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At least 19 recordsLinked to original sources
PubMed1997

Experimental study on donor nerves for brachial plexus injury: comparison between the spinal accessory nerve and the intercostal nerve.

The spinal accessory nerve and intercostal nerves are widely used as donor nerves for neurotization in patients with brachial plexus injuries. However, the characteristic differences in reinnervation by the spinal accessory and intercostal nerves have not been investigated. The purpose of this study is to compare the resulting contractile properties of the biceps muscles following nerve-crossing procedures of spinal accessory nerve and intercostal nerves to the musculocutaneous nerves. In 10 beagle dogs, the spinal accessory nerve was used to reinnervate the left biceps muscle, and the second and third intercostal nerves were used to reinnervate the right biceps muscle. After 10 months, the reinnervated muscles were studied by measuring their force of contraction as well as by histochemical methods. Biceps muscles reinnervated by spinal accessory nerves (A transfers) acquired the properties of fast, fatigable muscles, whereas those reinnervated by intercostal nerves (IC transfers) acquired the properties of slow, fatigue-resistant muscles. Furthermore, histochemical studies showed that type II fibers were predominant in A transfers, whereas type I fibers were predominant in IC transfers. This study clearly demonstrates the differences between the spinal accessory nerve and intercostal nerves as donor nerves. This may lead us to select appropriate donor nerves for nerve-crossing procedures and free-muscle transfer depending on the desired functions to be reconstructed.

Accessory Nerve↗
PubMed1999

Restoration of elbow flexion in brachial plexus avulsion injury: comparing spinal accessory nerve transfer with intercostal nerve transfer.

This study was performed to compare the clinical outcome of 2 types of commonly used nerve transfers, the spinal accessory nerve transfer and the intercostal nerve transfer. This study was a prospective randomized parallel trial involving 205 patients presenting between 1989 and 1994. All patients were males ranging in age from 16 to 43 years. All patients underwent surgery within 6 months of injury. Spinal accessory nerve transfer was performed in 130 patients; better results were obtained in terms of less operative time, fewer blood transfusions, fewer immediate complications, and better motor function (very good and good power in 83% of patients). Intercostal nerve transfer was performed in 75 patients; better results were observed in terms of earlier electromyographic evidence of motor reinnervation, improvement in protective sensation, and reduction of pain. However, very good and good motor recovery was observed in only 64% of patients. There was no significant difference with regard to tidal volume, vital capacity, and the FEV1 to FEV ratio before and after surgery in either group. Smoking adversely affected the rate of recovery. Spinal accessory nerve transfer should be used when motor function of the elbow flexors is the major concern. Intercostal nerve transfer should be performed in patients who need both motor and sensory reconstruction and in those who have chronic pain syndrome after brachial plexus injury.

Adolescent↗
PubMed2005

Ventilation and exercise performance after phrenic nerve and multiple intercostal nerve transfers for avulsed brachial plexus injury.

BACKGROUND: Diaphragmatic excursion, lung function, exercise performance, and clinical symptoms have not been previously described in patients after phrenic nerve transfer (PNT) and/or multiple intercostal nerve transfer (MIT) for the repair of avulsed brachial plexus injury (ABPI) to prevent functional musculoskeletal impairment in the shoulder. SETTING: A university-based hospital. METHODS: Dyspnea scores, chest ultrasonography to assess diaphragmatic excursion, and pulmonary function testing were performed to assess ventilation in patients sustaining trauma to their brachial plexus. In addition, cardiopulmonary exercise testing was also performed. These studies were obtained prior to surgical intervention, and were repeated postoperatively at 6, 12, 18, 24, and 36 months. The results obtained preoperatively were compared to those obtained throughout the postoperative monitoring period. RESULTS: This study demonstrates that the PNT-MIT procedure results in permanent ipsilateral diaphragmatic paralysis accompanied by an approximately 8% decrease in inspiratory capacity, FVC, and total lung capacity. There was also an 11% increase in diffusing capacity noted during the period between 6 months and 3 years after PNT-MIT procedure. Despite these measurable changes in lung function, the patients reported amelioration of their dyspnea complaint within 6 months of undergoing this procedure, which was due mainly to an improvement in their cardiovascular exercise performance related to increased daily activity. CONCLUSIONS: This study demonstrates that the PNT-MIT procedure is a safe method for the restoration of drop shoulder incurred by ABPI. This surgery has an impact on measurable diaphragmatic and lung function but with minimal impact in terms of postoperative clinical symptoms and exercise performance.

