CAIRO UNIVERSITY KASR AL-AINY MEDICAL SCHOOL

ANATOMY THORAX
ATYPICAL INTERCOSTAL NERVES
PREPARED BY: NORFAEZAH BINTI KAMALUDDIN STUDENT ID: 5066

ANATOMY THORAX | ATYPICAL INTERCOSTAL NERVES

THE INTERCOSTAL NERVES

The anterior primary rami of the thoracic spinal nerves from T1 to T11. 11 intercostal and 1 subcostal nerve : (a) The 1st nerve: supply fibres to the upper limb in addition to their thoracic branches to join the brachial plexus. (b) The next four nerves: limited in their distribution to the parietals of the thorax. (c) The lower five nerves: supply the parietals of the thorax and abdomen. (d) The 7th nerve: terminates at the xyphoid process, at the lower end of the sternum. (e) The 10th nerve: terminates at the umbilicus. (f) The last subcostal nerve: runs its entire course in the abdominal wall and groin. The nerve is the lower structure of the neurovascular bundle (intercostal V.A.N).

Classification: 5 Typical Intercostal Nerves 2nd to 6th nerves in the thoracic wall. 5 Atypical Intercostal Nerves 7th to 11th nerves run both in the thoracic and abdominal wall.

ANATOMY THORAX | ATYPICAL INTERCOSTAL NERVES ATYPICAL INTERCOSTAL NERVES Lower 5 intercostal nerves, from 7th to 11th intercostal spaces. The anterior divisions of the 7th, 8th, 9th, 10th and 11th thoracic intercostal nerves are continued anteriorly from the intercostal spaces into the abdominal wall hence they are named thoraco-abdominal nerves (or thoracicoabdominal intercostal nerves). Origin Anterior primary rami of the spinal nerves Course (1) Comes out from the intervertebral foramen. and relations (2) Runs laterally behind the sympathetic ganglion towards between the parietal pleura in the and the posterior intercostal membrane. thoracic wall (3) At the sternal angle enters the intercostal space running forwards between the innermost and the internal intercostal muscles. (4) At the anterior part lies between the internal intercostal muscle (anteriorly) and internal mammary vessels, parietal pleura, sternocostalis muscle (posteriorly). (5) Lateral to the sternum passes forwards piercing the internal intercostal muscle, anterior intercostal membrane and pectoralis major end as anterior cutaneous nerve.

Course (1) Enter the anterior abdominal wall by passing through the slips of origin of the transversus and abdominis muscle. relations in the (2) Run forwards and medially in the neurovascular plane of the anterior abdominal wall anterior between internal oblique and transversus abdominis muscle. abdominal wall (3) Each nerve ends by piercing the posterior wall of rectus sheath, rectus abdominis muscle and the anterior wall of the rectus sheath become anterior cutaneous nerve.

ANATOMY THORAX | ATYPICAL INTERCOSTAL NERVES

Branches

(1) Ganglionic branches: - Gives white ramus communicans (preganglionic) to, and receives a grey ramus communicans (postganglionic) from corresponding ganglion of sympathetic chain. (2) Collateral branch: - Runs along upper border of the rib below. - Supplies intercostal muscles. (3) Lateral cutaneous branch: - Pass laterally in mid-axillary line pierce the muscles of the intercostals space and serratus anterior muscle reach the skin divides into anterior and posterior branches supplies the skin of the side of the chest. (4) Anterior cutaneous branch: - Termination of the intercostals nerves. - Divides into medial and lateral supply the skin of the front of the chest. (5) Muscular branches: - From main nerve and its collateral branch supplies the intercostals muscles. (6) Pleural and peritoneal branches: - To the parietal layers of serous membranes. (7) Articular branches: - To the joints of the ribs. (8) Abdominal muscles branch - Supplies muscle of the skin of the anterior abdominal wall.

ANATOMY THORAX | ATYPICAL INTERCOSTAL NERVES

TABUNG DERMA PALESTIN PERUBATAN