Henry Gray (18251861). Anatomy of the Human Body. 1918.
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 intercostal 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 abdomen 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.
6d. The Lumbosacral Plexus
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 partsthe 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 communicantes 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