Adult↗
PubMed1997

Acute reconstruction of traumatic injuries of median and ulnar nerves by grafting with intercostal nerves from the rectus muscle: case reports.

In two cases of complicated hand and wrist injuries for which rectus flaps were used as soft-tissue coverage, intercostal nerves from the rectus muscles were harvested simultaneously to graft significant nerve defects. In one patient, a 7-cm ulnar-nerve defect was bridged with four intercostal nerves. The other patient had a 5-cm median-nerve defect repaired with three intercostal nerves. Both patients recovered either protective or normal sensation; and the patient with the median nerve injury recovered thenar muscle function. Intercostal nerves harvested with rectus muscle flaps can be the basis for acute grafting of nerve defects without using conventional nerve grafts at a traumatic site.

Abdominal Muscles↗
PubMed2003

Diffuse spinal and intercostal nerve involvement in chronic inflammatory demyelinating polyradiculoneuropathy: MRI findings.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon demyelinating disorder with a relapsing and remitting or continuously progressive course. Hypertrophic nerve roots, sometimes associated with gadolinium enhancement, has been reported more commonly in lumbar spine and less commonly in the brachial plexus and cervical roots; however, diffuse involvement of intercostal nerves bilaterally has never been reported previously. We present MRI findings which include diffuse enlargement and mild enhancement of roots and extraforaminal segments of nerves in all segments except a short segment between T12-L2 as well as all the intercostal nerves in a case of CIPD with a 10-year history.

Biopsy, Needle↗
PubMed1992

[A study on the communication between the pectoral nerve and the extramural nerve branches of the intercostal nerves].

Kumaki et al. (1979) defined the extramural nerve as the rudimentary sensory nerve which appeared on the upper thoracic wall; it branched off the root of the lateral cutaneous nerve of the second, third or fourth intercostal nerve, ran inferomedially adhering to the fascia of the intercostalis externus muscle and ended supplying the membrane covering the adjacent rib. They also stated that the extramural nerve (Rxm) occasionally became a cutaneous nerve which pierced the pectoralis muscles and supplied the skin covering the thoracic wall similar to the lateral cutaneous nerve (Rcl) or the anterior cutaneous nerve (Rca). Further, they proposed that the muscular nerves to the obliquus externus abdominis muscle which are usually situated below the fifth rib might be considered a part of this Rxm series. Although the definition of Rxm is still not widely accepted, Rxm is thought to be a key morphological factor influencing the variations of peripheral nerve arrangement on the thoracic wall. In the student course of gross anatomy dissection at Iwate Medical University School of Medicine during the years 1987-1991, three cases of Rxm communicating with the pectoral nerve and supplying the pectoralis major muscle were observed. Some cases have been reported in which Rcl innervates part of the pectoral muscles. However, the communication between the pectoral nerve and Rxm has not yet been discussed. Therefore, to clarify the morphological significance of the communication between Rxm and the pectoral nerve, the branching pattern and the distribution of the pectoral nerves were extensively investigated and the intramuscular nerve supply of some pectoral nerves, especially the pectoral nerves which communicated with Rxm, was examined in detail under a stereomicroscope. The results are summarized as follows: 1. In the first case, Rxm of the second intercostal nerve originated from Rcl, ran inferomedially adhering to the fascia of the intercostalis externus muscle and pierced the origin of the pectoralis minor muscle at the third intercostal space. Then Rxm turned superolaterally to communicate with a pectoral nerve which originated from the loop composed of the lateral and medial pectoral nerves and passed inferior to the pectoralis minor muscle. After communication, the pectoral nerve with Rxm supplied the caudalmost part of the sternocostal portion of the pectoralis major muscle. In the second case, a similar branch of Rxm of the second intercostal nerve passed inferior to the pectoralis minor muscle.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1980

The non-myelinated fibers of the phrenic and the intercostal nerves in the cat.

