- Intercostobrachial nerve:
- This nerve is a cutaneous branch of the intercostal nerves:
- Most commonly the second intercostal nerve:
- Which gives off a lateral cutaneous nerve:
- Which continues as the intercostobrachial nerve
- Which gives off a lateral cutaneous nerve:
- Most commonly the second intercostal nerve:
- The intercostal nerves arise from:
- The anterior rami of the thoracic spinal nerves
- The intercostobrachial nerve pierces the serratus anterior:
- Crosses the axilla to the medial side of the upper arm
- The intercostobrachial nerve is commonly in the surgical field during axillary lymph node dissections and may be severed during surgery, or subject to traction or postsurgical inflammation:
- Thus leading to intercostobrachial neuralgia
- This nerve is a cutaneous branch of the intercostal nerves:
- The larger intercostal nerves:
- Can be preserved with meticulous dissection
- Neuropathic symptoms:
- May be limited to numbness or tingling:
- But may also include a burning sensation
- May be limited to numbness or tingling:
- Techniques such as a regional nerve block:
- Have been described to alleviate symptoms in severe cases
- In a study of 200 patients who underwent axillary dissection:
- 76% had symptoms of intercostobrachial neuralgia postoperatively
- Of these patients, 82% reported improvement or resolution of these symptoms within 1 year:
- Reflecting the richness of the sensory nerve supply to the axilla and upper arm
- The thoracodorsal nerve:
- Is a branch of the posterior cord of the brachial plexus:
- It supplies motor function to the latissimus dorsi
- If injured, patients experience weakness with arm abduction, lateral flexion, and difficulty with activities such as climbing, swimming, and using the arms to pull the body up
- Is a branch of the posterior cord of the brachial plexus:
- The medial cord of the brachial plexus:
- Gives rise to the medial pectoral nerve:
- Which innervates both the pectoralis minor muscle and the pectoralis major muscle
- The medial pectoral nerve typically pierces the pectoralis minor muscle:
- But may wrap around the lateral aspect of the pectoralis minor before traveling on to innervate the distal pectoralis major muscle
- The lateral cord of the brachial plexus:
- Gives rise to the lateral pectoral nerve:
- Which innervates the pectoralis major muscle
- This nerve travels along the medial border of the pectoralis minor muscle:
- Then along the undersurface of the pectoralis major muscle along with the pectoral branch of the thoracoacromial artery to supply the proximal pectoralis major muscle
- Gives rise to the lateral pectoral nerve:
- The medial pectoral nerve bundle:
- Is often encountered during axillary dissection as it is located lateral to the lateral pectoral nerve
- If either of these nerves is injured:
- Pectoralis muscle atrophy can occur:
- Which can present as a late complication of surgery, with weakness of shoulder adduction, interior rotation, and flexion
- Pectoralis muscle atrophy can occur:
- The long thoracic nerve:
- Typically arises from anterior rami of the cervical spinal nerve roots C5 to C7
- It courses along the chest wall and supplies the serratus anterior muscle
- Injury to this nerve causes a winged scapula
- References:
- Sclafani LM, Baron RH. Sentinel lymph node biopsy and axillary dissection: added morbidity of the arm, shoulder and chest wall after mastectomy and reconstruction. Cancer J. 2008;14(4):216-222.
- Wisotzky EM, Saini V, Kao C. Ultrasound-guided intercostobrachial nerve block for intercostobrachial neuralgia in breast cancer patients: a case series. Prev Med Rep, 2016;8(3):273-277.
- Roses DF, Brooks AD, Harris MN, Shapiro RL, Mitnick J. Complications of level I and II axillary dissection in the treatment of carcinoma of the breast. Ann Sur. 1999;230(2):194-201.
- Porzionato A, Macchi V, Stecco C, Loukas M, Tubbs RS, De Caro R. Surgical anatomy of the pectoral nerves and the pectoral musculature. Clin Anat. 2012;25(5):559-575.
Rodrigo Arrangoiz MS, MD, FACS, FSSO 