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

  • Yoshihiro Hagiwara
  • Kenji Kanazawa
  • Akira Ando
  • Akimoto Nimura
  • Takashi Watanabe
  • Kazuhiro Majima
  • Keiichi Akita
  • Eiji Itoi



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.

Level of evidence

Diagnostic studies, Level III.


Humeral circumflex artery Shoulder MRI Blood flow Scapular position Posture 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Andary JL, Petersen SA (2002) The vascular anatomy of the glenohumeral capsule and ligaments: an anatomic study. J Bone Joint Surg Am 84:2258–2265PubMedGoogle Scholar
  2. 2.
    Ando A, Sugaya H, Hagiwara Y, Takahashi N, Watanabe T, Kanazawa K, Itoi E (2013) Identification of prognostic factors for the nonoperative treatment of stiff shoulder. Int Orthop 37:859–864CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Arndt J, Clavert P, Mielcarek P, Bouchaib J, Meyer N, Kempf JF et al (2012) Immediate passive motion versus immobilization after endoscopic supraspinatus tendon repair: a prospective randomized study. Orthop Traumatol Surg Res 98(6 Suppl):S131–S138CrossRefPubMedGoogle Scholar
  4. 4.
    Borstad JD, Ludewig PM (2005) The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther 35:227–238CrossRefPubMedGoogle Scholar
  5. 5.
    Codman EA (1934) The shoulder. Thomas Todd, Boston, pp 123–177Google Scholar
  6. 6.
    Duparc F, Muller JM, Fréger P (2001) Arterial blood supply of the proximal humeral epiphysis. Surg Radiol Anat 23:185–190CrossRefPubMedGoogle Scholar
  7. 7.
    Duplay ES (1896) De la perarthite scapula-humerale. Rev Frat Trav Med 53:226Google Scholar
  8. 8.
    Finley MA, Lee RY (2003) Effect of sitting posture on 3-dimensional scapular kinematics measured by skin-mounted electromagnetic tracking sensors. Arch Phys Med Rehabil 84:563–568CrossRefPubMedGoogle Scholar
  9. 9.
    Gerber C, Espinosa N, Perren TG (2001) Arthroscopic treatment of shoulder stiffness. Clin Orthop Relat Res 390:119–128CrossRefPubMedGoogle Scholar
  10. 10.
    Griegel-Morris P, Larson K, Mueller-Klaus K, Oatis CA (1992) Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Phys Ther 72:425–431PubMedGoogle Scholar
  11. 11.
    Grimsby O, Gray J (1997) Interrelation of the spine to the shoulder girdle. In: Donatelli R (ed) Physical therapy of the shoulder, 3rd edn. Churchill Livingstone, New York, pp 95–129Google Scholar
  12. 12.
    Gumina S, Di Giorgio G, Postacchini F, Postacchini R (2008) Subacromial space in adult patients with thoracic hyperkyphosis and in healthy volunteers. Chir Organi Mov 91:93–96CrossRefPubMedGoogle Scholar
  13. 13.
    Hagiwara Y, Ando A, Onoda Y, Takemura T, Minowa T, Hanagata N et al (2012) Coexistence of fibrotic and chondrogenic process in the capsule of idiopathic frozen shoulders. Osteoarthritis Cartilage 20:241–249CrossRefPubMedGoogle Scholar
  14. 14.
    Hand C, Clipsham K, Rees JL, Carr AJ (2008) Long-term outcome of frozen shoulder. J Shoulder Elbow Surg 17:231–236CrossRefPubMedGoogle Scholar
  15. 15.
    Hettrich CM, Boraiah S, Dyke JP, Neviaser A, Helfet DL, Lorich DG (2010) Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Joint Surg Am 92:943–948CrossRefPubMedGoogle Scholar
  16. 16.
    Holloway GB, Schenk T, Williams GR, Ramsey ML, Iannotti JP (2001) Arthroscopic capsular release for the treatment of refractory postoperative or post-fracture shoulder stiffness. J Bone Joint Surg Am 83:1682–1687PubMedGoogle Scholar
  17. 17.
