
- Circumflex scapular
- Thoracoacromial
- Suprascapular artery
Thus ligation of the ACHA medial to intertubercular groove will not devascularise the head