The humeral head is supplied mainly by the posterior circumflex humeral artery, with the anterior circumflex humeral artery and its arcuate branch also contributing. Four part fractures and loss of the medial calcar hinge raise the risk of avascular necrosis.
Gerber 1990
Anterior Circumflex Humeral A
- Supplies main blood supply of humeral head
- Arises from 3rd part of axillary artery
- Passes deep to coracobrachialis & both heads of biceps
- Gives rise to arcuate artery then passes around surgical NOH to anastomose with PCHA
- Arcuate a is the anterolateral branch of the ACHA & passes
- Under long head of biceps tendon
- Along lateral aspect of the tendon
- Enters the head at lateral & superior aspects of intertubercular groove
- Supplies almost entire epiphysis
- 1:9 patients the Arcuate a arises from the PCHA
Posterior Circumflex Humeral Artery
- Supplies posterior portion of the greater tuberosity & small portion of the posteroinferior articular segment
- Arises from 3rd part of axillary artery
- Passes through the quadrilateral space (between subscapularis, teres major, long head triceps, & humerus) with axillary nerve above it
- Anastomoses with profunda brachii & sends branches to shoulder joint
- Some anastomosis within head of the ACHA & PCHA with the recurrent branches of nutrient a of shaft
Doubtful if the rotator cuff vessels vascularise the underlying bone
Good anastomotic network with the
- PCHA
- Circumflex scapular
- Thoracoacromial
- Suprascapular artery
Thus ligation of the ACHA medial to intertubercular groove will not devascularise the head
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.