    Jeracitano D, Cooper RG, Lyon LJ, Jayson MI (1992) Abnormal temperature control suggesting sympathetic dysfunction in the shoulder skin of patients with frozen shoulder. Br J Rheumatol 31:539–542CrossRefPubMedGoogle Scholar
  18. 18.
    Kim YS, Chung SW, Kim JY, Ok JH, Park I, Oh JH (2012) Is early passive motion exercise necessary after arthroscopic rotator cuff repair? Am J Sports Med 40:815–821CrossRefPubMedGoogle Scholar
  19. 19.
    Lane LB, Villacin A, Bullough PG (1977) The vascularity and remodelling of subchondral bone and calcified cartilage in adult human femoral and humeral heads. An age- and stress-related phenomenon. J Bone Joint Surg Br 59:272–278PubMedGoogle Scholar
  20. 20.
    Lewis C, Erhard R, Drysdale G (2008) Kyphoscoliosis improvement while treating a patient for adhesive capsulitis using the active therapeutic movement version 2. J Manipulative Physiol Ther 31:715–722CrossRefPubMedGoogle Scholar
  21. 21.
    Ludewig PM, Cook TM (2000) Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther 80:276–291PubMedGoogle Scholar
  22. 22.
    Ludewig PM, Cook TM, Nawoczenski DA (1996) Three-dimensional scapular orientation and muscle activity at selected positions of humeral elevation. J Orthop Sports Phys Ther 24:57–65CrossRefPubMedGoogle Scholar
  23. 23.
    Miyakoshi N, Itoi E, Sato K, Suzuki K, Matsuura H (1998) Skin temperature of the shoulder: circadian rhythms in normal and pathologic shoulders. J Shoulder Elbow Surg 7:625–628CrossRefPubMedGoogle Scholar
  24. 24.
    Omoigui S (2007) The biochemical origin of pain: the origin of all pain is inflammation and the inflammatory response. Part 2 of 3—inflammatory profile of pain syndromes. Med Hypotheses 69:1169–1178CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Russek AS (1952) Diagnosis and treatment of scapulocostal syndrome. J Am Med Assoc 150:25–27CrossRefPubMedGoogle Scholar
  26. 26.
    Sarrafian SK (1983) Gross and functional anatomy of the shoulder. Clin Orthop Relat Res 173:11–19PubMedGoogle Scholar
  27. 27.
    Semenza GL (2003) Targeting HIF-1 for cancer therapy. Nat Rev Cancer 3:721–732CrossRefPubMedGoogle Scholar
  28. 28.
    Solem-Bertoft E (1999) Painful shoulder disorders from a physiotherapeutic view: a review of literature. Crit Rev Phys Rehabil Med 11:229–277Google Scholar
  29. 29.
    Tsuchida Y (1979) Rate of skin blood flow in various regions of the body. Plast Reconstr Surg 64:505–508CrossRefPubMedGoogle Scholar
  30. 30.
    Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, Simmons A et al (1998) Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 57:649–655CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Yabe Y, Hagiwara Y, Suda H, Ando A, Onoda Y, Tsuchiya M, Hatori K, Itoi E (2013) Joint immobilization induced hypoxic and inflammatory conditions in rat knee joints. Connect Tissue Res 54:210–217CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Yoshihiro Hagiwara
    • 1
  • Kenji Kanazawa
    • 1
  • Akira Ando
    • 1
  • Akimoto Nimura
    • 2
  • Takashi Watanabe
    • 3
  • Kazuhiro Majima
    • 4
  • Keiichi Akita
    • 2
  • Eiji Itoi
    • 1
  1. 1.Department of Orthopaedic SurgeryTohoku University School of MedicineSendaiJapan
  2. 2.Unit of Clinical Anatomy, Graduate SchoolTokyo Medical and Dental UniversityTokyoJapan
  3. 3.Division of Epidemiology, Department of Public Health and Forensic MedicineTohoku University Graduate School of MedicineSendaiJapan
  4. 4.Department of RadiologyTakeda General HospitalAizuwakamatsuJapan

Personalised recommendations