Variations of the circumflex humeral arteries: a cadaveric study

Objectives: Surgery is the main treatment option of both anatomical and surgical neck humeral fractures, which could result in damage to the circumflex humeral vessels. Current research studies have found that vascular supply to the shoulder is variable. However, the incidence of these variations and how they can affect the blood supply to the shoulder region is still under investigation. The aim of this study is to identify possible variation patterns of the circumflex humeral vessels. Methods: A total of 10 shoulders (3 males, 2 females; average age of 68.8 years) were dissected in Anatomy, University of Edinburgh, under the regulation of the Human Tissue (Scotland) Act 2006. Each shoulder was dissected, and tissues were removed to identify the axillary artery and its branches. Results: The anterior and posterior circumflex humeral arteries were observed to arise as single branches from the 3rd part of the axillary artery in 70% (n=7) and 80% (n=8), respectively. In one cadaver, the posterior circumflex humeral artery (PCHA) arose from the subscapular artery in one side (10%, n=1) and from the profunda brachii artery on the contralateral side (10%, n=1). In the remaining 10% (n=1), the anterior circumflex humeral artery (ACHA) was found as a branch from the PCHA, with the latter being a direct branch from the 3rd part of the axillary artery. Conclusion: Knowledge and awareness of these variations is essential to not only suspect, diagnose and treat possible complications of common fractures and dislocations in the region, but also to prevent iatrogenic injury.

Ultrasound-Guided Block of the Axillary Nerve: A Prospective, Randomized, Single-Blind Study Comparing Interfascial and Perivascular Injections

Background: The ultrasound-guided block of the axillary nerve may be complicated in cases in which the posterior circumflex humeral artery (PCHA) follows an abnormal course. Objectives: To develop a new technique that does not rely on direct visualization of the PCHA or the axillary nerve, and to compare interfascial injection and conventional perivascular injection for a block of the axillary nerve. Study Design: A prospective randomized study. Setting: An interventional pain-management practice in a university hospital. Methods: A total of 56 patients received ultrasound-guided block of the axillary nerve with either interfascial injection (IF Group) or perivascular injection with nerve stimulation (PV Group). The primary outcome was procedure duration, defined as the time interval from when the transducer contacted the skin to when the needle was removed from the skin. Results: The mean procedure time was significantly shorter in the IF Group than in the PV Group (64 seconds [SD 28.3] vs. 135 seconds [50.3], difference of −71.4 seconds; 95% confidence interval, −93.2 to −49.5) (P < 0.001). There were no differences in secondary outcomes, including the quality of blocks, between the 2 groups. Limitations: The practitioner was not blinded to the group to which the patients belonged. Conclusions: Ultrasound-guided block of the axillary nerve with interfascial injection can be performed without placing the needle near the PCHA. Key words: Block of axillary nerve, ultrasound-guided block, posterior circumflex humeral artery, interfascial injection

Unilateral variation in branching pattern of Right Axillary Artery - A Case Report

The Axillary artery is the continuation of the subclavian artery and is a major artery of the upper limb. During the routine dissection for Undergraduate Ayurvedic Medical Students of Sharada Ayurvedic Medical College, Yadgir, Karnataka, India, in the Department of Anatomy, we come across a variation in branching pattern of second and third part of right axillary artery in male cadaver approximately 55 years of age. The first part of axillary artery was found to be normal. In the second part of axillary artery we observed two branches, first one is thoracoacromial artery arose as usual second branch given common trunk which is further divided into lateral thoracic artery and subscapular artery. Even third part of axillary artery gave one common trunk that terminated by bifurcating into Anterior Circumflex Humeral Artery and Posterior Circumflex Humeral Artery.