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# Shoulder veins

The shoulder veins drain the shoulder into the [axillary vein](https://durgical.com/en/anatomy/axillary-vein/); they enlarge into detours if the main arm vein is blocked.

Official name: Veins around the shoulder

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## What it is

Veins that run with the arteries around the shoulder and shoulder blade.

## What it does

Drain the shoulder into the axillary vein.

## Key points

- When the axillary or subclavian vein is blocked, these veins enlarge into collaterals, seen as dilated veins over the shoulder and upper [chest](https://durgical.com/en/anatomy/region/chest/)
- The anterior circumflex humeral artery and its two veins form the "three sisters" at the lower border of [subscapularis](https://durgical.com/en/anatomy/subscapularis/) in the deltopectoral approach
- The thoracodorsal vein is part of the pedicle of the [latissimus dorsi](https://durgical.com/en/anatomy/latissimus-dorsi-muscle/) flap

## Key facts

**Drains**
Shoulder and scapular muscles (circumflex humeral, subscapular, thoracodorsal, suprascapular veins)

**Into**
Axillary vein (suprascapular -> external jugular/subclavian)

## Relations

**Course**
They follow their arteries: around the surgical neck of the [humerus](https://durgical.com/en/anatomy/humerus/), through the quadrangular and triangular spaces and along the lateral border of the [scapula](https://durgical.com/en/anatomy/scapula/); the suprascapular vein runs above the scapula toward the external jugular or [subclavian vein](https://durgical.com/en/anatomy/subclavian-veins/)

## How to find it

Mostly found in surgery: the "three sisters" at the lower edge of subscapularis in the deltopectoral approach, the posterior circumflex humeral vessels in the quadrangular space behind the surgical neck, and the thoracodorsal vein on the deep surface of latissimus dorsi.

## On imaging

In suspected axillary-subclavian obstruction, duplex ultrasound and CT or catheter venography show the block and the enlarged shoulder collaterals; venography with the arm raised can unmask compression at the thoracic outlet.

## Clinical notes

- Dilated collateral veins over the shoulder and upper chest are a visible sign of long-standing axillary-subclavian obstruction
- In the deltopectoral approach the "three sisters" are tied or coagulated to avoid bleeding when subscapularis is released
- The thoracodorsal vessels are preserved during axillary lymph node dissection

## Test yourself

Think of the answer, then tap the question to see it.

## What do dilated veins over the shoulder and upper chest suggest?

Long-standing axillary-subclavian vein obstruction, with the shoulder veins enlarged as collaterals.

## Which shoulder veins form part of the «three sisters» in the deltopectoral approach?

The two veins of the anterior circumflex humeral artery, at the lower border of subscapularis.

## Which shoulder vein is part of the latissimus dorsi flap pedicle?

The thoracodorsal vein.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
vena circumflexa anterior humeri TA2 4976

**Official Spanish (DeCS)**
Venas circunflejas del húmero, subescapular, circunfleja de la escápula, toracodorsal y supraescapular

**English (TA2)**
Veins around the shoulder

Sources: Terminologia Anatomica (TA2); [Anatomy, Shoulder and Upper Limb, Veins](https://www.ncbi.nlm.nih.gov/books/NBK546676/); [20.5 Circulatory Pathways](https://openstax.org/books/anatomy-and-physiology-2e/pages/20-5-circulatory-pathways) (OpenStax (Rice University), 2022) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/veins-around-the-shoulder/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/veins-around-the-shoulder/