The aim of this work was obtaining quantitative data relative to the non-myelinated fibers of some thoracic nerves of the cat. The study has been done both through the utilization of the light and the electron microscope. A comparative analysis of the results obtained from the muscle nerves (external intercostal nerve and phrenic nerve), cutaneous nerve (lateral collateral branch of the internal intercostal nerve) and mixed nerves (internal intercostal) has been made. The C muscle fibers have a smaller diameter than the C cutaneous fibers. Some of the non-myelinated fibers of the phrenic nerve are probably involved in the innervation of the pleura or of the peritoneum. The relative number of non-myelinated fibers varies according to the nerves. The factor linking the diameter of the non-myelinated fibers to their conduction velocity is approximately equal to 0.7.

Animals↗
PubMed1996

An anatomical analysis of the relationships between the intercostal nerves and the thoracic and abdominal muscles in man. I. Ramification of the intercostal nerves.

Minute dissection was performed on the ventral primary rami of the first thoracic to first lumbar nerves in two halves of an adult male cadaver in order to determine points of origins of muscular branches from the intercostal nerves. Generally, the muscular branches originated independently, but the branches supplying the intercostalis intimus and internus tended to originate as a common trunk. The muscular branching patterns were compiled in an illustration, and based on these patterns the serial homology of the thoracic and abdominal muscles was proposed. Although the obliquus externus abdominis has been thought to correspond to the intercostales externi, from these innervation findings it appears to correspond to the intercostales interni. Further, the quadratus lumborum seems homologous to the intercostales externi.

Anatomy, Comparative↗
PubMedDate not supplied

Microanatomy and number of nerve fibres of the lower intercostal nerves with respect to a nerve anastomosis. Donor nerve analysis. I. (IV).

A human intercostal nerve has about 10,000 myelinated nerve fibres, of which about 1000 to 2000 are motor. At about the axillary line the nervus intercostalis splits into the ramus cutaneous lateralis and a deep branch to the musculus rectus abdominis and other muscles. The ramus cutaneous lateralis consists of 2 skin branches of about 3000 nerve fibres and a muscle branch to the musculus obliquus externus of about 400 to 1100 nerve fibres. The deep branch to the musculus obliquus internus, the musculus transversus and the musculus rectus abdominis and the anterior skin consists of about 2500 to 7000 fibres of which 400 to 1700 are skin fibres. There is indication that the muscle branch to the musculus obliquus externus has about 50% motor fibres. The intercostal nerve is, as it splits after about 20 cm into 4 branches, a suitable donor of at least 2 different muscle functions and a skin sensible function for a direct nerve anastomosis. A crude model for calculating matching probabilities of motor and sensory fibres between donor and acceptor nerves is introduced. Besides the importance of having enough donor nerve fibres, it is calculated that the small amount of motor nerve fibres can be best used if muscle branches of the donor nerves are connected to muscle branches of the acceptor nerves. Because of the separation between normal laboratory animals and humans on the phylogenetic scale, differences in regeneration and plasticity are discussed.

Anastomosis, Surgical↗
PubMed1990

Restoration of elbow flexion and wrist extension in brachial plexus paralyses by means of free muscle transplantation innervated by intercostal nerve.

