An unusual innervation of pectoralis minor and major muscles from a branch of the intercostobrachial nerve

Loukas, Marios; Louis, Robert G.; Fogg, Quentin A.; Hallner, Barry; Gupta, Ankmalika

doi:10.1002/ca.20284

Cited by 23 publications

(16 citation statements)

References 10 publications

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“…Some authors had also previously described cases in which the intercostobrachial nerve penetrated the pectoralis major and minor muscles without innervating them (Cunnick et al,2001; Freeman et al,2003). The possible presence of motor nerve fibers for the pectoral muscles in the intercostobrachial nerve further supports the importance of its preservation during axillary surgical procedures (Loukas et al,2006b, 2007). Anastomosis has also been observed between the LPN and the subclavius nerve (Hovelacque,1927).…”

Section: Sensory Innervation and Connections With Other Nervesmentioning

confidence: 70%

“…Although this kind of communication was not confirmed in a more recent article (Loukas et al,2006c), other kinds of relationships with the PNs and muscles were described. In a case report, an additional medial pectoral branch, partially innervating the pectoralis minor muscle as well as the abdominal head of the pectoralis major muscle was seen arising from the intercostobrachial nerve (Loukas et al,2006b). In another case, the intercostobrachial nerve has been described to directly receive a branch from the MPN, which partially innervated the pectoralis major and minor muscles (Loukas et al,2007).…”

Section: Sensory Innervation and Connections With Other Nervesmentioning

confidence: 99%

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Surgical anatomy of the pectoral nerves and the pectoral musculature

et al. 2011

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The pectoral nerves (PNs) may be selectively injured through various traumatic mechanisms such as direct trauma, hypertrophic muscle compression, and iatrogenic injuries (breast surgery and axillary node dissection, pectoralis major muscle transfers). The PN may be surgically recovered through nerve transfers. They may also be used as donors to the musculocutaneous, axillary, long thoracic, and spinal accessory nerves and for reinnervation of myocutaneous free flaps. Thus, in this article, we reviewed the surgical anatomy of PN. A meta-analysis of the available literature showed that the lateral pectoral nerve (LPN) arises most frequently with two branches from the anterior divisions of the upper and middle trunks (33.8%) or as a single root from the lateral cord (23.4%). The medial pectoral nerve (MPN) usually arises from the medial cord (49.3%), anterior division of the lower trunk (43.8%), or lower trunk (4.7%). The two PN are usually connected immediately distal to the thoracoacromial artery by the so-called ansa pectoralis. The MPN may also show communications with the intercostobrachial nerve. In 50%-100% of cases, it may pass, at least with some branches, through the pectoralis minor muscle. The LPN supplies the upper portions of the pectoralis major muscle; the MPN innervates the lower parts of the pectoralis major and the pectoralis minor muscle. Among the accessory muscles of the pectoral girdle, the LPN may also innervate the tensor semivaginae articulationis humero-scapularis, pectoralis minimus, sternoclavicularis, axillary arch, sternalis, and infraclavicularis muscles; the MPN may innervate the pectoralis quartus, chondrofascialis, axillary arch, chondroepitrochlearis, and sternalis muscles.

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Section: Sensory Innervation and Connections With Other Nervesmentioning

confidence: 70%

Section: Sensory Innervation and Connections With Other Nervesmentioning

confidence: 99%

Surgical anatomy of the pectoral nerves and the pectoral musculature

et al. 2011

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“…It may receive contributions from other intercostal branches (T1, T3, and even T4) and can have a variety of anastomoses with branches of the brachial plexus, including the medial antebrachial cutaneous nerve, posterior cutaneous nerve of the forearm, and rarely with the pectoral nerves. [23][24][25] This nerve is often implicated in postmastectomy pain, particularly after axillary dissection or lymph node sampling. 26,27 Its variable anatomy may account for the conflicting reports of post-nerve injury symptoms.…”

Section: Innervation Of the Breast And Superficial Tissuesmentioning

confidence: 99%

Perioperative Breast Analgesia

Woodworth

Ivie

Nelson

et al. 2017

Regional Anesthesia and Pain Medicine

272

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Breast surgery is exceedingly common and may result in significant acute as well as chronic pain. Numerous options exist for the control of perioperative breast pain, including several newly described regional anesthesia techniques, but anesthesiologists have an insufficient understanding of the anatomy of the breast, the anatomic structures disrupted by the various breast surgeries, and the theoretical and experimental evidence supporting the use of the various analgesic options. In this article, we review the anatomy of the breast, common breast surgeries and their potential anatomic sources of pain, and analgesic techniques for managing perioperative pain. We performed a systematic review of the evidence for these analgesic techniques, including intercostal block, epidural administration, paravertebral block, brachial plexus block, and novel peripheral nerve blocks.

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“…A case report describes a variation of the branching pattern of the ICBN where the nerve gives rise to an additional medial pectoral branch, which has partial motor innervation to the pectoralis minor muscle and abdominal head of the pectoralis major muscle. Injuries to the ICBN with these variants can thus give rise to further motor losses in addition to typically reported sensory only paresthesias involved in intercostobrachial neuralgia [9]. In another study of 100 adult human cadavers, researchers examined the variants of ICBN and found 8 main variants of the ICBN, including a variant describing the ICBN arising from T2 and giving off a branch to the brachial plexus, and a less‐common variant in which lateral cutaneous branches of T2 and T3 fuse as a common trunk then split after exiting the intercostal space to form an ICBN [3].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐Guided Intercostobrachial Nerve Block for Intercostobrachial Neuralgia in Breast Cancer Patients: A Case Series

Wisotzky

Saini

Kao

2015

PM&R

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This case series describes 3 cases in which ultrasound-guided intercostobrachial perineural injection was used for intercostobrachial neuralgia, a common cause of postmastectomy pain syndrome. All cases had undergone modified radical mastectomy with axillary lymph node dissection for breast cancer. Two cases developed axillary and unilateral chest wall pain. The third case initially presented with axillary pain and lateral shoulder pain 1 year out from radical mastectomy. After a cervical epidural steroid injection, her lateral shoulder pain resolved, but she continued to have residual chest wall paresthesia. It was at this time, we decided to treat with an intercostobrachial nerve perineural injection. Injury to the intercostobrachial nerve is thought to be a common cause of postmastectomy pain. In our case series, all patients had pain relief after the intercostobrachial perineural injection. There is a relative dearth of published information on the treatment of postmastectomy pain and more specifically intercostobrachial neuralgia. We review the anatomy of the intercostobrachial nerve and its variants, etiologies of intercostobrachial neuralgia, and current indications and methods of an intercostobrachial perineural injection.

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An unusual innervation of pectoralis minor and major muscles from a branch of the intercostobrachial nerve

Cited by 23 publications

References 10 publications

Surgical anatomy of the pectoral nerves and the pectoral musculature

Surgical anatomy of the pectoral nerves and the pectoral musculature

Perioperative Breast Analgesia

Ultrasound‐Guided Intercostobrachial Nerve Block for Intercostobrachial Neuralgia in Breast Cancer Patients: A Case Series

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