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Intercostal neuralgia is a neuropathic condition that involves the intercostal nerves. The primary symptom is pain and it may be localized to the distribution of one or more of the intercostal nerves, manifesting as chest and abdominal pain. [ 18 ]
The most invasive method for treating iliocostal friction syndrome is the surgical resection of the floating ribs, [2] which excises the outer two-thirds of the rib while the individual is under anesthesia. [3] Special attention is made to preserve the intercostal nerve not to cause intercostal neuralgia. [8]
Rib resection differentiates from costal cartilage removal as it removes a small bone portion of the affected rib(s). [1] Laparoscopic costal cartilage removal is a minimally invasive , intra-abdominal approach to treating the condition.
Anterior cutaneous nerve entrapment syndrome (ACNES) is a nerve entrapment condition that causes chronic pain of the abdominal wall. [1] It occurs when nerve endings of the lower thoracic intercostal nerves (7–12) are 'entrapped' in abdominal muscles, causing a severe localized nerve (neuropathic) pain that is usually experienced at the front of the abdomen.
For this reason, a nerve resection may be considered after a failed decompression. Examples of nerves that may be good candidates for resection are lateral femoral cutaneous nerve, [42] zygomaticotemporal branch of the trigeminal nerve, [43] the posterior femoral cutaneous nerve, [44] [45] and the middle/superior cluneal nerves. [46]
The intercostal nerves are part of the somatic nervous system, and arise from the anterior rami of the thoracic spinal nerves from T1 to T11. [1] [2] The intercostal nerves are distributed chiefly to the thoracic pleura and abdominal peritoneum, and differ from the anterior rami of the other spinal nerves in that each pursues an independent course without plexus formation.
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The use of surgery in this context refers to the resection of the affected costal cartilages and some of the surrounding areas. [2] Some surgeons have resected cartilage matching the symptoms of Tietze syndrome under the assumption the cartilage was tubercular . [ 4 ]