Traumatic lesions of the brachial plexus with nerve root avulsion pose extremely complex therapeutic problems. Since 1965, the authors have performed neurotization of the musculocutaneous nerve by intercostal nerves in order to restore elbow flexion. The results of this operation are considerably poorer when the interval between the trauma and the neurotization exceeds 6 months. In these late cases, the authors have used, since 1978, a free muscle transfer reinnervated by a transposed intercostal nerve. 17 patients have been operated by means of this technique; 8 of the 11 patients with a follow-up exceeding one year recovered elbow flexion force evaluated to be M3 or more. Encouraged by these results, the authors have extended this procedure to restoration of wrist extension by free musculocutaneous transfer of the gracilis muscle innervated by intercostal nerves. 17 of the 29 patients operated have a follow-up of more than one year and 9 these cases have regained wrist extension with a score of M3 or more.

Adolescent↗
PubMed1989

Direct nerve crossing with the intercostal nerve to treat avulsion injuries of the brachial plexus.

One hundred seventy-nine patients with root avulsion brachial plexus injuries were treated with direct nerve crossing with the intercostal nerve and 159 cases were followed more than 1 1/2 years after the operation. When suture was done to the musculocutaneous nerve, 90% of 10 children who had operation within 7 months of injury and 81.8% of 110 adults, younger than 40 years with operation within 6 months of injury regained grade 3 or 4 elbow flexion power. This direct method seems to produce better results than those of nerve crossing, which uses intermediary nerve grafts.

Adolescent↗
PubMed1987

Nerve fibre counts for an intercostal nerve to cauda equina nerve root anastomosis.

Mean nerve root diameters of thoracal, lumbal and sacral roots have been determined and the corresponding cross section areas calculated. The myelinated axons of these roots have been counted and the axon densities calculated. The myelinated axons of 3 lower intercostal nerves have also been counted. One intercostal nerve has with about 9,000 myelinated fibres enough axons for the regeneration of the ventral (3,000) and dorsal (16,000) myelinated fibres of the sacral roots 3 and 4 together. One intercostal has enough nerve fibres to reconstruct urinary bladder and bowel function on one side. The importance of performing a nerve anastomosis which considers functional aspects has been emphasized.

Aged↗
PubMed2001

[Intercostal nerve syndrome].

The intercostal nerve syndrome is caused by an impingement of the intercostals nerve at the level of the anterior rectus sheath. It may lead to acute or chronic abdominal pain, it should therefore be considered in the differential diagnosis of the acute or chronic abdomen. A positive Carnett-test and an effective local anaesthesia at the point of maximal tenderness allow the correct diagnosis. In our retrospective study 14 patients with 15 entrapment syndromes are described. If, sometimes after a few diagnostic and therapeutic detours, the diagnosis is established, surgical intervention with resection of the altered nerve at it's exit of the anterior rectus sheath can usually abolish the pain with little side effects.

Abdomen, Acute↗
PubMed1997

Neurotization of motor nerves innervating the lower extremity by utilizing the lower intercostal nerves.

An animal model in the rat was developed to study the reinnervation of ventral roots contributing to lower-extremity nerves by use of intercostal nerves. Intercostal nerves and distal cauda equina roots were anastomosed, using a collagen tube and microsurgical technique. Most experimental animals could lift their previously paralyzed legs and could walk with a severe limp by 9 months postoperatively. Recordings of nerve action potentials (NAPs) and muscle action potentials (MAPs) indicated that the intercostal and sciatic nerves had some functional connections. Histologic analysis 12 months after repair demonstrated axonal regeneration extending from the intercostal nerves to and down lumbar ventral roots. Most of the regenerated fibers were moderately well-myelinated. Connections between the neurons of the anterior horn cells in the lower thoracic spinal cord and the reinnervated sciatic nerve were confirmed by retrograde tracer, using fast blue.

Action Potentials↗
PubMed2006

Multiple lumbar plexus neurotizations of the ninth, tenth, and eleventh intercostal nerves.

