Skip to main content

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

Knee Surgery, Sports Traumatology, Arthroscopy volume 23, pages 1467–1472 (2015)Cite this article

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Andary JL, Petersen SA (2002) The vascular anatomy of the glenohumeral capsule and ligaments: an anatomic study. J Bone Joint Surg Am 84:2258–2265

    PubMed  Google Scholar 

  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 37:859–864

    Article  PubMed Central  PubMed  Google Scholar 

  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–S138

    Article  CAS  PubMed  Google Scholar 

  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 35:227–238

    Article  PubMed  Google Scholar 

  5. Codman EA (1934) The shoulder. Thomas Todd, Boston, pp 123–177

    Google Scholar 

  6. Duparc F, Muller JM, Fréger P (2001) Arterial blood supply of the proximal humeral epiphysis. Surg Radiol Anat 23:185–190

    Article  CAS  PubMed  Google Scholar 

  7. Duplay ES (1896) De la perarthite scapula-humerale. Rev Frat Trav Med 53:226

    Google Scholar 

  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 84:563–568

    Article  PubMed  Google Scholar 

  9. Gerber C, Espinosa N, Perren TG (2001) Arthroscopic treatment of shoulder stiffness. Clin Orthop Relat Res 390:119–128

    Article  PubMed  Google Scholar 

  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 72:425–431

    CAS  PubMed  Google Scholar 

  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 95–129

    Google Scholar 

  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 91:93–96

    Article  PubMed  Google Scholar 

  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 20:241–249

    Article  CAS  PubMed  Google Scholar 

  14. Hand C, Clipsham K, Rees JL, Carr AJ (2008) Long-term outcome of frozen shoulder. J Shoulder Elbow Surg 17:231–236

    Article  PubMed  Google Scholar 

  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 92:943–948

    Article  PubMed  Google Scholar 

  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 83:1682–1687

    PubMed  Google Scholar 

  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 31:539–542

    Article  CAS  PubMed  Google Scholar 

  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 40:815–821

    Article  PubMed  Google Scholar 

  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 59:272–278

    CAS  PubMed  Google Scholar 

  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 31:715–722

    Article  PubMed  Google Scholar 

  21. Ludewig PM, Cook TM (2000) Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther 80:276–291

    CAS  PubMed  Google Scholar 

  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 24:57–65

    Article  CAS  PubMed  Google Scholar 

  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 7:625–628

    Article  CAS  PubMed  Google Scholar 

  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 69:1169–1178

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Russek AS (1952) Diagnosis and treatment of scapulocostal syndrome. J Am Med Assoc 150:25–27

    Article  CAS  PubMed  Google Scholar 

  26. Sarrafian SK (1983) Gross and functional anatomy of the shoulder. Clin Orthop Relat Res 173:11–19

    PubMed  Google Scholar 

  27. Semenza GL (2003) Targeting HIF-1 for cancer therapy. Nat Rev Cancer 3:721–732

    Article  CAS  PubMed  Google Scholar 

  28. Solem-Bertoft E (1999) Painful shoulder disorders from a physiotherapeutic view: a review of literature. Crit Rev Phys Rehabil Med 11:229–277

    Google Scholar 

  29. Tsuchida Y (1979) Rate of skin blood flow in various regions of the body. Plast Reconstr Surg 64:505–508

    Article  CAS  PubMed  Google Scholar 

  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 57:649–655

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  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 54:210–217

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Yoshihiro Hagiwara, Kenji Kanazawa, Akira Ando & Eiji Itoi

  2. Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Akimoto Nimura & Keiichi Akita

  3. Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Takashi Watanabe

  4. Department of Radiology, Takeda General Hospital, 3-27 Yamaga-machi, Aizuwakamatsu, 965-8585, Japan

    Kazuhiro Majima

Authors
  1. Yoshihiro Hagiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenji Kanazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akira Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akimoto Nimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takashi Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kazuhiro Majima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Keiichi Akita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eiji Itoi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshihiro Hagiwara.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hagiwara, Y., Kanazawa, K., Ando, A. et al. Blood flow changes of the anterior humeral circumflex artery decrease with the scapula in internal rotation. Knee Surg Sports Traumatol Arthrosc 23, 1467–1472 (2015). https://doi.org/10.1007/s00167-013-2823-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-013-2823-2

Keywords

  • Humeral circumflex artery
  • Shoulder
  • MRI
  • Blood flow
  • Scapular position
  • Posture