The circumference of its articular surface is slightly constricted and is termed the anatomical neck, in contradistinction to a constriction below the tubercles called the surgical neck which is frequently the seat of fracture. Fracture of the anatomical neck rarely occurs. The diameter of the humeral head is generally larger in men than in women. Anatomical neck
The anatomical neck (collum anatomicum) is obliquely directed, forming an obtuse angle with the body. It is best marked in the lower half of its circumference; in the upper half it is represented by a narrow groove separating the head from the tubercles. The line separating the head from the rest of the upper end is called the anatomical neck. It affords attachment to the articular capsule of the shoulder-joint, and is perforated by numerous vascular foramina. Fracture of the anatomical neck rarely occurs.The anatomical neck of the humerus is an indentation distal to the head of the humerus on which the articular capsule attaches. Surgical neck
The surgical neck is a narrow area distal to the tubercles that is a common site of fracture. It makes contact with the axillary nerve and the posterior humeral circumflex artery. Greater tubercle
The greater tubercle (tuberculum majus; greater tuberosity) is a large, posteriorly placed projection that is placed laterally. The greater tubercle is where supraspinatus, infraspinatus and teres minor muscles are attached. The crest of the greater tubercle forms the lateral lip of the bicipital groove and is the site for insertion of pectoralis major.
However, because the diagnostic criteria were published independently from one another, the final recommendations differed greatly from one another. The Aspen Neurobehavioral Work-group was convened to explore the underlying causes of these disparities. In the end, the Aspen Work-group provided a consensus statement regarding definitions and diagnostic criteria disorder of consciousness which include the vegetative state (VS) and the minimally conscious state (MCS). Ethical issues
One of the major ethical concerns involving patients with severe brain damage is their inability to communicate. By definition, patients who are unconscious or are minimally conscious are incapable of giving informed consent which is required for participation in clinical research. Typically, written approval is obtained from family members or legal representatives. The inability to receive informed consent has led to much research being refused grants, ethics committee approval, or research publication. This puts patients in these conditions at risk of being denied therapy that may be life-saving. The right to die
The right to die in patients with severe cognitive impairment has developed over time because of their grave neurological state and the perceived futility of continued treatment. Such cases have been debated vigorously in the past, as in the case with Terri Schiavo who was diagnosed with persistent vegetative state. In the case of minimally conscious state patients, they are neither permanently unconscious nor are they necessarily hopelessly damaged. Thus, these patients warrant additional evaluation. On one hand, some argue that entertaining the possibility of intervention in some patients may erode the "right to die" moral obligation.