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Eleventh Intercostal Nerve
Nervous System

Eleventh Intercostal Nerve

Nervus intercostalis undecimus

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Quick Facts

Origin: Eleventh thoracic nerve.

Course: Travels within the eleventh intercostal space.

Branches: Collateral, lateral cutaneous, and anterior cutaneous branches.

Supply: The anterior ramus supplies motor innervation to the muscles of the eleventh intercostal space and abdominal muscles. It also conveys sensory innervation from the skin of the abdominal wall.

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Origin

The anterior ramus of eleventh thoracic nerve (or eleventh intercostal nerve) is one of two branches of the eleventh thoracic nerve, the other being the posterior ramus.

Course

The anterior ramus passes forward, lying between the pleura of the lungs and the internal intercostal membranes. It then enters the space between the internal intercostal and innermost intercostal muscles to course through the eleventh intercostal space. It is also accompanied by an intercostal artery and vein, where the vein sits closest to the rib above, followed by the artery and nerve.

As the anterior rami of the seventh to eleventh thoracic nerves leave the intercostal space, they continue anteriorly into the abdominal wall. They course between the transversus abdominis and internal abdominal oblique muscles. They then enter the lateral margin of the rectus sheath, passing posterior to the rectus abdominis muscle. They pierce the rectus abdominis muscle and the anterior rectus sheath to pass anteriorly to the overlying skin.

Branches

Near its origin, the anterior ramus of the eleventh thoracic nerve gives off a collateral branch that descends in the intercostal space and courses along the inferior border of the space, in the same plane as the anterior ramus itself.

The lateral cutaneous branch of the anterior ramus of eleventh thoracic nerve branches from the anterior ramus around the mid-axillary line. It briefly accompanies the nerve before piercing through the chest wall. The lateral branch further subdivides into anterior and posterior branches that supplying the overlying skin.

The anterior cutaneous branch arises as the anterior ramus of eleventh thoracic nerve pierces the anterior rectus sheath.

Supplied Structures & Function

The anterior ramus of the eleventh thoracic nerve supplies the intercostal muscles of the eleventh intercostal space (external intercostal, internal intercostal, innermost intercostal). It also supplies motor innervation to most of the abdominal muscles (rectus abdominis, external abdominal oblique, internal abdominal oblique, transversus abdominis) and sensory innervation from the anterolateral abdominal wall. Sensory fibers also extend to the costal parts of diaphragm and parietal peritoneum.

List of Clinical Correlates

—Referred pain

—Transversus abdominis plane (TAP) block

Learn more about this topic from other Elsevier products

Intercostal Nerve

ScienceDirect image

The intercostal nerve frequently runs within the middle of the intercostal space (73% of the time) and occasionally courses along the inferior aspect of the intercostal space just above the subjacent rib (Hardy, 1988).

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