Download ThoracoAbdominbal Nerves Subcostal Nerve

ThoracoAbdominbal Nerves Subcostal Nerve IlioHypoGastric IlioInguinal
GenitoFemoral Obturator Patellar Plexus
Thoraco Abdominal Nerves
T7 – T11
Ventral rami of T7 – T11
Pass behind the costal cartilages
Between Transverse Abdominus and the Internal Abdominal Oblique
Supply all three muscle
1. Transverse Abdominus
2. Internal Abdominal Oblique
3. External Abdominal Oblique
4. Rectus Abdominus
5. Note that they do not innervate the skin for sensory except for the midline area
overlying the Rectus Abdominus
End as the Anterior Cutaneous Branch
1. Penetrate the anterior sheath of the rectus near the midline to innervate the skin
over the area of the Rectus Abdominus
2. Short medial branch
3. Long lateral branch
In the chest they supply
1. External Intercostal
2. Internal Intercostal
3. Posterior Inferior Serratus
Lateral Cutaneous Branches innervate the skin
Anteriorly up to the border of the Rectus Abdominus and
Posteriorly towards the border of the Erector Spinae
1. Axillary Line
2. Divide into anterior and posterior branches
3. Anterior to as far as the lateral border of the Rectus Abdominus Muscle
4. Posterior to as far as the border of the Erector Spinae Muscles
Subcostal T12
1. follows lower border of the 12th rib
2. has no thoracic distribution
3. crosses quadratus lumborum beneath the transversalis fascia
4. penetrates the transversus abdominus muscle
5. distributes like the lower intercostals
6. supplies the pyramidalis muscle
7. communicates with the iliohypogastric
8. its large lateral cutaneous branch does not divide into anterior posterior branches
a. passes over the crest of the ilium several centimeters behind the ASIS
b. supplies the skin of the hip to about the greater trochanter
woodburne page 366
cutaneous nerves of the abdominal wall
1. anterior and lateral branches of the intercostal nerves T7 – T11
2. anterior terminal of the subcostal nerve
3. branch of the iliohypogastric nerve
iliohypogastric nerve L1
1. traverses the abdominal wall like the throacoabdominal Intercostal nerves
a. emerges from psoas muscle along its lateral border
b. crosses the quadratus lumborum muscle and
c. penetrates the transversus abdominus muscle near the iliac crest
d. woodburne page 515
2. Anterior branchpierces the aponeurosis of the external abdominal oblique several
centimeters above the superficial inguinal ring
3. Distributes to the suprapubic region
4. The lateral cutaneous branch
a. Crosses the iliac crest at the junction of the anterior and middle thirds
b. Supplies the gluteal region
T7 immediately below the Xiphoid
T10 above and below the umbilicus
L1 Suprapubic from the anterior branch of the iliohypgastric
Innervation of the scrotum
1. anterior scrotal branch of the nerve
2. posterior scrotal branch of the pudendal
3. and the posterior femoral cutaneous nerve
IlioInguinal Nerve
1. traverses the inguinal canal to supply the superficial inguinal ring
2. emerges on the lateral aspect of the spermatic cord
3. distributes to the upper and medial parts of the thigh
4. its anterior scrotal branch passes to the root of the penis and the anterior portion
of the scrotum by way of the perineum
Woodburne p419
IlioInguinal Nerve
1. similar patht to the IlioHpogastric
2. frequently are joined into a common trunk
3. in 35% of cases the ilioInguinal is combined with the genitofemoral nerve and has
a course with=in the abdomen
4. woodburne pages 515 and 516
GenitoFemoral Nerve L1 – L2
1. passes through the psoas muscle
2. emerges on the vental surfacenear about L3 L4
3. under the psoas fascia
4. the genital branch enters the deep ring of the inguinal canal
5. supplies the cremaster muscle and the skin of the scrotum and the adjacent thigh
6. the femoral branch
7. more medial
8. passes under the inguinal ligament
9. on the anterior surface of the external iliac arteries
10. below the inguinal ligament it pierces the femoral sheath and passes through the
saphenous opening or directly through the fascia lata to supply the skin over the
femoral triangle lateral to that supplied by the iliInguinal nerve
11. woodburne page516
lateral femoral cutaneous L2 L3
1. lateral border of the psoas
2. dingle or in branches
3. crosses iliac muscle deep to its fascia
4. towards the ASIS
5. passes under the lateral aspect of the inguinal ligament
6. superficial or deep to the Sartorius
7. about 10cm below the ASIS divides into anterior and posterior
8. woodburne page 516
Obturator
1. Anterior braches of the L2L3L4
2. Passes behind the common iliac artery
3. Then lateral to the intenal iliac vessels and ureter
4. Lies against the obturator internus muscle
5. Accompanies the obturator artery and vein to the oobturator foramen and
6. passes with them through the obturator canal into the thigh
7. in the canal divides into anterior and posterior branches
8. which supply the hip and knee joints and the medial aspect fte skin of the thigh
9. woodburne page 516
Saphenous Nerve
1. is the terminal branch of the femoral nerve
2. arises from the femoral nerve in the femoral triangle
3. enters the adductor canal
4. where it crosses the femoral artery anteriorly from lateral to medial
5. at the distal end it pierces its fascial covering in company with the descending
genicular artery
6. at the knee joint it emerges between the Sartorius and the tendon of the gracillis
7. below the knee it meets up with the greater saphenous vein
8. branches of the saphenous nerve arising in the adductor canal communicate with
the obturator nerve and the anterior cutaneous branch of the femoral nerve
9. an infrapatellar branch given off at the level of the knee pierces the Sartorius
muscle and the fascia lata and curves below the knee over the medial condyole
area of the tibia to help form the patellar plexus
10. the saphenous continues on with the saphenous vein and distributes to the medial
and front side of the lower leg and foot as well as to the dorsum of the leg meeting
the innervation on the back of the leg with that of the sural nerve in a kind of line
defined by the lesser saphenous vein or basically a line drawn down the middle of
the back of the lower leg
11. Woodburne p 582
Patellar plexus
1. formed by the saphenoous nerve
2. with communcationg branches from the
a. anterior cutaneous branch of the femoral nerve
b. lateral femoral cutaneous nerve
c. obturator nerve anterior branch
d. woodburne page 582