THE ARTERIAL VASCULARIZATION OF THE HUMERAL HEAD - AN ANATOMICAL STUDY

In twenty-nine specimens from fresh cadavera, we performed an anatomical study of the arteries of the humeral head to determine their intraosseous distributions. A radiopaque suspension was injected into the anterior circumflex, posterior circumflex, suprascapular, thoracoacromial, or subscapular artery and then the specimens were dissected and were analyzed macroscopically, and radiographs were made in three mutually perpendicular projections. In addition, sixteen of the specimens were cut into four-millimeter slices and were studied microradiographically. The humeral head was shown to have been perfused by the anterolateral ascending branch of the anterior circumflex artery in all specimens. That vessel ran parallel to the lateral aspect of the tendon of the long head of the biceps and entered the humeral head where the proximal end of the intertubercular groove met the greater tuberosity. When the intraosseous (terminal) part of the anterolateral branch, the so-called arcuate artery, had been perfused, almost the entire epiphysis was radiopaque. The posterior circumflex artery vascularized only the posterior portion of the greater tuberosity and a small posteroinferior part of the head. Anastomoses between the different arteries were abundant, but vascularization of all of the humeral head was possible only through the anterolateral branch of the anterior circumflex artery. CLINICAL RELEVANCE: The anterolateral branch of the anterior circumflex artery can be seen and should be protected during an operation. If this branch is injured, only anastomoses that are distal to the lesion can compensate for the resulting loss of blood supply. The closer an anastomosis with the anterolateral branch is to the point of entry of the branch into the humeral head, the more important it is, and the more care should be taken to preserve it. The closer this vessel is injured to its point of entry into the humeral head, the greater the risk to the vascularity of the humeral head.