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Sixth Intercostal Nerve
Nervous System

Sixth Intercostal Nerve

Nervus intercostalis sextus

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


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 sixth 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. At the anterior portion of the intercostal space, the anterior ramus passes anterior to the transversus thoracis muscle and the internal thoracic vessels, where it reaches its termination as the anterior cutaneous branch.


Near its origin, the anterior ramus of the sixth 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 sixth 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 extend towards pectoralis major muscle and the scapula and latissimus dorsi muscles, respectively, thus, supplying the overlying skin.

The anterior cutaneous branch arises as the anterior ramus of sixth thoracic nerve reaches the anterior portion of the intercostal space. The anterior cutaneous branch also pierces the chest wall.

Supplied Structures & Function

The anterior ramus of the sixth thoracic nerve supplies motor innervation to the intercostal muscles of the sixth intercostal space (external intercostal, internal intercostal, innermost intercostal), transversus thoracis, serratus posterior superior, and the serratus anterior muscles. The anterior ramus of the sixth thoracic nerve also innervates the most superior fibers of the rectus abdominis and external oblique muscles. It also receives sensory innervation to the skin overlying the sixth intercostal space.

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Intercostal Nerve

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Slipping rib syndrome is produced by impingement of an intercostal nerve between two costal cartilages, secondary to the subluxation of an interchondral articulation.

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