Intercostobrachial nerve

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Anatomy Originates from lateral cutaneous nerve of second and third intercostal nerves to innervate the posterior part of the axilla. This nerve often anastomizes with the medial cutaneous nerve of the upper arm (from the medial cord of the brachial plexus).

Symptoms Pain in the axilla, chest wall, or thorax. Often occurs one or two months after mastectomy. Reduced movement of the shoulder enhances pain.

Signs Sensation is impaired in the axilla, chest wall, and proximal upper arm.

Differential diagnosis Operations in the axilla (removal of lymph nodes)

Following surgery for thoracic outlet syndrome Lung tumors

Reference Assa J (1974) The intercostobrachial nerve in radical mastectomy. J Surg Oncol 6: 123-126

Iliohypogastric nerve

Intercostobrachial Nerve
Fig. 30. lliohypogastric nerve anatomy. 1 lliohypogastric nerve. 2 llioinguinal nerve. 3 Obturator nerve. 4 Genitofemo-ral nerve

Fibers originate at L1, then emerge from the lateral border of the psoas, crossing Anatomy the lower border of the kidney, then the lateral abdominal wall. Then the nerve crosses the transverse abdominal muscle above iliac crest and passes between the transverse and oblique internal abdominal muscles. Finally two branches are given off: the lateral anterior and anterior cutaneous nerves.

Burning and stabbing pain in the ilioinguinal region, which may radiate to- Symptoms wards the genital area or hip. Symptoms increase when walking.

Difficult to examine. Spontaneous bulging of abdominal wall. Sensory deficit Signs may be present. Tinel's sign over a surgical scar may be observed. Slight flexion of hip while standing.

Diagnosis Electrophysiology is not routinely available. Clinical distribution.

Differential diagnosis Spontaneous entrapment in abdominal wall, surgery, hernioraphy, appendectomy, abdominoplasty, nephrectomy, endometriosis.

Therapy Steroids locally, scar removal, neurolysis.

Ilioinguinal nerve

Intercostobrachial Nerve

Fig. 31. llioinguinal nerve anatomy. a A-female. 1 llioinguinal nerve. b B-male. 1 lliohypogas-tric nerve. 2 llioinguinal nerve

Ilioinguinal Nerve Route Kidney Removal

Fig. 32. Ilioinguinal nerve lesion after gynecologic surgery. The sensory loss (marked with a ball pen) reached almost the labia

The ilioinguinal nerve originates with fibers from T12 and L1. The motor component innervates the internal and external oblique muscles, and the transverse abdominal muscle.

The sensory component covers the skin overlying the pubic symphysis, the superomedial aspect of the femoral triangle, the anterior scrotal surface, and the root of the penis/labia majora and mons pubis (Fig. 31).

Clinical syndrome Hyperesthesia, sometimes with significant pain over the lower abdominal quadrant and the inguinal region and genitalia (Fig. 32).

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