Anatomy of the terminal branch of the posterior circumflex humeral artery: relevance to the deltopectoral approach to the shoulder

Bone Joint J. 2016 Oct;98-B(10):1395-1398. doi: 10.1302/0301-620X.98B10.38011.


Aims: Despite the expansion of arthroscopic surgery of the shoulder, the open deltopectoral approach is increasingly used for the fixation of fractures and arthroplasty of the shoulder. The anatomy of the terminal branches of the posterior circumflex humeral artery (PCHA) has not been described before. We undertook an investigation to correct this omission.

Patients and methods: The vascular anatomy encountered during 100 consecutive elective deltopectoral approaches was recorded, and the common variants of the terminal branches of the PCHA are described.

Results: In total, 92 patients (92%) had a terminal branch that crossed the space between the deltoid and the proximal humerus and which was therefore vulnerable to tearing or avulsion during the insertion of the blade of a retractor during the deltopectoral approach to the shoulder. In 75 patients (75%) there was a single vessel, in 16 (16%) a double vessel and in one a triple vessel.

Conclusion: The relationship of these vessels to the landmark of the tendon of the insertion of pectoralis major into the proximal humerus is described. Damage to these previously undocumented branches can cause persistent bleeding leading to prolonged surgery and post-operative haematoma and infection, as well as poor visualisation during the procedure. Cite this article: Bone Joint J 2016;98-B:1395-8.

Keywords: Anatomy; Deltopectoral; Posterior humeral circumflex artery; Shoulder.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Arteries / anatomy & histology*
  • Cadaver
  • Deltoid Muscle / blood supply*
  • Female
  • Fracture Fixation*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Shoulder Fractures / diagnosis
  • Shoulder Fractures / surgery*
  • Young Adult