The topographic anatomy of the lower intercostal nerves is less known than the upper ones except for the twelfth intercostal nerve. It is possible to use the lower intercostal nerves to carry out a neurotization of the lumbar roots. We studied the anatomy of the ninth, tenth, and eleventh intercostal nerves in order to specify the data of descriptive and topographic anatomy allowing to carry out their harvesting under good conditions. Ninth, tenth, and eleventh intercostal nerves of 50 cadavers were dissected. The proximal part of the nerve in the posterior intercostal space was exposed through a posterior approach. The lateral intercostal space was exposed through a lateral approach, under the latissimus dorsi, which made it possible to harvest the intercostals nerve. The proximal course of the nerve in posterior intercostals space was the same in all the cases. The nerve moves obliquely towards the outside to reach the lower border of the rib. The exit of posterior intercostal space is a fibrous strait that marks the entry of a channel between two muscular layers. We describe an aponevrotic channel in which the nerve and the vessels are, immediately at the lower border of the cranial rib. The mean total length of intercostal nerve harvested by our technique was 17.96 cm for the ninth intercostal nerve, 17.14 cm for the tenth intercostal nerve, and 15.94 cm for the eleventh intercostal nerve. The bifurcation of the intercostal nerve in a deep branch and the ramus cutaneus lateralis was found in the majority of the cases, from 9.5 to 21 cm of the emergence of the intercostal nerve in posterior intercostal space. This anatomical study of the ninth, tenth, and eleventh intercostal nerves in posterior intercostal space and lateral intercostal space appears to us to allow the realization of a reliable surgical harvesting.

Cadaver↗
PubMed2004

The thoracoabdominal intercostal nerves: an anatomical study for their use in neurotization.

The topographic anatomy of the lower intercostal nerves is less known than that of the upper ones, except for the subcostal nerve (twelfth intercostal nerve). It is possible to use the lower intercostal nerves to neurotize the lumbar roots. We studied the anatomy of the ninth, tenth and eleventh intercostal nerves in order to specify the descriptive and topographical anatomical data that will allow their harvest in good condition. The ninth, tenth and eleventh intercostal nerves of 30 cadavers were dissected. The proximal part of the nerves in the posterior intercostal space was exposed through a posterior approach. The lateral intercostal space was exposed through a lateral approach, deep to the latissimus dorsi, that made it possible to harvest the intercostal nerve. The proximal course of the nerves in the posterior intercostal space was the same in all cases. The nerves move obliquely towards the outside to reach the lower border of the rib. The exit of the posterior intercostal space is a fibrous strait, which marks the entry of a channel between two muscular layers. We describe an aponeurotic channel in which the nerve and vessels run, immediately at the lower border of the cranial rib. The mean total length of intercostal nerve harvested by our technique was 17.86 cm for the ninth intercostal nerve, 16.95 cm for the tenth and 15.75 cm for the eleventh. Bifurcation of the intercostal nerve into a deep branch and the lateral cutaneous branch was found in the majority of the cases, 9.5-21 cm from the emergence of the intercostal nerve in the posterior intercostal space. This anatomical study of the ninth, tenth and eleventh intercostal nerves in the posterior intercostal and lateral intercostal spaces appears to us to allow reliable surgical harvesting.

Cadaver↗
PubMed1995

The effect of unilateral intercostal nerve transfer upon lung function.

Intercostal nerve transfer is a well-established technique in the treatment of some severe brachial plexus lesions in adults. There is, however, concern that in the presence of an ipsilateral phrenic nerve palsy it may lead to a significant compromise of respiratory function. 20 patients having intercostal nerve transfers had their lung function assessed pre-operatively and 6 weeks post-operatively. The patients were subsequently questioned about symptoms of respiratory dysfunction. There was no evidence that intercostal nerve transfer leads to a significant reduction in respiratory function in adults. It therefore appears safe to perform intercostal nerve transfers in adults following brachial plexus injuries even in the presence of an ipsilateral phrenic nerve palsy.

Adolescent↗