948 NEUROLOGY 



The Lower Thoracic Nerves. The anterior divisions of the seventh, eighth, ninth, 

 tenth, and eleventh thoracic nerves are continued anteriorly from the intercostal 

 spaces into the abdominal wall; hence they are named thoracicoabdominal inter- 

 costal nerves. They have the same arrangement as the upper ones as far as the 

 anterior ends of the intercostal spaces, where they pass behind the costal cartilages, 

 and between the Obliquus internus and Transversus abdominis, to the sheath of 

 the Rectus abdominis, which they perforate. They supply the Rectus abdominis 

 and end as the anterior cutaneous branches of the abdomen; they supply the skin 

 of the front of the abdomen. The lower intercostal nerves supply the Intercostales 

 and abdominal muscles; the last three send branches to the Serratus posterior 

 inferior. About the middle of their course they give off lateral cutaneous branches. 

 These pierce the Intercostales externi and the Obliquus externus abdominis, in the 

 same line as the lateral cutaneous branches of the upper thoracic nerves, and divide 

 into anterior and posterior branches, which are distributed to the skin of the abdo- 

 men and back; the anterior branches supply the digitations of the Obliquus externus 

 abdominis, and extend downward and forward nearly as far as the margin of the 

 Rectus abdominis; the posterior branches pass backward to supply the skin over 

 the Latissimus dorsi. 



The anterior division of the twelfth thoracic nerve is larger than the others; it 

 runs along the lower border of the twelfth rib, often gives a communicating branch 

 to the first lumbar nerve, and passes under the lateral lumbocostal arch. It then 

 runs in front of the Quadratus lumborum, perforates the Transversus, and passes 

 forward between it and the Obliquus internus to be distributed in the same manner 

 as the lower intercostal nerves. It communicates with the iliohypogastric nerve 

 of the lumbar plexus, and gives a branch to the Pyramidalis. The lateral cutaneous 

 branch of the last thoracic nerve is large, and does not divide into an anterior and 

 a posterior branch. It perforates the Obliqui internus and externus, descends over 

 the iliac crest in front of the lateral cutaneous branch of the iliohypogastric (Fig. 

 819), and is distributed to the skin of the front part of the gluteal region, some of 

 its filaments extending as low as the greater trochanter. 



The Lumbosacral Plexus (Plexus Lumbosacralis). 



The anterior divisions of the lumbar, sacral, and coccygeal nerves form the 

 lumbosacral plexus, the first lumbar nerve being frequently joined by a branch 

 from the twelfth thoracic. For descriptive purposes this plexus is usually divided 

 into three parts the lumbar, sacral, and pudendal plexuses. 



The Lumbar Nerves (Nn. Lumbales). 



The anterior divisions of the lumbar nerves (rami anteriores) increase in size 

 from above downward. They are joined, near their origins, by gray rami com- 

 municantes from the lumbar ganglia of the sympathetic trunk. These rami consist 

 of long, slender branches which accompany the lumbar arteries around the sides of 

 the vertebral bodies, beneath the Psoas major. Their arrangement is somewhat 

 irregular: one ganglion may give rami to two lumbar nerves, or one lumbar nerve 

 may receive rami from two ganglia. The first and second, and sometimes the 

 third and fourth lumbar nerves are each connected with the lumbar part of the 

 sympathetic trunk by a white ramus communicans. 



The nerves pass obliquely outward behind the Psoas major, or between its 

 fasciculi, distributing filaments to it and the Quadratus lumborum. The first 

 three and the greater part of the fourth are connected together in this situation 

 by anastomotic loops, and form the lumbar plexus. The smaller part of the fourth 

 joins with the fifth to form the lumbosacral trunk, which assists in the formation 



