Trunk nerves (intercostal, sympathetic, vagus nerve)
Intercostal nerves (T1-T11) and subcostal nerve (T12)
Nervi intercostales (Th1-Th11) et nervus subcostalis (Th12)
- Origin
- Anterior rami of the thoracic spinal nerves T1 through T12
- Insertion
- Course in the subcostal groove of ribs within the neurovascular bundle (VAN: vein, artery, nerve—nerve is most inferior and exposed) giving lateral and anterior cutaneous branches
- Function
- Motor innervation to intercostal and abdominal muscles; sensory innervation to the thoracic/abdominal dermatomes (T4 nipples, T10 umbilicus), parietal pleura, and parietal peritoneum
- Innervation
- Somatic motor and somatic sensory
- Movement & chain
- Respiratory chest wall mechanics
- Palpation
- Palpation along Valleix points on intercostal spaces
- Clinical
- Herpes zoster (shingles: viral reactivation in the dorsal root ganglion with dermatomal vesiculobullous rash and neuropathic pain), post-herpetic neuralgia (PHN), intercostal neuralgia following thoracic surgery or rib fractures.
- Segmental innervation
- T1-T12 dermatomes (T4 nipple line, T10 umbilical line, T12 suprapubic)
- In clinical practice
- Ultrasound-guided intercostal/erector spinae plane (ESP) nerve blocks for pain relief in multiple rib fractures to allow deep inspiration and pulmonary toilet
- Region in the model
- Trunk nerves (intercostal, sympathetic, vagus nerve)