Review Question - QID 210182

The anterior humeral circumflex artery (AHCA) and its venae comitantes, collectively called the "three sisters", are commonly identified and ligated during a standard deltopectoral approach to the shoulder.

When viewed on an arteriogram, the posterior humeral circumflex artery (PHCA) appears larger than the AHCA. The PHCA is the dominant blood supply to the proximal humerus. The three sisters can usually be identified overlying the inferior aspect of the subscapularis tendon when the humerus is externally rotated. If they are not dissected and ligated, brisk bleeding can occur if they are inadvertently transected.

Chalmers et al. review various surgical exposures of the shoulder. They highlight the advantages and disadvantages of each approach. They caution against overzealous dissection of subdeltoid adhesions, especially in revision settings, to prevent damage to the PHCA.

Zlotolow et al. review surgical exposures of the humerus. Like Chalmers et al., they stress a deep appreciation of neurovascular structures to prevent injury and allow for safe extensile exposures. They state that the deltopectoral approach is the most widely used in the treatment of proximal humerus fractures, but emphasize that the lateral deltoid-splitting approach is an attractive option for rotator cuff repair and the surgical fixation of valgus-impacted proximal humerus fractures.

Figure A shows an arteriogram of the shoulder. Illustration A is a labeled arteriogram of the shoulder.

Incorrect Answers:
Answer 1: A corresponds to the PHCA.
Answer 3: C corresponds to the deltoid branch of the profunda brachii.
Answer 4: D corresponds to the brachial artery.
Answer 5: E corresponds to the clavicular branch of the thoracoacromial artery.